The role of the gut microbiome in paediatric irritable bowel syndrome

Alexandra S McHarg; Steven Leach; Alexandra S McHarg; Steven Leach

doi:10.3934/microbiol.2022030

AIMS Microbiology

2022, Volume 8, Issue 4: 454-469. doi: 10.3934/microbiol.2022030

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The role of the gut microbiome in paediatric irritable bowel syndrome

Alexandra S McHarg ^{1,2
,
,},
Steven Leach ^1,2

1.
School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
2.
Westfield Research Laboratories, Sydney Children's Hospital, Randwick, NSW, Australia

Received: 31 August 2022 Revised: 10 November 2022 Accepted: 14 November 2022 Published: 22 November 2022

Irritable bowel syndrome (IBS) is a common and disabling condition in children. The pathophysiology of IBS is thought to be multifactorial but remains incompletely understood. There is growing evidence implicating the gut microbiome in IBS. Intestinal dysbiosis has been demonstrated in paediatric IBS cohorts; however, no uniform or consistent pattern has been identified. The exact mechanisms by which this dysbiosis contributes to IBS symptoms remain unknown. Available evidence suggests the imbalance produces a functional dysbiosis, with altered production of gases and metabolites that interact with the intestinal wall to cause symptoms, and enrichment or depletion of certain metabolic pathways. Additional hypothesised mechanisms include increased intestinal permeability, visceral hypersensitivity and altered gastrointestinal motility; however, these remain speculative in paediatric patients, with studies limited to animal models and adult populations. Interaction between dietary components and intestinal microbiota, particularly with fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs), has drawn increasing attention. FODMAPs have been found to trigger and worsen IBS symptoms. This is thought to be related to products of their fermentation by a dysbiotic microbial population, although this remains to be proven. A low-FODMAP diet has shown promising success in ameliorating symptoms in some but not all patients. There remains much to be discovered about the role of the dysbiotic microbiome in paediatric IBS.
- irritable bowel syndrome,
- gut microbiome,
- dysbiosis,
- child,
- diet,
- low-FODMAP
Citation: Alexandra S McHarg, Steven Leach. The role of the gut microbiome in paediatric irritable bowel syndrome[J]. AIMS Microbiology, 2022, 8(4): 454-469. doi: 10.3934/microbiol.2022030

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Abstract

Irritable bowel syndrome (IBS) is a common and disabling condition in children. The pathophysiology of IBS is thought to be multifactorial but remains incompletely understood. There is growing evidence implicating the gut microbiome in IBS. Intestinal dysbiosis has been demonstrated in paediatric IBS cohorts; however, no uniform or consistent pattern has been identified. The exact mechanisms by which this dysbiosis contributes to IBS symptoms remain unknown. Available evidence suggests the imbalance produces a functional dysbiosis, with altered production of gases and metabolites that interact with the intestinal wall to cause symptoms, and enrichment or depletion of certain metabolic pathways. Additional hypothesised mechanisms include increased intestinal permeability, visceral hypersensitivity and altered gastrointestinal motility; however, these remain speculative in paediatric patients, with studies limited to animal models and adult populations. Interaction between dietary components and intestinal microbiota, particularly with fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs), has drawn increasing attention. FODMAPs have been found to trigger and worsen IBS symptoms. This is thought to be related to products of their fermentation by a dysbiotic microbial population, although this remains to be proven. A low-FODMAP diet has shown promising success in ameliorating symptoms in some but not all patients. There remains much to be discovered about the role of the dysbiotic microbiome in paediatric IBS.

Abbreviations

IBS

irritable bowel syndrome

IBS-C

irritable bowel syndrome, constipation subtype

IBS-D

irritable bowel syndrome, diarrhoea subtype

IBS-M

irritable bowel syndrome, mixed constipation and diarrhoea subtype

IBS-U

irritable bowel syndrome, unclassified

FGID

functional gastrointestinal disorder

rRNA

ribosomal ribonucleic acid

SCFA

short chain fatty acid

RCT

randomised controlled trial

FODMAP

fermentable oligosaccharides, disaccharides, monosaccharides and polyols

TACD

traditional American childhood diet

Conflict of interest

All authors declare no conflicts of interest in this review.

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