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The role of the gut microbiome in paediatric irritable bowel syndrome
Alexandra S McHarg1,2, Steven Leach1,2
1School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
Insights
Pediatric irritable bowel syndrome (IBS) involves gut microbiome imbalances, but the exact mechanisms causing symptoms are unclear. Further research is needed to understand how gut bacteria and diet, like FODMAPs, impact childhood IBS.
Area of Science:
- Gastroenterology
- Microbiology
- Pediatrics
Background:
- Irritable bowel syndrome (IBS) is a prevalent and debilitating condition in children.
- Its pathophysiology is multifactorial and not fully understood, with growing evidence pointing to the gut microbiome.
- Intestinal dysbiosis, an imbalance in gut bacteria, is observed in pediatric IBS but lacks a consistent pattern.
Purpose of the Study:
- To explore the role of the gut microbiome and its metabolites in pediatric IBS.
- To investigate the potential mechanisms linking gut dysbiosis to IBS symptoms in children.
- To examine the interaction between diet, particularly FODMAPs, and the gut microbiota in pediatric IBS.
Main Methods:
- Review of existing literature on pediatric IBS, gut microbiome, and dietary factors.
- Analysis of studies investigating intestinal dysbiosis in children with IBS.
- Examination of proposed mechanisms including altered metabolite production, intestinal permeability, and gastrointestinal motility.
Main Results:
- While intestinal dysbiosis is noted in pediatric IBS, specific patterns remain unidentified.
- Altered production of gases and metabolites by a dysbiotic microbiome is hypothesized to cause IBS symptoms.
- Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) are implicated in triggering and exacerbating IBS symptoms through fermentation.
Conclusions:
- The precise mechanisms by which gut dysbiosis contributes to pediatric IBS symptoms require further elucidation.
- The interaction between diet (e.g., FODMAPs) and a dysbiotic microbiome is a key area of interest.
- While a low-FODMAP diet shows promise, its efficacy varies, highlighting the complexity of pediatric IBS management.
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.
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