Medically reviewed by Onikepe Adegbola, MD, PhD
Antibiotic therapy can indirectly increase the risk of developing irritable bowel syndrome (IBS) by inducing significant changes in the gut bacterial composition, a review study has reported with substantial evidence.
The review article, “Antibiotics, gut microbiota, and irritable bowel syndrome: What are the relations?” was published in the World Journal of Gastroenterology.
IBS is one of the most common gastrointestinal disorders that involve abdominal bloating and recurrent abdominal pain in association with changes in bowel habits (diarrhea, constipation, or both). It harms patients’ quality of life and places a significant financial strain on healthcare systems. Despite intensive research, the pathophysiology of this disease remains a mystery.
Over the past few decades, the pathogenesis of IBS has involved abnormality in the intestinal barrier, improper gastrointestinal movement, intestinal hypersensitivity, immunity changes, and emotional disorders.
Later, several studies have reported that the gut microbial community plays a major role in developing IBS. The microbial imbalance within the gut contributes to all the above-listed multifactorial pathogenesis.
Although the antibiotic discovery is a remarkable breakthrough in the history of medicine as it has saved countless lives, its use has grown significantly at a higher rate. Multiple studies have revealed that inappropriate use of antibiotics could develop antibiotic resistance, thereby increasing the risk of allergy, autoimmune diseases, and obesity.
That’s how studies conducted in the last few decades suggested that antibiotic therapy could also increase the risk of developing IBS by inducing a significant alteration in the gut bacterial composition.
Thus, a team of researchers has summarized the major findings that could link antibiotic use with the development of IBS.
Antibiotics such as macrolides and tetracyclines change the bacterial composition of the gut by boosting pathogenic bacteria (e.g., Escherichia coli, Klebsiella sonnei, Shigella sonnei, Enterobacter sonnei) while decreasing mutually beneficial species (e.g., Bifidobacterium). This arises because of bacteria’ interdependence, as they share several metabolic pathways. As a result, the loss of one type of bacteria might alter the growth of other germs, resulting in IBD.
The researchers concluded that there is clear and consistent evidence from multiple studies that people with IBS have altered the composition of their gut microbiota and that these abnormalities are associated with the production of gastrointestinal symptoms. However, studies comparing the fecal microbiota of patients with IBS with healthy controls yielded mixed results. There has yet to be agreement on the different microbiome markers in IBS. Although certain common threads were discovered in this study, future large-scale investigations are needed to shed light on this subject. They added that independent investigation of the gut microbiota and its metabolites will aid in the development of novel microbiota-based therapy options that focus on addressing the underlying pathophysiology of IBS rather than symptom relief. Several recent studies have looked at the impact of antibiotics on gut microbiota composition, and the findings were strikingly comparable to those seen in IBS.
Overall, researchers believe that the Rome V criteria could establish a new description of postantibiotic IBS. Antibiotics, as major disruptors of the gut microbiota, appear to play a role in all facets of IBS pathophysiology. However, further research is needed in this area.
Mamieva, Z., Poluektova, E., Svistushkin, V., Sobolev, V., Shifrin, O., Guarner, F., & Ivashkin, V. (2022). Antibiotics, gut microbiota, and irritable bowel syndrome: What are the relations?. World journal of gastroenterology, 28(12), 1204–1219. https://doi.org/10.3748/wjg.v28.i12.1204