肠易激综合征与肠道菌群

人体肠道是一个庞大而复杂的以专性厌氧菌为主的微生态系统,约400种细菌定植在肠道内,仅类杆菌和双歧杆菌就占细菌总数的90%以上。肠道菌群根据定植部位的不同可进一步分为肠腔菌群和黏膜菌群两类,肠腔菌群占主要部分,参与对肠道食物的分解消化过程。黏膜菌群则形成肠黏膜屏障,调节肠道免疫状态。在健康状况良好的情况下,机体与正常菌群之间保持着生态平衡,各微生物之间维持着稳定的比例,并作为机体的屏障,拮抗外来致病微生物的入侵。一旦这种平衡受到破坏,机体就会容易发生变化而导致肠道疾病的出现。     

粪菌移植对肠易激综合征模型大鼠内脏敏感性及免疫功能的影响

目的 探讨粪菌移植(fecal microbiota transplantation,FMT)对肠易激综合征(irritable bowel syndrome,IBS)模型大鼠内脏敏感性及免疫功能的影响.方法 将60只SD大鼠随机分为正常组、IBS组和FMT组,采用化学刺激的方法对IBS组和FMT组大鼠构建IBS动物模...     

肠易激综合征的肠道菌群干预

肠道菌群是人体的重要组成部分,并在肠易激综合征的发病过程中起到重要作用。近年来的研究表明,多种 类型的微生态制剂能够对肠易激综合征起到治疗作用。文章总结了肠道菌群调节在肠易激综合征方面的循证医学 证据,结合临床实践经验进行归纳,并提出肠道菌群干预应遵循“先破后立”的原则。     

肠易激综合征患者服用酪酸菌制剂前后的肠道菌群变化

目的:肠易激综合征(IBS)常合并存在肠道菌群失调,缺乏特效疗法。酪酸菌(Cb)是一种含有耐酸性芽胞的微生态制剂,本研究用于治疗IBS,观察酪酸菌制剂的临床疗效及肠道菌群状况。方法:从门诊随机选择21例男性,9例女性。检测大便常见菌群和病原菌,采用Miles-Misro介绍的滴注法操作。每次培养时均选上述细菌标准菌株一同培养作质控。结果:治疗前总厌氧菌、双歧杆菌和乳酸杆菌下降,而有潜在致病性的梭菌明显上升,无致病菌生长。治疗后腹泻次数明显减少,总有效率为83.4％,双歧杆菌和乳酸杆菌升高明显。结论:IBS易致肠菌失调。酪酸菌能抑制肠道内腐败菌、病原菌,并能促进双歧杆菌,乳酸菌等肠道内的有益菌发育。     

肠易激综合征患者肠道目标菌群分析

目的探讨肠易激综合征(IBS)患者与健康者肠道菌群的差异。方法对46例病患的肠道菌群进行细菌培养,与20例正常健康者肠道菌群进行对比。结果 IBS组和对照组均未找到已知的特异致病菌。IBS组肠道菌群中乳酸杆菌、双歧杆菌的菌落数与对照组相比显著减少,肠球菌的菌落数显著增加(P<0.05);大肠杆菌、真菌与对照组相比无显著差异(P>0.05)。结论 IBS与肠道菌群失调有相关性,来该院治疗的IBS患者存在肠道菌群失调。     

肠道菌群与肠易激综合征关系的研究进展

人体内存在数量庞大的肠道菌群，在肠易激综合征（IBS）等多种疾病的发病机制中起着重要的作用。近年来，以宏基因组学为代表的培养非依赖性技术方法为全面准确地分析肠道菌群提供了有力的工具。肠道菌群在IBS发病中的作用已逐渐被阐明，益生菌干预成为调节肠道菌群的重要手段。此文对上述研究进展作一综述。     

肠道感染和肠道菌群与肠易激综合征

肠易激综合征(IBS)是一种常见的胃肠功能性疾病。近年来,肠道感染、肠道菌群与IBS关系的研究已成为热点。此文探讨IBS与肠道感染、肠道菌群的关系以及微生态制剂治疗IBS的效果。     

溃疡性结肠炎患者粪菌移植后胃肠道功能及肠道菌群的影响分析

目的分析溃疡性结肠炎(ulcerative colitis, UC)患者粪菌移植(fecal microbiota transplantation, FMT)后胃肠道功能及肠道菌群的影响.方法选取从2016-04/2018-05在杭州市老年病医院就诊的UC的患者共100例,按入组顺序随机均分为两组,每组50例.对照组依病情口服柳氮磺吡啶片;观察组在此基础上加以FMT进行治疗.比较两组疗效,分别于治疗前后测定两组患者相关炎症因子[C反应蛋白(C reactive protein, CRP)、白介素-6(Interleukin-6, IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α)].采用Sutherland指数评分、肠道菌群评分和肠镜评分对两组患者的胃肠道功能及肠道菌进行比较.结果观察组总有效率96.00%显著高于对照组的70.00%(P 0.05),两组经治疗后TNF-α、IL-6、CRP水平明显降低(P0.05),观察组明显低于对照组(P0.05)观察组肠道菌群、肠镜评分及Surtherland指数治疗后明显降低(P0.05);明显低于对照组水平(P0.05).两组治疗后肠道菌群、肠镜评分及Surtherland指数有显著差异.结论采用FMT治疗UC患者,能明显改善患者胃肠道功能及肠道菌群评分.     

粪菌移植的研究现状、存在问题与发展方向

粪菌移植已经用于治疗难治性难辨梭状芽孢杆菌感染、炎症性肠病、腹泻型和便秘型肠易激综合征。但哪些患者适合用,哪些人适合做供体,怎么样是理想的移植方法等问题还没有完全解决,有关其机制、技术标准化、安全性评估等方面尚处于起步阶段,有待于深入研究。本文对FMT的研究现状、存在问题与发展方向作一介绍,并提出粪人工组合菌群移植是未来重要研究方向。     

肠易激综合征患者肠道微生态对照研究

近年来研究发现，肠易激综合征(IBS)的发生率在肠道感染后显著增加，使用抗生素后相关肠道症状常见，这些情况使人们开始考虑IBS等功能性胃肠道疾病可能与肠道菌群失调有关。本试验采用微生态检测方法了解IBS患者肠道微生态情况。     

Intestinal microbiota in pathophysiology and management of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a functional bowel disorder without any structural or metabolic abnormalities that sufficiently explain the symptoms, which include abdominal pain and discomfort, and bowel habit changes such as diarrhea and constipation. Its pathogenesis is multifactorial: visceral hypersensitivity, dysmotility, psychosocial factors, genetic or environmental factors, dysregulation of the brain-gut axis, and altered intestinal microbiota have all been proposed as possible causes. The human intestinal microbiota are composed of more than 1000 different bacterial species and 10¹⁴ cells, and are essential for the development, function, and homeostasis of the intestine, and for individual health. The putative mechanisms that explain the role of microbiota in the development of IBS include altered composition or metabolic activity of the microbiota, mucosal immune activation and inflammation, increased intestinal permeability and impaired mucosal barrier function, sensory-motor disturbances provoked by the microbiota, and a disturbed gut-microbiota-brain axis. Therefore, modulation of the intestinal microbiota through dietary changes, and use of antibiotics, probiotics, and anti-inflammatory agents has been suggested as strategies for managing IBS symptoms. This review summarizes and discusses the accumulating evidence that intestinal microbiota play a role in the pathophysiology and management of IBS.     

Altered metabolism of bile acids correlates with clinical parameters and the gut microbiota in patients with diarrhea-predominant irritable bowel syndrome

BACKGROUNDBile acids (BAs) have attracted attention in the research of irritable bowel syndrome with predominant diarrhea (IBS-D) due to their ability to modulate bowel function and their tight connection with the gut microbiota. The composition of the fecal BA pool in IBS-D patients is reportedly different from that in healthy populations. We hypothesized that BAs may participate in the pathogenesis of IBS-D and the altered BA profile may be correlated with the gut microbiome.AIMTo investigate the role of BAs in the pathogenesis of IBS-D and the correlation between fecal BAs and gut microbiota.METHODSFifty-five IBS-D patients diagnosed according to the Rome IV criteria and twenty-eight age-, sex-, and body mass index-matched healthy controls (HCs) were enrolled in this study at the gastroenterology department of China-Japan Friendship Hospital. First, clinical manifestations were assessed with standardized questionnaires, and visceral sensitivity was evaluated via the rectal distension test using a high-resolution manometry system. Fecal primary BAs including cholic acid (CA) and chenodeoxycholic acid (CDCA), secondary BAs including deoxycholic acid (DCA), lithocholic acid (LCA), and ursodeoxycholic acid (UDCA) as well as the corresponding tauro- and glyco-BAs were examined by ultraperformance liquid chromatography coupled to tandem mass spectrometry. The gut microbiota was analyzed using 16S rRNA gene sequencing. Correlations between fecal BAs with clinical features and gut microbiota were explored.RESULTSFecal CA (IBS-D: 3037.66 [282.82, 6917.47] nmol/g, HC: 20.19 [5.03, 1304.28] nmol/g; P < 0.001) and CDCA (IBS-D: 1721.86 [352.80, 2613.83] nmol/g, HC: 57.16 [13.76, 1639.92] nmol/g; P < 0.001) were significantly increased, while LCA (IBS-D: 1621.65 [58.99, 2396.49] nmol/g, HC: 2339.24 [1737.09, 2782.40]; P = 0.002] and UDCA (IBS-D: 8.92 [2.33, 23.93] nmol/g, HC: 17.21 [8.76, 33.48] nmol/g; P = 0.025) were significantly decreased in IBS-D patients compared to HCs. Defecation frequency was positively associated with CA (r = 0.294, P = 0.030) and CDCA (r = 0.290, P = 0.032) and negatively associated with DCA (r = −0.332, P = 0.013) and LCA (r = −0.326, P = 0.015) in IBS-D patients. In total, 23 of 55 IBS-D patients and 15 of 28 HCs participated in the visceral sensitivity test. The first sensation threshold was negatively correlated with CDCA (r = −0.459, P = 0.028) in IBS-D patients. Furthermore, the relative abundance of the family Ruminococcaceae was significantly decreased in IBS-D patients (P < 0.001), and 12 genera were significantly lower in IBS-D patients than in HCs (P < 0.05), with 6 belonging to Ruminococcaceae. Eleven of these genera were negatively correlated with primary BAs and positively correlated with secondary BAs in all subjects.CONCLUSIONThe altered metabolism of BAs in the gut of IBS-D patients was associated with diarrhea and visceral hypersensitivity and might be ascribed to dysbiosis, especially the reduction of genera in Ruminococcaceae.     

Effects of fecal microbiota transplantation in subjects with irritable bowel syndrome are mirrored by changes in gut microbiome

ABSTRACT

Irritable bowel syndrome (IBS) is a common disorder of the lower gastrointestinal tract. The pathophysiology is far from settled, but a gut microbial dysbiosis is hypothesized to be a contributing factor. We earlier published a randomized double-blind placebo-controlled clinical trial on fecal microbiota transplantation (FMT) for IBS – the REFIT trial. The present data set describes the engraftment and includes participants from the study who received active FMT; 14 participants with effect of FMT (Effect) and 8 without (No effect). Samples were collected at baseline, after 6 and 12 months. Samples from the transplants (Donor) served as a comparator. In total 66 recipient samples and 17 donor samples were subjected to deep metagenomic sequencing, and taxonomic and functional analyses were performed. Alpha diversity measures showed a significantly increased diversity and evenness in the IBS groups compared to the donors. Taxonomic profiles showed higher relative abundance of phylum Firmicutes, and lower relative abundance of phylum Bacteroidetes, compared to donors at baseline. This profile was shifted toward the donor profile following FMT. Imputed growth rates showed that the resulting growth pattern was a conglomerate of donor and recipient activity. Thirty-four functional subclasses showed distinct differences between baseline samples and donors, most of which were shifted toward a donor-like profile after FMT. All of these changes were less pronounced in the No effect group. We conclude that FMT induces long-term changes in gut microbiota, and these changes mirror the clinical effect of the treatment. The study was registered in ClinicalTrials.gov (NCT02154867).     

Lower Bifidobacteria counts in both duodenal mucosa-associated and fecal microbiota in irritable bowel syndrome patients

AIM： To determine the composition of both fecal and duodenal mucosa-associated microbiota in irritable bowel syndrome （IBS） patients and healthy subjects using molecular-based techniques.
METHODS： Fecal and duodenal mucosa brush samples were obtained from 41 IBS patients and 26 healthy subjects. Fecal samples were analyzed for the composition of the total microbiota using fluorescent in situ hybridization （FISH） and both fecal and duodenal brush samples were analyzed for the composition of bifidobacteria using real-time polymerase chain reaction.
RESULTS： The FISH analysis of fecal samples revealed a 2-fold decrease in the level of bifidobacteria （4.2 ± 1.3 vs 8.3 ± 1.9, P 〈 0.01） in IBS patients compared to healthy subjects, whereas no major differences in other bacterial groups were observed. At the species level, Bifidobacterium catenulatum levels were significantly lower （6 ± 0.6 vs 19 ± 2.5, P 〈 0.001） in the IBS patients in both fecal and duodenal brush samples than in healthy subjects.
CONCLUSION： Decreased bifidobacteria levels in both fecal and duodenal brush samples of IBS patients compared to healthy subjects indicate a role for microbiotic composition in IBS pathophysiology.     

便秘型肠易激综合征肛门直肠动力学的临床研究

目的　观察便秘型肠易激综合征 (IBS)的肛门直肠动力学改变。方法　采用灌注式测压装置测定 18例便秘型IBS患者和 15例健康人的肛门直肠压力、直肠对容量刺激的最低敏感量、最大耐受量及直肠顺应性。结果　便秘型IBS的直肠、肛门内外括约肌静息压力、内括约肌主动收缩压、模拟排便时直肠收缩压、内外括约肌净减压与对照组相比无显著性差异。肛门 直肠屏障压便秘型IBS组高于对照组 (P <0 0 5 )。直肠对容量刺激的最低敏感量便秘型IBS组低于对照组 (P <0 0 5 ) ,最大耐受量及顺应性均高于对照组 (P <0 0 1)。结论　便秘型IBS存在肛门直肠动力学异常 ,这种异常可能是导致便秘的原因     

褪黑激素与肠易激综合征

肠易激综合征是一种原因不明的慢性肠功能紊乱性疾病，其发病机制尚不清楚。其治疗方法也在不断改进中，褪黑激素对肠易激综合征的治疗有着积极的作用。     

Gut dysbiosis and irritable bowel syndrome: The potential role of probiotics

Objective

To discuss the role of gut dysbiosis in the development of irritable bowel syndrome (IBS) and the impact of probiotics as a potential therapeutic measure.

Overgrowth of the indigenous gut microbiome and irritable bowel syndrome

Culture-independent molecular techniques have demonstrated that the majority of the gut microbiota is uncultivable.Application of these molecular techniques to more accurately identify the indigenous gut microbiome has moved with great pace over recent years,leading to a substantial increase in understanding of gut microbial communities in both health and a number of disorders,including irritable bowel syndrome(IBS).Use of culture-independent molecular techniques already employed to characterise faecal and,to a lesser extent,colonic mucosal microbial populations in IBS,without reliance on insensitive,traditional microbiological culture techniques,has the potential to more accurately determine microbial composition in the small intestine of patients with this disorder,at least that occurring proximally and within reach of sampling.Current data concerning culture-based and culture-independent analyses of the small intestinal microbiome in IBS are considered here.