7Irritable bowel syndrome

The intestinal microbiota interacts with several aspects of gastrointestinal function that may affect the expression or progression of disease. For example, a role for bacterial metabolism of bile acids and food has been linked to colorectal cancer development. Studies have also shown a potential role of the intestinal microbiota in the modulation of inflammation in the intestine and joints. Normal gut physiology is molded by the interaction between the intestinal microbiota and the host’s gastrointestinal tissues, including motility, absorption and secretion, and intestinal permeability. Early studies in axenic mice demonstrated gross morphological abnormalities and gut motor dysfunction related to the absence of a normal microflora, raising the possibility that shifts in commensal bacterial populations could play a role in the development of altered motility states including functional disorders of the gut. This chapter concentrates on the experimental evidence for a role of intestinal microbiota and the potential therapeutic value of probiotics in functional diseases such as irritable bowel syndrome. Key words: intestinal microflora; irritable bowel syndrome; gut function; motility; probiotics. IS THE INTESTINAL MICROBIOTA ALTERED IN IRRITABLE BOWEL SYNDROME? There are limitations to the study of the gastrointestinal flora by conventional microbiological techniques as most resident bacteria cannot be cultured. There is, however, evidence that the intestinal microbiota is altered in patients with irritable bowel syndrome (IBS) when compared to normal individuals. A number of studies have reported lower numbers of lactobacilli and bifidobacteria in IBS patients, and a shift from the dominant anaerobic species such as Bacteroides spp and Bifidobacterium spp to Clostridium spp.1,2 It has been suggested that the differences in the intestinal microbiot