Bugs and irritable bowel syndrome: The good, the bad and the ugly

J Gastroenterol Hepatol. 2010 Feb;25(2):244-51. doi: 10.1111/j.1440-1746.2009.06133.x. Epub 2010 Jan 14.


Recently, there has been strong interest in the therapeutic potential of probiotics for irritable bowel syndrome (IBS). At the same time, there is a rapidly growing body of evidence to support an etiological role for gastrointestinal infection and the associated immune activation in the development of post-infectious IBS. In a more controversial area, small intestinal bacterial overgrowth has been associated with a subset of patients with IBS; the issue of whether it is appropriate to treat a subset of IBS patients with antibiotics and probiotics is currently a matter for debate. Thus, it appears that the gastrointestinal microbial flora may exert beneficial effects for symptoms of IBS under some circumstances, while in other situations gut microbes could give rise to symptoms of IBS. How do we make sense of the apparently diverse roles that 'bugs' may play in IBS? To address this question, we have conducted an in-depth review, attempting where possible to draw lessons from Asian studies.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Asian Continental Ancestry Group
  • Bacterial Infections / ethnology
  • Bacterial Infections / microbiology*
  • Bacterial Infections / therapy
  • Evidence-Based Medicine
  • Gastrointestinal Tract / microbiology*
  • Gastrointestinal Tract / parasitology
  • Helminthiasis / ethnology
  • Helminthiasis / parasitology
  • Humans
  • Intestinal Diseases, Parasitic / ethnology
  • Intestinal Diseases, Parasitic / parasitology
  • Irritable Bowel Syndrome / diagnosis
  • Irritable Bowel Syndrome / ethnology
  • Irritable Bowel Syndrome / microbiology*
  • Irritable Bowel Syndrome / parasitology
  • Irritable Bowel Syndrome / therapy
  • Probiotics / therapeutic use*
  • Risk Factors


  • Anti-Bacterial Agents