Antibiotics for the Treatment of Irritable Bowel Syndrome.pdfVIP

Gastroenterology Hepatology Volume 7, Issue 7 July 2011 455 Antibiotics for the Treatment of Irritable Bowel Syndrome Robert J. Basseri, MD, Stacy Weitsman, MS, Gillian M. Barlow, PhD, and Mark Pimentel, MD, FRCP(C) Dr. Basseri, Ms. Weitsman, and Dr. Barlow are affiliated with the GI Motility Program at Cedars-Sinai Medical Center in Los Angeles, California, where Dr. Pimentel serves as Director. Address correspondence to: Dr. Mark Pimentel Director, GI Motility Program Cedars-Sinai Medical Center 8730 Alden Drive Thalians Building, 2nd Floor East Los Angeles, CA 90048; Tel: 310-869-3513; Fax: 310-423-8356; E-mail: pimentelm@cshs.org Keywords Irritable bowel syndrome, antibiotics, neomycin, rifaximin, re-treatment Abstract:? Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder with an estimated worldwide prevalence of 10–20%. IBS can be associated with severe gastrointestinal symp- toms, including abdominal pain, bloating, and altered bowel func- tion. Although the causes of IBS remain undefined, recent research has increasingly suggested roles for gut flora in IBS. These roles involve postinfectious IBS, which can occur after a single episode of acute gastroenteritis, and small intestinal bacterial overgrowth, in which elevated populations of aerobic and anaerobic bacteria cause abdominal pain and altered bowel function. More recently, poten- tial roles for methanogens in contributing to IBS subtypes have also been identified. In this paper, we review the different mechanisms by which gut flora may contribute to IBS and also discuss the efficacy and safety of various antibiotic therapies for treating IBS symptoms. Irritable bowel syndrome (IBS) is the most common gastro-intestinal disorder worldwide, affecting 10–20% of the adult population.1,2 IBS is characterized by recurrent abdominal pain, bloating, altered bowel function (constipation, diarrhea, or both), and a myriad of gastrointestinal symptoms.3-8 Severe