Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2023; 29(21): 3241-3256
Published online Jun 7, 2023. doi: 10.3748/wjg.v29.i21.3241
Emerging role of the gut microbiome in post-infectious irritable bowel syndrome: A literature review
Vasile Valeriu Lupu, Cristina Mihaela Ghiciuc, Gabriela Stefanescu, Cristina Maria Mihai, Alina Popp, Maria Oana Sasaran, Laura Bozomitu, Iuliana Magdalena Starcea, Anca Adam Raileanu, Ancuta Lupu
Vasile Valeriu Lupu, Cristina Mihaela Ghiciuc, Gabriela Stefanescu, Laura Bozomitu, Iuliana Magdalena Starcea, Anca Adam Raileanu, Ancuta Lupu, Faculty of General Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
Cristina Maria Mihai, Faculty of General Medicine, Ovidius University, Constanta 900470, Romania
Alina Popp, Faculty of General Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest 020021, Romania
Maria Oana Sasaran, Faculty of General Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology, Targu Mures 540142, Romania
Author contributions: Lupu VV, Bozomitu L, Starcea IM, Adam Raileanu A, and Lupu A wrote the initial draft; Ghiciuc CM, Stefanescu G, Mihai CM, Popp A, and Sasaran MO reviewed and edited the article; Ghiciuc CM, Stefanescu G, Mihai CM, Popp A, Sasaran MO, Bozomitu L, Starcea IM, Adam Raileanu A and Lupu A contributed equally with Lupu VV to this article.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Anca Adam Raileanu, MD, PhD, Attending Doctor, Faculty of General Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, Iasi 700115, Romania.
Received: February 16, 2023
Peer-review started: February 16, 2023
First decision: April 2, 2023
Revised: April 4, 2023
Accepted: May 8, 2023
Article in press: May 8, 2023
Published online: June 7, 2023

Post-infectious irritable bowel syndrome (PI-IBS) is a particular type of IBS, with symptom onset after an acute episode of infectious gastroenteritis. Despite infectious disease resolution and clearance of the inciting pathogen agent, 10% of patients will develop PI-IBS. In susceptible individuals, the exposure to pathogenic organisms leads to a marked shift in the gut microbiota with prolonged changes in host-microbiota interactions. These changes can affect the gut-brain axis and the visceral sensitivity, disrupting the intestinal barrier, altering neuromuscular function, triggering persistent low inflammation, and sustaining the onset of IBS symptoms. There is no specific treatment strategy for PI-IBS. Different drug classes can be used to treat PI-IBS similar to patients with IBS in general, guided by their clinical symptoms. This review summarizes the current evidence for microbial dysbiosis in PI-IBS and analyzes the available data regarding the role of the microbiome in mediating the central and peripheral dysfunctions that lead to IBS symptoms. It also discusses the current state of evidence on therapies targeting the microbiome in the management of PI-IBS. The results of microbial modulation strategies used in relieving IBS symptomatology are encouraging. Several studies on PI-IBS animal models reported promising results. However, published data that describe the efficacy and safety of microbial targeted therapy in PI-IBS patients are scarce. Future research is required.

Keywords: Gut microbiome, Infectious gastroenteritis, Irritable bowel syndrome, Post infection syndrome, Pathophysiology, Inflammation

Core Tip: Acute infectious gastroenteritis can trigger the onset of irritable bowel syndrome (IBS), leading to the development of post-infectious IBS (PI-IBS). PI-IBS is a clinical entity associated with gut dysbiosis. Alterations in the gut microbiome can affect the gut-brain axis, visceral sensitivity, intestinal barrier, intestinal secretion, gut motility, and immune activation, which in turn can cause IBS symptoms. A better understanding of PI-IBS is necessary to develop more targeted and effective treatments. Therapies targeting the microbiome, such as probiotics, antibiotics, diet, and fecal microbiota transplants, improve IBS symptoms. There is a lack of evidence of their efficiency in PI-IBS.