title: Irritable bowel syndrome, inflammatory bowel disease and the microbiome.
abstract: OBJECTIVE
  The review aims to update the reader on current developments in our understanding of how the gut microbiota impact on inflammatory bowel disease and the irritable bowel syndrome. It will also consider current efforts to modulate the microbiota for therapeutic effect.
  
  
  RESULTS
  Gene polymorphisms associated with inflammatory bowel disease increasingly suggest that interaction with the microbiota drives pathogenesis. This may be through modulation of the immune response, mucosal permeability or the products of microbial metabolism. Similar findings in irritable bowel syndrome have reinforced the role of gut-specific factors in this 'functional' disorder. Metagenomic analysis has identified alterations in pathways and interactions with the ecosystem of the microbiome that may not be recognized by taxonomic description alone, particularly in carbohydrate metabolism. Treatments targeted at the microbial stimulus with antibiotics, probiotics or prebiotics have all progressed in the past year. Studies on the long-term effects of treatment on the microbiome suggest that dietary intervention may be needed for prolonged efficacy.
  
  
  CONCLUSIONS
  The microbiome represents 'the other genome', and to appreciate its role in health and disease will be as challenging as with our own genome. Intestinal diseases occur at the front line of our interaction with the microbiome and their future treatment will be shaped as we unravel our relationship with it.
authors.affiliation: Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
authors.forename: Giles
authors.initials: G
authors.lastname: Major
authors.forename: Robin
authors.initials: R
authors.lastname: Spiller
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004040:Dietary Carbohydrates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000178:diet therapy* / Q000276:immunology / Q000382:microbiology; D007413:Intestinal Mucosa / Q000276:immunology / Q000382:microbiology*; D043183:Irritable Bowel Syndrome / Q000178:diet therapy* / Q000276:immunology / Q000382:microbiology; D008297:Male; D054892:Metagenome; D064307:Microbiota; D056692:Prebiotics; D019936:Probiotics
chemical_list: D000900:Anti-Bacterial Agents; D004040:Dietary Carbohydrates; D056692:Prebiotics