title: Microbiota, gastrointestinal infections, low-grade inflammation, and antibiotic therapy in irritable bowel syndrome: an evidence-based review.
abstract: BACKGROUND
  Post-infectious irritable bowel syndrome (PI-IBS) prevalence, small intestinal bacterial overgrowth (SIBO), altered microbiota, low-grade inflammation, and antibiotic therapy in IBS are all controversial issues.
  
  
  OBJECTIVE
  To conduct an evidence-based review of these factors.
  
  
  METHODS
  A review of the literature was carried out up to July 2012, with the inclusion of additional articles as far as August 2013, all of which were analyzed through the Oxford Centre for Evidence-Based Medicine (OCEBM) system.
  
  
  RESULTS
  1.There is greater SIBO probability in IBS when breath tests are performed, but prevalence varies widely (2-84%). 2.The gut microbiota in individuals with IBS is different from that in healthy subjects, but a common characteristic present in all the patients has not been established. 3.The incidence and prevalence of PI-IBS varies from 9-10% and 3-17%, respectively, and the latter decreases over time. Bacterial etiology is the most frequent but post-viral and parasitic cases have been reported. 4.A sub-group of patients has increased enterochromaffin cells, intraepithelial lymphocytes, and mast cells in the intestinal mucosa, but no differences between PI-IBS and non-PI-IBS have been determined. 5.Methanogenic microbiota has been associated with IBS with constipation. 6.Rifaximin at doses of 400mg TID/10days or 550mg TID/14days is effective treatment for the majority of overall symptoms and abdominal bloating in IBS. Retreatment effectiveness appears to be similar to that of the first cycle.
  
  
  CONCLUSIONS
  Further studies are required to determine the nature of the gut microbiota in IBS and the differences in low-grade inflammation between PI-IBS and non-PI-IBS. Rifaximin has shown itself to be effective treatment for IBS, regardless of prior factors.
authors.affiliation: Laboratorio de Hígado, Páncreas y Motilidad (HIPAM), Departamento de Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Hospital General de México, México DF, México. Electronic address: maxjulio@prodigy.net.mx.
authors.forename: M
authors.initials: M
authors.lastname: Schmulson
authors.affiliation: Departamento de Gastroenterología, Facultad de Medicina, Universidad Autónoma de Guadalajara, Guadalajara, Jalisco, México.
authors.forename: M V
authors.initials: MV
authors.lastname: Bielsa
authors.affiliation: Servicio de Gastroenterología, Servicio de Medicina Interna, Hospital Ángeles-CMP, San Luis Potosí, San Luis Potosí, México.
authors.forename: R
authors.initials: R
authors.lastname: Carmona-Sánchez
authors.affiliation: Servicio de Endoscopia, Instituto Nacional de Cancerología, México DF, México.
authors.forename: A
authors.initials: A
authors.lastname: Hernández
authors.affiliation: Coordinación Delegacional de Investigación en Salud, Instituto Mexicano del Seguro Social, Puebla, Puebla, México.
authors.forename: A
authors.initials: A
authors.lastname: López-Colombo
authors.affiliation: Programa de Inmunología Molecular Microbiana, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), México DF, México.
authors.forename: Y
authors.initials: Y
authors.lastname: López Vidal
authors.affiliation: Laboratorio de Hígado, Páncreas y Motilidad (HIPAM), Departamento de Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Hospital General de México, México DF, México.
authors.forename: M
authors.initials: M
authors.lastname: Peláez-Luna
authors.affiliation: Laboratorio de Fisiología Digestiva y Motilidad Gastrointestinal, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Veracruz, México; Facultad de Medicina «Miguel Alemán Valdés», Universidad Veracruzana, Veracruz, Veracruz, México.
authors.forename: J M
authors.initials: JM
authors.lastname: Remes-Troche
authors.affiliation: Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Hospital Civil de Culiacán, Culiacán, Sinaloa, México.
authors.forename: J L
authors.initials: JL
authors.lastname: Tamayo
authors.affiliation: Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, México.
authors.forename: M A
authors.initials: MA
authors.lastname: Valdovinos
mesh_terms: D019317:Evidence-Based Medicine; D005767:Gastrointestinal Diseases / Q000382:microbiology* / Q000473:pathology*; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000382:microbiology* / Q000473:pathology*; D064307:Microbiota
keywords: Adultos; Adults; Antibiotic treatment; Bacteria overgrowth; Children; Inflamación de bajo grado; Irritable bowel syndrome; Low-grade inflammation; Microbiota; Niños; Post-infectious; Postinfeccioso; Revisión sistemática basada en evidencias; Rifaximin; Rifaximina; Sobrepoblación bacteriana; Systematic evidence-based review; Síndrome de intestino irritable; Tratamiento con antibióticos