Egyre több kísérletes és klinikai tapasztalat bizonyítja az irritábilis bél, irritábilis szem és irritábilis elme tünetek együttes előfordulását. Ennek alapján egyre határozottabban fogalmazódik meg egy új koncepció, miszerint a gyomor-bél, a szem és a neuropszichiátriai tüneteket egy közös kórtani mechanizmus, a mikroflóra és a bélnyálkahártya szimbiózisának zavara (dysbiosis) kapcsolja egybe. Következésképpen, a szimbiózis fenntartása, illetve helyreállítása egy ígéretes új terápiás lehetőség a betegség kezelésére, továbbá a visszaesések megelőzésére. Napjainkban széles körben ajánlják az élő probiotikus baktériumokat tartalmazó készítményeket, esetenként prebiotikummal kombinálva a bélflóra egyensúlyának helyreállítására és ezáltal a panaszok csökkentésére. Több vizsgálat viszont előnyösebb hatásról számolt be a hővel kezelt (elölt) probiotikumok alkalmazásával. A szerzők saját vizsgálatai szerint a hatás tovább növelhető, ha a lizált (fragmentált) probiotikumokat kombinálva alkalmazzuk A-, B-, D-vitaminnal és ómega-3 zsírsavakkal, amelyek a gazdaszervezetre fejtik ki a hatásukat. Ezek a tapasztalatok koncepcióváltást sürgetnek, miszerint a szimbiózis helyreállítása akkor lehet eredményes, ha a kezelésben azonos súlyt kap a mikroflóra és a bélnyálkahártya funkcióinak helyreállítása. Orv. Hetil., 2014, 155(37), 1454–1460.
König, J., Brummer, R. J.: Alteration of the intestinal microbiota as a cause of and a potential therapeutic option in irritable bowel syndrome. Benef. Microbes, 2014, 5(3), 247–261.
Nellesen, D., Yee, K., Chawla, A., et al.: A systematic review of the economic and humanistic burden of illness in irritable bowel syndrome and chronic constipation. J. Manag. Care Pharm., 2013, 19(9), 755–764.
Fortea, J., Prior, M.: Irritable bowel syndrome with constipation: a European-focused systematic literature review of disease burden. J. Med. Econ., 2013, 16(3), 329–341.
Sisson, G., Ayis, S., Sherwood, R. A., et al.: Randomised clinical trial: a liquid multi-strain probiotic vs. placebo in the irritable bowel syndrome – a 12 week double-blind study. Aliment. Pharmacol. Ther., 2014, 40(1), 51–62.
Dinan, T. G., Cryan, J. F.: Melancholic microbes: a link between gut microbiota and depression? Neurogastroenterol. Motil., 2013, 25(9), 713–719.
Bajaj, J. S., Heuman, D. M., Hylemon, P. B., et al.: Randomised clinical trial: Lactobacillus GG modulates gut microbiome, metabolome and endotoxemia in patients with cirrhosis. Aliment. Pharmacol. Ther., 2014, 39(10), 1113–1125.
Borody, T. J., Brandt, L. J., Paramsothy, S.: Therapeutic faecal microbiota transplantation: current status and future developments. Curr. Opin. Gastroenterol., 2014, 30(1), 97–105.
Feher, J.: Tear film abnormalities and mucous membrane disorders associated with neurohormonal dysfunctions. In: Hurwitz, J., Miglior, M., Spinelli, D., van Bijsterveld, O. P. (eds.): The Lacrimal System. Kluwer, Milano, 1994.
Feher, J.: Contribution of neurogenic inflammation to irritable eye syndrome (dry eye, photophobia and headache). Adv. Exp. Med. Biol., 2002, 506, 1047–1050.
Hallak, J. A., Jassim, S., Khanolkar, V., et al.: Symptom burden of patients with dry eye disease: a four domain analysis. PLoS One, 2013, 8(12), e82805.
Wu, J. C.: Psychological co-morbidity in functional gastrointestinal disorders: epidemiology, mechanisms and management. J. Neurogastroenterol. Motil., 2012, 18(1), 13–18.
Labbé, A., Wang, Y. X., Jie, Y., et al.: Dry eye disease, dry eye symptoms and depression: the Beijing Eye Study. Br. J. Ophthalmol., 2013, 97(11), 1399–1403.
Barton, A., Pal, B., Whorwell, P. J., et al.: Increased prevalence of sicca complex and fibromyalgia in patients with irritable bowel syndrome. Am. J. Gastroenterol., 1999, 94(7), 1898–1901.
Türkyilmaz, K., Türkyilmaz, A. K., Kurt, E. E., et al.: Dry eye in patients with fibromyalgia and its relevance to functional and emotional status. Cornea, 2013, 32(6), 862–866.
Akiho, H., Ihara, E., Nakamura, K.: Low-grade inflammation plays a pivotal role in gastrointestinal dysfunction in irritable bowel syndrome. World J. Gastrointest. Pathophysiol., 2010, 1(3), 97–105.
Barabino, S., Chen, Y., Chauhan, S., et al.: Ocular surface immunity: homeostatic mechanisms and their disruption in dry eye disease. Prog. Retin. Eye Res., 2012, 31(3), 271–285.
Vehof, J., Kozareva, D., Hysi, P. G., et al.: Relationship between dry eye symptoms and pain sensitivity. JAMA Ophthalmol., 2013, 131(10), 1304–1308.
Stabell, N., Stubhaug, A., Flægstad, T., et al.: Increased pain sensitivity among adults reporting irritable bowel syndrome symptoms in a large population-based study. Pain, 2013, 154(3), 385–392.
Marlicz, W., Zawada, I., Starzyńska, T.: Irritable bowel syndrome – irritable bowel or irritable mind? Pol. Merkur. Lekarski, 2012, 32(187), 64–69. [Polish]
Ohman, L., Simrén, M.: Intestinal microbiota and its role in irritable bowel syndrome (IBS). Curr. Gastroenterol. Rep., 2013, 15(5), 323.
Parkes, G. C., Rayment, N. B., Hudspith, B. N., et al.: Distinct microbial populations exist in the mucosa-associated microbiota of sub-groups of irritable bowel syndrome. Neurogastroenterol. Motil., 2012, 24(1), 31–39.
Jeffery, I. B., O’Toole, P. W., Öhman, L., et al.: An irritable bowel syndrome subtype defined by species-specific alterations in faecal microbiota. Gut, 2012, 61(7), 997–1006.
Gecse, K., Róka, R., Séra, T., et al.: Leaky gut in patients with diarrhea-predominant irritable bowel syndrome and inactive ulcerative colitis. Digestion, 2012, 85(1), 40–46.
Wilcz-Villega, E., McClean, S., O’Sullivan, M.: Reduced E-cadherin expression is associated with abdominal pain and symptom duration in a study of alternating and diarrhea predominant IBS. Neurogastroenterol. Motil., 2014, 26(3), 316–325.
Keita, A. V., Söderholm, J. D.: The intestinal barrier and its regulation by neuroimmune factors. Neurogastroenterol. Motil., 2010, 22(7), 718–733.
Vivinus-Nébot, M., Frin-Mathy, G., Bzioueche, H., et al.: Functional bowel symptoms in quiescent inflammatory bowel diseases: role of epithelial barrier disruption and low-grade inflammation. Gut, 2014, 63(5), 744–752.
Solakivi, T., Kaukinen, K., Kunnas, T., et al.: Serum fatty acid profile in subjects with irritable bowel syndrome. Scand. J. Gastroenterol., 2011, 46(3), 299–303.
Kilkens, T. O., Honig, A., Maes, M., et al.: Fatty acid profile and affective dysregulation in irritable bowel syndrome. Lipids, 2004, 39(5), 425–431.
Clarke, G., Fitzgerald, P., Hennessy, A. A., et al.: Marked elevations in pro-inflammatory polyunsaturated fatty acid metabolites in females with irritable bowel syndrome. J. Lipid Res., 2010, 51(5), 1186–1192.
Sanders, M. E., Guarner, F., Guerrant, R., et al.: An update on the use and investigation of probiotics in health and disease. Gut, 2013, 62(5), 787–796.
Ortiz-Lucas, M., Tobias, A., Saz, P., et al.: Effect of probiotic species on irritable bowel syndrome symptoms: A bring up to date meta-analysis. Rev. Esp. Enferm. Dig., 2013, 105(1), 19–36.
Yoon, J. S., Sohn, W., Lee, O. Y., et al.: Effect of multi-species probiotics on irritable bowel syndrome: a randomized, double-blind, placebo-controlled trial. J. Gastroenterol. Hepatol., 2014, 29(1), 52–59.
Charbonneau, D., Gibb, R. D., Quigley, E. M.: Fecal excretion of Bifidobacterium infantis 35624 and changes in fecal microbiota after eight weeks of oral supplementation with encapsulated probiotic. Gut Microbes, 2013, 4(3), 201–211.
Begtrup, L. M., de Muckadell, O. B., Kjeldsen, J., et al.: Long-term treatment with probiotics in primary care patients with irritable bowel syndrome – a randomised, double-blind, placebo controlled trial. Scand. J. Gastroenterol., 2013, 48(10), 1127–1135.
Drouault-Holowacz, S., Bieuvelet, S., Burckel, A., et al.: A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroenterol. Clin. Biol., 2008, 32(2), 147–152.
Cappello, C., Tremolaterra, F., Pascariello, A., et al.: A randomised clinical trial (RCT) of a symbiotic mixture in patients with irritable bowel syndrome (IBS): effects on symptoms, colonic transit and quality of life. Int. J. Colorectal Dis., 2013, 28(3), 349–358.
Farup, P. G., Jacobsen, M., Ligaarden, S. C., et al.: Probiotics, symptoms, and gut microbiota: what are the relations? A randomized controlled trial in subjects with irritable bowel syndrome. Gastroenterol. Res. Pract., 2012, 2012, 214102.
Cannon, J. P., Lee, T. A., Bolanos, J. T., et al.: Pathogenic relevance of Lactobacillus: a retrospective review of over 200 cases. Eur. J. Clin. Microbiol. Infect. Dis., 2005, 24(1), 31–40.
Petrunov, B., Marinova, S., Markova, R., et al.: Cellular and humoral systemic and mucosal immune responses stimulated in volunteers by an oral polybacterial immunomodulator “Dentavax”. Int. Immunopharmacol., 2006, 6(7), 1181–1193.
Hirose, Y., Murosaki, S., Yamamoto, Y., et al.: Daily intake of heat-killed Lactobacillus plantarum L-137 augments acquired immunity in healthy adults. J. Nutr., 2006, 136(12), 3069–3073.
Kotani, Y., Shinkai, S., Okamatsu, H., et al.: Oral intake of Lactobacillus pentosus strain b240 accelerates salivary immunoglobulin A secretion in the elderly: A randomized, placebo-controlled, double-blind trial. Immun. Ageing, 2010, 7, 11.
Shinkai, S., Toba, M., Saito, T., et al.: Immunoprotective effects of oral intake of heat-killed Lactobacillus pentosus strain b240 in elderly adults: a randomised, double-blind, placebo-controlled trial. Br. J. Nutr., 2013, 109(10), 1856–1865.
Xiao, S. D., Zhang, D. Z., Lu, H., et al.: Multicenter, randomized, controlled trial of heat-killed Lactobacillus acidophilus LB in patients with chronic diarrhea. Adv. Ther., 2003, 20(5), 253–260.
Tarrerias, A. L., Costil, V., Vicari, F., et al.: The effect of inactivated Lactobacillus LB fermented culture medium on symptom severity: observational investigation in 297 patients with diarrhea-predominant irritable bowel syndrome. Dig. Dis., 2011, 29(6), 588–591.
Enck, P., Zimmermann, K., Menke, G., et al.: A mixture of Escherichia coli (DSM 17252) and Enterococcus faecalis (DSM 16440) for treatment of the irritable bowel syndrome – a randomized controlled trial with primary care physicians. Neurogastroenterol. Motil., 2008, 20(10), 1103–1109.
Salazar-Lindo, E., Figueroa-Quintanilla, D., Caciano, M. I., et al.: Effectiveness and safety of Lactobacillus LB in the treatment of mild acute diarrhea in children. J. Pediatr. Gastroenterol. Nutr., 2007, 44(5), 571–576.
Martens, U., Enck, P., Zieseniss, E.: Probiotic treatment of irritable bowel syndrome in children. Ger. Med. Sci., 2010, 8, Doc07.
Awad, H., Mokhtar, H., Imam, S. S., et al.: Comparison between killed and living probiotic usage versus placebo for the prevention of necrotizing enterocolitis and sepsis in neonates. Pak. J. Biol. Sci., 2010, 13(6), 253–262.
Feher, J., Pinter, E., Kovács, I., et al.: Irritable eye syndrome: neuroimmune mechanisms and benefits of selected nutrients. Ocul. Surf., 2014, 12(2), 134–145.
Johannesson, E., Simrén, M., Strid, H., et al.: Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Am. J. Gastroenterol., 2011, 106(5), 915–922.
Luo, B., Xiang, D., Nieman, D. C., et al.: The effects of moderate exercise on chronic stress-induced intestinal barrier dysfunction and antimicrobial defense. Brain Behav. Immun., 2014, 39, 99–106.
Radak, Z., Ihasz, F., Koltai, E., et al.: The redox-associated adaptive response of brain to physical exercise. Free Radic. Res., 2014, 48(1), 84–92.