Review Articles
Vol. 98 No. 2 (2025)
https://doi.org/10.4081/jbr.2025.13873

Microbiota-gut-brain axis: towards a microbiota-centred approach for irritable bowel syndrome

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Received: 8 April 2025
Accepted: 10 March 2026
Published: 18 November 2025
318
Views
197
Downloads
Contents | Review Articles
Microbiota, Irritable Bowel Syndrome (IBS), Disorder of the Gut-Brain Interaction (DGBI)

Authors

Andrea Costantino
Department of Pathophysiology and Transplantation, University of Milan; Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy.
Gennaro Tagliamonte
https://orcid.org/0009-0004-7506-7581
Department of Pathophysiology and Transplantation, University of Milan, Italy.
Marcello Romeo
drmarcelloromeo@gmail.com
https://orcid.org/0000-0001-6991-6357
Department of Biology and Biotechnology, University of Pavia, Pavia, Italy.

Irritable Bowel Syndrome (IBS) is a highly prevalent Disorder of the Gut-Brain Interaction (DGBI). Despite years of research, the mechanisms of IBS pathogenesis are not yet fully understood, but a key role is played by the gut-brain axis, whose alteration may lead to visceral hypersensitivity and altered motility. In recent years, advancements in research on the gut microbiota have shifted the understanding of the underlying pathophysiological mechanisms in IBS, with increasing attention to the role of the microbiota. In IBS patients, studies showed an altered gut microbial composition, with elevated levels of Clostridia and Escherichia coli, while Bacteroidia, Lactobacillus spp., and Bifidobacterium spp. were diminished. Moreover, an increased Firmicutes/ Bacteroidetes ratio and a lower microbial diversity was commonly observed in many IBS patients. The complex interplay between the gut microbiota and the gut-brain axis is leading to the intriguing concept of a microbiota-gut-brain axis. Evidence for microbiota- altering interventions is still heterogeneous, with a described role of antibiotics, probiotics, prebiotics, while interventions such as Faecal Microbiota Transplantation (FMT) remain used primarily in research settings. A knowledge gap still exists about the microbiota profile of the ideal donor in FMT for IBS patients. Finally, the recent advancements in artificial intelligence offer new possibilities to improve diagnosis of IBS and efficacy of microbiota altering interventions to improve symptoms. Today, there is a need for gastroenterologists to develop expertise in this field and to collaborate with specialist of microbiota to manage this complex disease. Microbiota tests are increasingly used by patients, and personalized medicine will require gastroenterologists to adopt microbiota modulation strategies with the help of an expert microbiologist.

Downloads

Download data is not yet available.
1. Ford AC, Sperber AD, Corsetti M, Camilleri M. Irritable bowel syndrome. Lancet 2020;396:1675–88. DOI: https://doi.org/10.1016/S0140-6736(20)31548-8
2. Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome foundation global study. Gastroenterology 2021;160:99-114.e3.
3. Van Oudenhove L, Levy RL, Crowell MD, et al. Biopsychosocial aspects of functional gastrointestinal disorders: how central and environmental processes contribute to the development and expression of functional gastrointestinal disorders. Gastroenterology 2016;150:1355-67.e2. DOI: https://doi.org/10.1053/j.gastro.2016.02.027
4. Buono JL, Carson RT, Flores NM. Health-related quality of life, work productivity, and indirect costs among patients with irritable bowel syndrome with diarrhea. Health Qual Life Outcomes 2017;15:35. DOI: https://doi.org/10.1186/s12955-017-0611-2
5. Pace F, Molteni P, Bollani S, et al. Inflammatory bowel disease versus irritable bowel syndrome: a hospital-based, case-control study of disease impact on quality of life. Scand J Gastroenterol 2003;38:1031–8. DOI: https://doi.org/10.1080/00365520310004524
6. Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV. Gastroenterology 2016;S0016-5085(16)00223-7.
7. Bhattarai Y, Muniz Pedrogo DA, Kashyap PC. Irritable bowel syndrome: a gut microbiota-related disorder? Am J Physiol Gastrointest Liver Physiol 2017;312:G52–62. DOI: https://doi.org/10.1152/ajpgi.00338.2016
8. Barbara G, Grover M, Bercik P, et al. Rome foundation working team report on post-infection irritable bowel syndrome. Gastroenterology 2019;156:46-58.e7. DOI: https://doi.org/10.1053/j.gastro.2018.07.011
9. Klem F, Wadhwa A, Prokop LJ, et al. Prevalence, risk factors, and outcomes of irritable bowel syndrome after infectious enteritis: a systematic review and meta-analysis. Gastroenterology 2017;152:1042-54.e1. DOI: https://doi.org/10.1053/j.gastro.2016.12.039
10. Collins SM. A role for the gut microbiota in IBS. Nat Rev Gastroenterol Hepatol 2014;11:497-505. DOI: https://doi.org/10.1038/nrgastro.2014.40
11. Ford AC, Harris LA, Lacy BE, et al. Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Aliment Pharmacol Ther 2018;48:1044–60.
12. Nardone G, Compare D. The human gastric microbiota: is it time to rethink the pathogenesis of stomach diseases? United Eur Gastroenterol J 2015;3:255–60. DOI: https://doi.org/10.1177/2050640614566846
13. El Aidy S, van den Bogert B, Kleerebezem M. The small intestine microbiota, nutritional modulation and relevance for health. Curr Opin Biotechnol 2015;32:14–20. DOI: https://doi.org/10.1016/j.copbio.2014.09.005
14. Mariat D, Firmesse O, Levenez F, et al. The Firmicutes/Bacteroidetes ratio of the human microbiota changes with age. BMC Microbiol 2009;9:123. DOI: https://doi.org/10.1186/1471-2180-9-123
15. Eckburg PB, Bik EM, Bernstein CN, et al. Diversity of the human intestinal microbial flora. Science 2005;308:1635–8. DOI: https://doi.org/10.1126/science.1110591
16. Borre YE, O’Keeffe GW, Clarke G, et al. Microbiota and neurodevelopmental windows: implications for brain disorders. Trends Mol Med 2014;20:509–18. DOI: https://doi.org/10.1016/j.molmed.2014.05.002
17. Bäckhed F, Roswall J, Peng Y, et al. Dynamics and stabilization of the human gut microbiome during the first year of life. Cell Host Microbe 2015;17:690–703. DOI: https://doi.org/10.1016/j.chom.2015.04.004
18. Singh RK, Chang HW, Yan D, et al. Influence of diet on the gut microbiome and implications for human health. J Transl Med 2017;15:73. DOI: https://doi.org/10.1186/s12967-017-1175-y
19. Sommer F, Bäckhed F. The gut microbiota—masters of host development and physiology. Nat Rev Microbiol 2013;11:227–38. DOI: https://doi.org/10.1038/nrmicro2974
20. Adak A, Khan MR. An insight into gut microbiota and its functionalities. Cell Mol Life Sci 2019;76:473–93. DOI: https://doi.org/10.1007/s00018-018-2943-4
21. Martens EC, Lowe EC, Chiang H, et al. Recognition and degradation of plant cell wall polysaccharides by two human gut symbionts. PLoS Biol 2011;9:e1001221. DOI: https://doi.org/10.1371/journal.pbio.1001221
22. Portune KJ, Beaumont M, Davila AM, et al. Gut microbiota role in dietary protein metabolism and health-related outcomes: The two sides of the coin. Trends Food Sci Technol 2016;57:213–32. DOI: https://doi.org/10.1016/j.tifs.2016.08.011
23. Wahlström A, Sayin SI, Marschall HU, Bäckhed F. Intestinal crosstalk between bile acids and microbiota and its impact on host metabolism. Cell Metab 2016;24:41–50. DOI: https://doi.org/10.1016/j.cmet.2016.05.005
24. Round JL, Lee SM, Li J, et al. The Toll-like receptor 2 pathway establishes colonization by a commensal of the human microbiota. Science 2011;332:974–7. DOI: https://doi.org/10.1126/science.1206095
25. Telesford KM, Yan W, Ochoa-Reparaz J, et al. A commensal symbiotic factor derived from Bacteroides fragilis promotes human CD39⁺Foxp3⁺ T cells and Treg function. Gut Microbes 2015;6:234–42. DOI: https://doi.org/10.1080/19490976.2015.1056973
26. Geuking MB, Cahenzli J, Lawson MAE, et al. Intestinal bacterial colonization induces mutualistic regulatory T cell responses. Immunity 2011;34:794–806. DOI: https://doi.org/10.1016/j.immuni.2011.03.021
27. Chiba T, Seno H. Indigenous Clostridium species regulate systemic immune responses by induction of colonic regulatory T cells. Gastroenterology 2011;141:1114–6. DOI: https://doi.org/10.1053/j.gastro.2011.07.013
28. Atarashi K, Tanoue T, Shima T, et al. Induction of colonic regulatory T cells by indigenous Clostridium species. Science 2011;331:337–41. DOI: https://doi.org/10.1126/science.1198469
29. Anderson RC, Cookson AL, McNabb WC, et al. Lactobacillus plantarum DSM 2648 is a potential probiotic that enhances intestinal barrier function. FEMS Microbiol Lett 2010;309:184–92. DOI: https://doi.org/10.1111/j.1574-6968.2010.02038.x
30. Putaala H, Salusjärvi T, Nordström M, et al. Effect of four probiotic strains and Escherichia coli O157:H7 on tight-junction integrity and cyclo-oxygenase expression. Res Microbiol 2008;159:692–8. DOI: https://doi.org/10.1016/j.resmic.2008.08.002
31. Knight R, Vrbanac A, Taylor BC, et al. Best practices for analysing microbiomes. Nat Rev Microbiol 2018;16:410–22. DOI: https://doi.org/10.1038/s41579-018-0029-9
32. Santiago A, Panda S, Mengels G, et al. Processing faecal samples: a step forward for standards in microbial community analysis. BMC Microbiol 2014;14:112. DOI: https://doi.org/10.1186/1471-2180-14-112
33. Cardona S, Eck A, Cassellas M, et al. Storage conditions of intestinal microbiota matter in metagenomic analysis. BMC Microbiol 2012;12:158. DOI: https://doi.org/10.1186/1471-2180-12-158
34. Costea PI, Zeller G, Sunagawa S, et al. Towards standards for human fecal sample processing in metagenomic studies. Nat Biotechnol 2017;35:1069–76. DOI: https://doi.org/10.1038/nbt.3960
35. Clarridge JE. Impact of 16S rRNA gene sequence analysis for identification of bacteria on clinical microbiology and infectious diseases. Clin Microbiol Rev 2004;17:840–62. DOI: https://doi.org/10.1128/CMR.17.4.840-862.2004
36. Metzker ML. Emerging technologies in DNA sequencing. Genome Res 2005;15:1767–76. DOI: https://doi.org/10.1101/gr.3770505
37. Li J, Jia H, Cai X, et al. An integrated catalog of reference genes in the human gut microbiome. Nat Biotechnol 2014;32:834–41. DOI: https://doi.org/10.1038/nbt.2942
38. Almeida A, Nayfach S, Boland M, et al. A unified catalog of 204 938 reference genomes from the human gut microbiome. Nat Biotechnol 2021;39:105–14. DOI: https://doi.org/10.1038/s41587-020-0603-3
39. Hillestad EMR, van der Meeren A, Nagaraja BH, et al. Gut bless you: the microbiota-gut-brain axis in irritable bowel syndrome. World J Gastroenterol 2022;28:412–31. DOI: https://doi.org/10.3748/wjg.v28.i4.412
40. Bauermeister A, Mannochio-Russo H, Costa-Lotufo LV, et al. Mass spectrometry-based metabolomics in microbiome investigations. Nat Rev Microbiol 2022;20:143–60. DOI: https://doi.org/10.1038/s41579-021-00621-9
41. Zeng H, Umar S, Rust B, et al. Secondary bile acids and short chain fatty acids in the colon: a focus on colonic microbiome, cell proliferation, inflammation, and cancer. Int J Mol Sci 2019;20:1214. DOI: https://doi.org/10.3390/ijms20051214
42. Dalile B, Van Oudenhove L, Vervliet B, Verbeke K. The role of short-chain fatty acids in microbiota–gut–brain communication. Nat Rev Gastroenterol Hepatol 2019;16:461–78. DOI: https://doi.org/10.1038/s41575-019-0157-3
43. Agus A, Planchais J, Sokol H. Gut microbiota regulation of tryptophan metabolism in health and disease. Cell Host Microbe 2018;23:716–24.
44. Ahmadi S, Wang S, Nagpal R, et al. A human-origin probiotic cocktail ameliorates aging-related leaky gut and inflammation via modulating the microbiota/taurine/tight junction axis. JCI Insight 2020;5:e132055. DOI: https://doi.org/10.1172/jci.insight.132055
45. Bravo JA, Forsythe P, Chew MV, et al. Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. Proc Natl Acad Sci USA 2011;108:16050–5. DOI: https://doi.org/10.1073/pnas.1102999108
46. Yang Z, Wang Q, Liu Y, et al. Gut microbiota and hypertension: association, mechanisms and treatment. Clin Exp Hypertens 2023;45:2195135. DOI: https://doi.org/10.1080/10641963.2023.2195135
47. Jiang H, Ling Z, Zhang Y, et al. Altered fecal microbiota composition in patients with major depressive disorder. Brain Behav Immun 2015;48:186–94. DOI: https://doi.org/10.1016/j.bbi.2015.03.016
48. McLoughlin RF, Berthon BS, Jensen ME, et al. Short-chain fatty acids, prebiotics, synbiotics, and systemic inflammation: a systematic review and meta-analysis. Am J Clin Nutr 2017;106:930–45. DOI: https://doi.org/10.3945/ajcn.117.156265
49. Larraufie P, Martin-Gallausiaux C, Lapaque N, et al. SCFAs strongly stimulate PYY production in human enteroendocrine cells. Sci Rep 2018;8:74. DOI: https://doi.org/10.1038/s41598-017-18259-0
50. Agus A, Planchais J, Sokol H. Gut microbiota regulation of tryptophan metabolism in health and disease. Cell Host Microbe 2018;23:716–24. DOI: https://doi.org/10.1016/j.chom.2018.05.003
51. Fucarino A, Burgio S, Paladino L, et al. The microbiota is not an organ: introducing the muco-microbiotic layer as a novel morphofunctional structure. Anatomia 2022;1:186–203. DOI: https://doi.org/10.3390/anatomia1020019
52. Cappello F, Saguto D, Burgio S, et al. Does intestine morphology still have secrets to reveal? a proposal about the “ghost” layer of the bowel. Appl Biosci 2022;1:95–100. DOI: https://doi.org/10.3390/applbiosci1010006
53. Mishima Y, Ishihara S. Molecular mechanisms of microbiota-mediated pathology in irritable bowel syndrome. Int J Mol Sci 2020;21:8664. DOI: https://doi.org/10.3390/ijms21228664
54. Duan R, Zhu S, Wang B, Duan L. Alterations of gut microbiota in patients with irritable bowel syndrome based on 16s rrna-targeted sequencing: a systematic review. Clin Transl Gastroenterol 2019;10:e00012. DOI: https://doi.org/10.14309/ctg.0000000000000012
55. Wang L, Alammar N, Singh R, et al. Gut microbial dysbiosis in the irritable bowel syndrome: a systematic review and meta-analysis of case-control studies. J Acad Nutr Diet 2020;120:565–86. DOI: https://doi.org/10.1016/j.jand.2019.05.015
56. Pittayanon R, Lau JT, Yuan Y, et al. Gut microbiota in patients with irritable bowel syndrome—a systematic review. Gastroenterology 2019;157:97–108. DOI: https://doi.org/10.1053/j.gastro.2019.03.049
57. Jacobs JP, Lagishetty V, Hauer MC, et al. Multi-omics profiles of the intestinal microbiome in irritable bowel syndrome and its bowel habit subtypes. Microbiome 2023;11:5. DOI: https://doi.org/10.1186/s40168-022-01450-5
58. Jeffery IB, Das A, O’Herlihy E, et al. Differences in fecal microbiomes and metabolomes of people with vs without irritable bowel syndrome and bile acid malabsorption. Gastroenterology 2020;158:1016-28.e8. DOI: https://doi.org/10.1053/j.gastro.2019.11.301
59. Das A, O’Herlihy E, Shanahan F, et al. The fecal mycobiome in patients with Irritable Bowel Syndrome. Sci Rep 2021;11:124. DOI: https://doi.org/10.1038/s41598-020-79478-6
60. Chassard C, Dapoigny M, Scott KP, et al. Functional dysbiosis within the gut microbiota of patients with constipated-irritable bowel syndrome. Aliment Pharmacol Ther 2012;35:828–38. DOI: https://doi.org/10.1111/j.1365-2036.2012.05007.x
61. Zhu X, Han Y, Du J, et al. Microbiota-gut-brain axis and the central nervous system. Oncotarget 2017;8:53829–38. DOI: https://doi.org/10.18632/oncotarget.17754
62. Martin CR, Osadchiy V, Kalani A, Mayer EA. The brain-gut-microbiome axis. Cell Mol Gastroenterol Hepatol 2018;6:133–48. DOI: https://doi.org/10.1016/j.jcmgh.2018.04.003
63. Cryan JF, O’Riordan KJ, Cowan CSM, et al. The microbiota-gut-brain axis. Physiol Rev 2019;99:1877–2013. DOI: https://doi.org/10.1152/physrev.00018.2018
64. Hill C, Guarner F, Reid G, et al. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol 2014;11:506–14. DOI: https://doi.org/10.1038/nrgastro.2014.66
65. Preidis GA, Weizman AV, Kashyap PC, Morgan RL. AGA technical review on the role of probiotics in the management of gastrointestinal disorders. Gastroenterology 2020;159:708-38.e4.
66. Ford AC, Harris LA, Lacy BE, et al. Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Aliment Pharmacol Ther 2018;48(10):1044–60. DOI: https://doi.org/10.1111/apt.15001
67. Barbaro MR, Bianco F, Cremon C, et al. A probiotic mixture of Lactobacillus rhamnosus LR 32, Bifidobacterium lactis BL 04, and Bifidobacterium longum BB 536 counteracts the increase in permeability induced by the mucosal mediators of irritable bowel syndrome by acting on zonula occludens 1. Int J Mol Sci 2025;26:2656. DOI: https://doi.org/10.3390/ijms26062656
68. Sichetti M, De Marco S, Pagiotti R, et al. Anti-inflammatory effect of multistrain probiotic formulation (L. rhamnosus, B. lactis, and B. longum). Nutrition 2018;53:95–102. DOI: https://doi.org/10.1016/j.nut.2018.02.005
69. di Vito R, Conte C, Traina G. A multi-strain probiotic formulation improves intestinal barrier function by the modulation of tight and adherent junction proteins. Cells 2022;11:2617. DOI: https://doi.org/10.3390/cells11162617
70. di Vito R, Di Mezza A, Conte C, Traina G. The crosstalk between intestinal epithelial cells and mast cells is modulated by the probiotic supplementation in co-culture models. Int J Mol Sci 2023;24:4157. DOI: https://doi.org/10.3390/ijms24044157
71. Santonocito R, Paladino L, Vitale AM, et al. Nanovesicular mediation of the gut-brain axis by probiotics: insights into irritable bowel syndrome. Biology 2024;13:296. DOI: https://doi.org/10.3390/biology13050296
72. Mercer M, Brinich MA, Geller G, et al. How patients view probiotics: findings from a multicenter study of patients with inflammatory bowel disease and irritable bowel syndrome. J Clin Gastroenterol 2012;46:138–44. DOI: https://doi.org/10.1097/MCG.0b013e318225f545
73. Flint HJ, Scott KP, Louis P, Duncan SH. The role of the gut microbiota in nutrition and health. Nat Rev Gastroenterol Hepatol 2012;9:577–89. DOI: https://doi.org/10.1038/nrgastro.2012.156
74. Wilson B, Whelan K. Prebiotic inulin-type fructans and galacto-oligosaccharides: definition, specificity, function, and application in gastrointestinal disorders. J Gastroenterol Hepatol 2017;32:64–8. DOI: https://doi.org/10.1111/jgh.13700
75. Azpiroz F, Dubray C, Bernalier-Donadille A, et al. Effects of scFOS on the composition of fecal microbiota and anxiety in patients with irritable bowel syndrome: a randomized, double blind, placebo controlled study. Neurogastroenterol Motil 2017;29:12911. DOI: https://doi.org/10.1111/nmo.12911
76. Olesen M, Gudmand-Hoyer E. Efficacy, safety, and tolerability of fructooligosaccharides in the treatment of irritable bowel syndrome. Am J Clin Nutr 2000;72:1570–5. DOI: https://doi.org/10.1093/ajcn/72.6.1570
77. Silk DBA, Davis A, Vulevic J, et al. Clinical trial: the effects of a trans-galactooligosaccharide prebiotic on faecal microbiota and symptoms in irritable bowel syndrome. Aliment Pharmacol Ther 2009;29:508–18. DOI: https://doi.org/10.1111/j.1365-2036.2008.03911.x
78. Jamshidi P, Farsi Y, Nariman Z, et al. Fecal microbiota transplantation in irritable bowel syndrome: a systematic review and meta-analysis of randomized controlled trials. Int J Mol Sci 2023;24:14562. DOI: https://doi.org/10.3390/ijms241914562
79. Costantino A, Pessarelli T, Vecchiato M, et al. A practical guide to the proper prescription of physical activity in patients with irritable bowel syndrome. Dig Liver Dis 2022;54:1600–4. DOI: https://doi.org/10.1016/j.dld.2022.08.034
80. Johannesson E, Simrén M, Strid H, et al. Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol 2011;106:915–22. DOI: https://doi.org/10.1038/ajg.2010.480
81. Severo JS, Silva ACA da, Santos BLB Dos, et al. Physical exercise as a therapeutic approach in gastrointestinal diseases. J Clin Med 2025;14:1708. DOI: https://doi.org/10.3390/jcm14051708
82. Staudacher HM, Whelan K. The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS. Gut 2017;66:1517–27. DOI: https://doi.org/10.1136/gutjnl-2017-313750
83. Pessarelli T, Sorge A, Elli L, Costantino A. The low-FODMAP diet and the gluten-free diet in the management of functional abdominal bloating and distension. Front Nutr 2022;9:1007716. DOI: https://doi.org/10.3389/fnut.2022.1007716
84. Balsiger LM, Rusticeanu M, Langhorst J, et al. Review: food-induced mucosal alterations visualized using endomicroscopy. Neurogastroenterol Motil 2025;37:e14930. DOI: https://doi.org/10.1111/nmo.14930
85. Fritscher-Ravens A, Pflaum T, Mösinger M, et al. Many patients with irritable bowel syndrome have atypical food allergies not associated with IgE. Gastroenterology 2019;157:109-118.e5. DOI: https://doi.org/10.1053/j.gastro.2019.03.046
86. Pavan F, Costantino A, Tontini GE, et al. Is IBS a food allergy? Confocal Laser Endomicroscopy findings in patients with IBS: A narrative review. Appl Sci 2025;15:3717. DOI: https://doi.org/10.3390/app15073717
87. Costantino A, Aversano GM, Lasagni G, et al. Diagnostic management of patients reporting symptoms after wheat ingestion. Front Nutr 2022;9:1007007. DOI: https://doi.org/10.3389/fnut.2022.1007007
88. Hanna-Jairala I, Drossman DA. Central neuromodulators in irritable bowel syndrome: why, how, and when. Am J Gastroenterol 2024;119:1272–84. DOI: https://doi.org/10.14309/ajg.0000000000002800
89. Ford AC, Wright-Hughes A, Alderson SL, et al. Amitriptyline at low dose and titrated for irritable bowel syndrome as second-line treatment in primary care (ATLANTIS): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2023;402:1773–85. DOI: https://doi.org/10.1016/S0140-6736(23)01523-4
90. Ford AC, Lacy BE, Harris LA, et al. Effect of antidepressants and psychological therapies in irritable bowel syndrome: an updated systematic review and meta-analysis. Am J Gastroenterol 2019;114:21–39. DOI: https://doi.org/10.1038/s41395-018-0222-5
91. Gaylord SA, Palsson OS, Garland EL, et al. Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial. Am J Gastroenterol 2011;106:1678–88. DOI: https://doi.org/10.1038/ajg.2011.184
92. Naliboff BD, Smith SR, Serpa JG, et al. Mindfulness-based stress reduction improves irritable bowel syndrome (IBS) symptoms via specific aspects of mindfulness. Neurogastroenterol Motil 2020;32:e13828. DOI: https://doi.org/10.1111/nmo.13828
93. Radziwon CD, Lackner JM. Cognitive behavioral therapy for IBS: how useful, how often, and how does it work? Curr Gastroenterol Rep 2017;19:49. DOI: https://doi.org/10.1007/s11894-017-0590-9
94. El-Salhy M, Hatlebakk JG, Gilja OH, et al. Efficacy of faecal microbiota transplantation for patients with irritable bowel syndrome in a randomised, double-blind, placebo-controlled study. Gut 2020;69:859–67. DOI: https://doi.org/10.1136/gutjnl-2019-319630
95. El-Salhy M, Winkel R, Casen C, et al. Efficacy of fecal microbiota transplantation for patients with irritable bowel syndrome at 3 years after transplantation. Gastroenterology 2022;163:982-94.e14. DOI: https://doi.org/10.1053/j.gastro.2022.06.020
96. Cammarota G, Pecere S, Ianiro G, et al. Principles of DNA-based gut microbiota assessment and therapeutic efficacy of fecal microbiota transplantation in gastrointestinal diseases. Dig Dis 2016;34:279–85. DOI: https://doi.org/10.1159/000443362
97. Bhagavathula AS, Al Qady AM, Aldhaleei WA. Diagnostic accuracy and quality of artificial intelligence models in irritable bowel syndrome: A systematic review. World J Gastroenterol 2025;31:106836. DOI: https://doi.org/10.3748/wjg.v31.i23.106836
98. Su Q, Liu Q, Lau RI, et al. Faecal microbiome-based machine learning for multi-class disease diagnosis. Nat Commun 2022;13:6818. DOI: https://doi.org/10.1038/s41467-022-34405-3
99. Karakan T, Gundogdu A, Alagözlü H, et al. Artificial intelligence-based personalized diet: a pilot clinical study for irritable bowel syndrome. Gut Microbes 2022;14:2138672. DOI: https://doi.org/10.1080/19490976.2022.2138672
100. Tunali V, Arslan NÇ, Ermiş BH, et al. A multicenter randomized controlled trial of microbiome-based artificial intelligence-assisted personalized diet vs low-FODMAP diet: a novel approach for the management of irritable bowel syndrome. Am J Gastroenterol 2024;119:1901–12. DOI: https://doi.org/10.14309/ajg.0000000000002862
101. Rodiño-Janeiro BK, Vicario M, Alonso-Cotoner C, et al. A review of microbiota and irritable bowel syndrome: future in therapies. Adv Ther 2018;35:289–310. DOI: https://doi.org/10.1007/s12325-018-0673-5
102. Preidis GA, Weizman AV, Kashyap PC, Morgan RL. AGA technical review on the role of probiotics in the management of gastrointestinal disorders. Gastroenterology 2020;159:708-38.e4. DOI: https://doi.org/10.1053/j.gastro.2020.05.060
103. Su GL, Ko CW, Bercik P, et al. AGA clinical practice guidelines on the role of probiotics in the management of gastrointestinal disorders. Gastroenterology 2020;159:697–705. DOI: https://doi.org/10.1053/j.gastro.2020.05.059
104. Moayyedi P, Ford AC, Talley NJ, et al. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut 2010;59:325–32. DOI: https://doi.org/10.1136/gut.2008.167270
105. Wu Y, Li Y, Zheng Q, Li L. The efficacy of probiotics, prebiotics, synbiotics, and fecal microbiota transplantation in irritable bowel syndrome: a systematic review and network meta-analysis. Nutrients 2024;16:2114. DOI: https://doi.org/10.3390/nu16132114
106. Zhang WX, Shi LB, Zhou MS, et al. Efficacy of probiotics, prebiotics and synbiotics in irritable bowel syndrome: a systematic review and meta-analysis of randomized, double-blind, placebo-controlled trials. J Med Microbiol 2023;72:1758. DOI: https://doi.org/10.1099/jmm.0.001758
107. Xie P, Luo M, Deng X, et al. Outcome-specific efficacy of different probiotic strains and mixtures in irritable bowel syndrome: a systematic review and network meta-analysis. Nutrients. 2023;15:3856. DOI: https://doi.org/10.3390/nu15173856
108. Goodoory VC, Ford AC. Antibiotics and probiotics for irritable bowel syndrome. Drugs 2023;83:687–99. DOI: https://doi.org/10.1007/s40265-023-01871-y
109. Ceccherini C, Daniotti S, Bearzi C, Re I. Evaluating the efficacy of probiotics in IBS treatment using a systematic review of clinical trials and multi-criteria decision analysis. Nutrients 2022;14:2689. DOI: https://doi.org/10.3390/nu14132689
110. Lacy BE, Pimentel M, Brenner DM, et al. ACG clinical guideline: management of irritable bowel syndrome. Am J Gastroenterol 2021;116:17–44. DOI: https://doi.org/10.14309/ajg.0000000000001036

How to Cite



Microbiota-gut-brain axis: towards a microbiota-centred approach for irritable bowel syndrome. (2025). Journal of Biological Research - Bollettino Della Società Italiana Di Biologia Sperimentale, 98(2). https://doi.org/10.4081/jbr.2025.13873
Copyright (c) 2025 the Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.