Alterations in Intestinal Microbial Flora and Human Disease

Mohamed Othman; Roberto Agüero; Henry C. Lin

Disclosures

Curr Opin Gastroenterol. 2008;24(1):11-16. 

In This Article

Bacterial Antigens and Hypersensitivity in Fibromyalgia

Animal studies suggest a relationship between bacterial toxins and hypersensitivity. In a rat model, exposure to endotoxin resulted in local inflammation and hyperalgesia.[60] Similarly, exposure to lipopolysaccharide induced visceral hypersensitivity in rats.[61] Although the mechanism of endotoxin-induced hyperalgesia is not completely understood, a recent animal study demonstrated that exposure to endotoxin increased the production of prostaglandins and simultaneously decreased nitrous oxide production, resulting in inflammatory hyperalgesia.[62]

Fibromyalgia, a condition of musculoskeletal hypersensitivity, provides us with a fascinating model on the link between gut bacteria and somatic hypersensitivity. Between 30 and 75% of patients with fibromyalgia also have symptoms meeting the criteria for IBS.[63] Somatic hypersensitivity was demonstrated in IBS and fibromyalgia patients, suggesting that somatic hypersensitivity could be a common feature of the two disorders.[64] The role of gut microbes in fibromyalgia is suggested by the finding that of 42 patients with the condition, all of them tested positive for hydrogen/methane production, as determined by LBT, a finding similar to a previous study in IBS in which 84% of patients had an abnormal LBT.[27,65] These observations suggest that SIBO is a common feature in both disorders and that altered gut microbiota in SIBO may play a role in the induction of somatic or visceral hypersensitivity, with affected patients meeting the diagnostic criteria for IBS, fibromyalgia or both disorders.[65]

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