Volume 87, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



The role of in irritable bowel syndrome (IBS) is incompletely known. We aimed to investigate whether eradication of alleviates symptoms in IBS. Twenty-five positive IBS patients were treated with Metronidazole (MZ) or Tetracycline. The patients were mostly female (89%), and mean age (SD) was 35.1 (8.2) years. Microbiological response, evaluated 2 weeks post-treatment, was observed in 15 of 25 patients (60%), all by MZ. Clinical response, defined as adequate relief of symptoms, was observed in 7 of 22 patients (32%), all by MZ. In a logistic regression analysis, we found no significant association between clinical and microbiological response. This case study did not support our hypothesis of a simple association between and IBS. Some -infections were insufficiently treated by MZ. Further studies into the prevalence and effect of eradication of in IBS and into efficient treatments of are warranted.


Article metrics loading...

Loading full text...

Full text loading...



  1. Choung RS, Locke GR, III, 2011. Epidemiology of IBS. Gastroenterol Clin North Am 40: 110.[Crossref]
  2. Spiegel BM, , 2009. The burden of IBS: looking at metrics. Curr Gastroenterol Rep 11: 265269.[Crossref]
  3. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC, , 2006. Functional bowel disorders. Gastroenterology 130: 14801491.[Crossref]
  4. El-Serag HB, Olden K, Bjorkman D, , 2002. Health-related quality of life among persons with irritable bowel syndrome: a systematic review. Aliment Pharmacol Ther 16: 11711185.[Crossref]
  5. Agarwal N, Spiegel BM, , 2011. The effect of irritable bowel syndrome on health-related quality of life and health care expenditures. Gastroenterol Clin North Am 40: 1119.[Crossref]
  6. Quigley EM, Bergman F, Bytzer P, Fried M, Hunt M, Hungin AP, , 2007. Systematic review on the management of irritable bowel syndrome in the European Union. Eur J Gastroenterol Hepatol 19: S11S37.[Crossref]
  7. Quigley EM, Bytzer P, Jones R, Mearin F, , 2006. Irritable bowel syndrome: the burden and unmet needs in Europe. Dig Liver Dis 38: 717723.[Crossref]
  8. Thabane M, Kottachchi DT, Marshall JK, , 2007. Systematic review and meta-analysis: the incidence and prognosis of post-infectious irritable bowel syndrome. Aliment Pharmacol Ther 26: 535544.[Crossref]
  9. Ghoshal UC, Ranjan P, , 2011. Post-infectious irritable bowel syndrome: the past, the present and the future. J Gastroenterol Hepatol 26 (Suppl 3): 94101.[Crossref]
  10. Jeffery IB, O'Toole PW, Ohman L, Claesson MJ, Deane J, Quigley EM, Simren M, , 2011. An irritable bowel syndrome subtype defined by species-specific alterations in fecal microbiota. Gut 61: 9971006.[Crossref]
  11. Salonen A, de Vos WM, Palva A, , 2010. Gastrointestinal microbiota in irritable bowel syndrome: present state and perspectives. Microbiology 156: 32053215.[Crossref]
  12. Rajilic-Stojanovic M, Biagi E, Heilig HG, Kajander K, Kekkonen RA, Tims S, de Vos WM, , 2011. Global and deep molecular analysis of microbiota signatures in fecal samples from patients with irritable bowel syndrome. Gastroenterology 141: 17921801.[Crossref]
  13. Tana C, Umesaki Y, Imaoka A, Handa T, Kanazawa M, Fukudo S, , 2010. Altered profiles of intestinal microbiota and organic acids may be the origin of symptoms in irritable bowel syndrome. Neurogastroenterol Motil 22: 512515.
  14. Brenner DM, Moeller MJ, Chey WD, Schoenfeld PS, , 2009. The utility of probiotics in the treatment of irritable bowel syndrome: a systematic review. Am J Gastroenterol 104: 10331049.[Crossref]
  15. Majewski M, McCallum RW, , 2007. Results of small intestinal bacterial overgrowth testing in irritable bowel syndrome patients: clinical profiles and effects of antibiotic trial. Adv Med Sci 52: 139142.
  16. Pimentel M, Chow EJ, Lin HC, , 2003. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome. a double-blind, randomized, placebo-controlled study. Am J Gastroenterol 98: 412419.
  17. Pimentel M, Park S, Mirocha J, Kane SV, Kong Y, , 2006. The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial. Ann Intern Med 145: 557563.[Crossref]
  18. Pimentel M, Chatterjee S, Chow EJ, Park S, Kong Y, , 2006. Neomycin improves constipation-predominant irritable bowel syndrome in a fashion that is dependent on the presence of methane gas: subanalysis of a double-blind randomized controlled study. Dig Dis Sci 51: 12971301.[Crossref]
  19. Pimentel M, Lembo A, Chey WD, Zakko S, Ringel Y, Yu J, Mareya SM, Shaw AL, Bortey E, Forbes WP, , 2011. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med 364: 2232.[Crossref]
  20. Esposito I, de Leone A, Di Gregorio S, Giaquinto S, de Magistris L, Ferrieri A, Riegler G, , 2007. Breath test for differential diagnosis between small intestinal bacterial overgrowth and irritable bowel disease: an observation on non-absorbable antibiotics. World J Gastroenterol 13: 60166021.[Crossref]
  21. Menees SB, Maneerattannaporn M, Kim HM, Chey WD, , 2012. The efficacy and safety of rifaximin for the irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol 107: 2835.[Crossref]
  22. Sharara AI, Aoun E, Abdul-Baki H, Mounzer R, Sidani S, Elhajj I, , 2006. A randomized double-blind placebo-controlled trial of rifaximin in patients with abdominal bloating and flatulence. Am J Gastroenterol 101: 326333.[Crossref]
  23. Barratt JL, Harkness J, Marriott D, Ellis JT, Stark D, , 2011. A review of Dientamoeba fragilis carriage in humans: several reasons why this organism should be considered in the diagnosis of gastrointestinal illness. Gut Microbes 2: 312.[Crossref]
  24. Stark D, Barratt J, Roberts T, Marriott D, Harkness J, Ellis J, , 2010. A review of the clinical presentation of dientamoebiasis. Am J Trop Med Hyg 82: 614619.[Crossref]
  25. Lagace-Wiens PR, VanCaeseele PG, Koschik C, , 2006. Dientamoeba fragilis: an emerging role in intestinal disease. CMAJ 175: 468469.[Crossref]
  26. Johnson EH, Windsor JJ, Clark CG, , 2004. Emerging from obscurity: biological, clinical, and diagnostic aspects of Dientamoeba fragilis . Clin Microbiol Rev 17: 553570.[Crossref]
  27. Stensvold CR, Lewis HC, Hammerum AM, Porsbo LJ, Nielsen SS, Olsen KE, Arendrup MC, Nielsen HV, Molbak K, , 2009. Blastocystis: unravelling potential risk factors and clinical significance of a common but neglected parasite. Epidemiol Infect 137: 16551663.[Crossref]
  28. de Wit MA, Koopmans MP, Kortbeek LM, van Leeuwen NJ, Vinje J, van Duynhoven YT, , 2001. Etiology of gastroenteritis in sentinel general practices in the Netherlands. Clin Infect Dis 33: 280288.[Crossref]
  29. Stark D, van Hal S, Marriott D, Ellis J, Harkness J, , 2007. Irritable bowel syndrome: a review on the role of intestinal protozoa and the importance of their detection and diagnosis. Int J Parasitol 37: 1120.[Crossref]
  30. Stark D, Beebe N, Marriott D, Ellis J, Harkness J, , 2005. Prospective study of the prevalence, genotyping, and clinical relevance of Dientamoeba fragilis infections in an Australian population. J Clin Microbiol 43: 27182723.[Crossref]
  31. Girginkardesler N, Coskun S, Cüneyt Balcioğlu I, Ertan P, Ok UZ, , 2003. Dientamoeba fragilis, a neglected cause of diarrhea, successfully treated with secnidazole. Clin Microbiol Infect 9: 110113.[Crossref]
  32. Colea A, Silard R, Panaitescu D, Florescu P, Roman N, Capraru T, , 1980. Studies on Dientamoeba fragilis in Romania. II. Incidence of Dientamoeba fragilis in healthy persons. Arch Roum Pathol Exp Microbiol 39: 4953.
  33. Borody TJ, Warren EF, Wettstein A, Robertson G, Recabarren P, Fontela A, Herdman K, Surace R, , 2002. Eradication of Dientamoeba fragilis can resolve IBS-like symptoms. J Gastroenterol Hepatol 17: A103.[Crossref]
  34. Stark DJ, Beebe N, Marriott D, Ellis JT, Harkness J, , 2006. Dientamoebiasis: clinical importance and recent advances. Trends Parasitol 22: 9296.[Crossref]
  35. Yakoob J, Jafri W, Beg MA, Abbas Z, Naz S, Islam M, Khan R, , 2010. Blastocystis hominis and Dientamoeba fragilis in patients fulfilling irritable bowel syndrome criteria. Parasitol Res 107: 679684.[Crossref]
  36. Jimenez-Gonzalez DE, Martinez-Flores WA, Reyes-Gordillo J, Ramirez-Miranda ME, Arroyo-Escalante S, Romero-Valdovinos M, Stark D, Souza-Saldivar V, Martinez-Hernandez F, Flisser A, Olivo-Diaz A, Maravilla P, , 2012. Blastocystis infection is associated with irritable bowel syndrome in a Mexican patient population. Parasitol Res 110: 12691275.[Crossref]
  37. Engsbro AL, Bytzer P, , 2011. Diagnostic strategies in patients suspected of irritable bowel syndrome. Gut 60 (Suppl 3): A58.
  38. Stensvold CR, Arendrup MC, Jespersgaard C, Molbak K, Nielsen HV, , 2007. Detecting Blastocystis using parasitologic and DNA-based methods: a comparative study. Diagn Microbiol Infect Dis 59: 303307.[Crossref]
  39. Stensvold CR, Nielsen SD, Badsberg JH, Engberg J, Friis-Moller N, Nielsen SS, Nielsen HV, Friis-Moller A, , 2011. The prevalence and clinical significance of intestinal parasites in HIV-infected patients in Denmark. Scand J Infect Dis 43: 129135.[Crossref]
  40. Camilleri M, Mangel AW, Fehnel SE, Drossman DA, Mayer EA, Talley NJ, , 2007. Primary endpoints for irritable bowel syndrome trials: a review of performance of endpoints. Clin Gastroenterol Hepatol 5: 534540.[Crossref]
  41. Nagata N, Marriott D, Harkness J, Ellis JT, Stark D, , 2012. In vitro susceptibility testing of Dientamoeba fragilis . Antimicrob Agents Chemother 56: 487494.[Crossref]
  42. Verweij JJ, Mulder B, Poell B, van Middelkoop D, Brienen EA, van Lieshout L, , 2007. Real-time PCR for the detection of Dientamoeba fragilis in fecal samples. Mol Cell Probes 21: 400404.[Crossref]
  43. Yang J, Scholten T, , 1977. Dientamoeba fragilis: a review with notes on its epidemiology, pathogenicity, mode of transmission, and diagnosis. Am J Trop Med Hyg 26: 1622.
  44. Cuffari C, Oligny L, Seidman EG, , 1998. Dientamoeba fragilis masquerading as allergic colitis. J Pediatr Gastroenterol Nutr 26: 1620.[Crossref]
  45. Kurt O, Girginkardesler N, Balcioglu IC, Ozbilgin A, Ok UZ, , 2008. A comparison of metronidazole and single-dose ornidazole for the treatment of dientamoebiasis. Clin Microbiol Infect 14: 601604.[Crossref]
  46. Oxner RB, Paltridge GP, Chapman BA, Cook HB, Sheppard PF, , 1987. Dientamoeba fragilis: a bowel pathogen? N Z Med J 100: 6465.
  47. Preiss U, Ockert G, Broemme S, Otto A, , 1991. On the clinical importance of Dientamoeba fragilis infections in childhood. J Hyg Epidemiol Microbiol Immunol 35: 2734.
  48. Camilleri M, Mangel AW, Fehnel SE, Drossman DA, Mayer EA, Talley NJ, , 2007. Primary endpoints for irritable bowel syndrome trials: a review of performance of endpoints. Clin Gastroenterol Hepatol 5: 534540.[Crossref]
  49. Spiegel B, Camilleri M, Bolus R, Andresen V, Chey WD, Fehnel S, Mangel A, Talley NJ, Whitehead WE, , 2009. Psychometric evaluation of patient-reported outcomes in irritable bowel syndrome randomized controlled trials: a Rome Foundation report. Gastroenterology 137: 19441953.[Crossref]
  50. Mangel AW, Bornstein JD, Hamm LR, Buda J, Wang J, Irish W, Urso D, , 2008. Clinical trial: asimadoline in the treatment of patients with irritable bowel syndrome. Aliment Pharmacol Ther 28: 239249.[Crossref]
  51. Chang L, Ameen VZ, Dukes GE, McSorley DJ, Carter EG, Mayer EA, , 2005. A dose-ranging, phase II study of the efficacy and safety of alosetron in men with diarrhea-predominant IBS. Am J Gastroenterol 100: 115123.[Crossref]
  52. Drossman DA, Danilewitz M, Naesdal J, Hwang C, Adler J, Silberg DG, , 2008. Randomized, double-blind, placebo-controlled trial of the 5-HT1A receptor antagonist AZD7371 tartrate monohydrate (robalzotan tartrate monohydrate) in patients with irritable bowel syndrome. Am J Gastroenterol 103: 25622569.[Crossref]
  53. Bosman DK, Benninga MA, van de Berg P, Kooijman GC, van Gool T, , 2004. Dientamoeba fragilis: possibly an important cause of persistent abdominal pain in children. Ned Tijdschr Geneeskd 148: 575579.
  54. Butler WP, , 1996. Dientamoeba fragilis. An unusual intestinal pathogen. Dig Dis Sci 41: 18111813.[Crossref]
  55. Dardick KR, , 1983. Tetracycline treatment of Dientamoeba fragilis . Conn Med 47: 6970.
  56. Millet V, Spencer MJ, Chapin M, Stewart M, Yatabe JA, Brewer T, Garcia LS, , 1983. Dientamoeba fragilis, a protozoan parasite in adult members of a semicommunal group. Dig Dis Sci 28: 335339.[Crossref]
  57. Norberg A, Nord CE, Evengard B, , 2003. Dientamoeba fragilis–a protozoal infection which may cause severe bowel distress. Clin Microbiol Infect 9: 6568.[Crossref]
  58. Spencer MJ, Garcia LS, Chapin MR, , 1979. Dientamoeba fragilis. An intestinal pathogen in children? Am J Dis Child 133: 390393.[Crossref]
  59. Spencer MJ, Chapin MR, Garcia LS, , 1982. Dientamoeba fragilis: a gastrointestinal protozoan infection in adults. Am J Gastroenterol 77: 565569.
  60. Vandenberg O, Souayah H, Mouchet F, Dediste A, van Gool T, , 2007. Treatment of Dientamoeba fragilis infection with paromomycin. Pediatr Infect Dis J 26: 8890.[Crossref]

Data & Media loading...

  • Received : 06 Dec 2011
  • Accepted : 09 Sep 2012

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error