Study Finds Irritable Bowel Syndrome is Endoscopically Identifiable, Offering New Opportunities for Diagnosis


Investigators identified 2 subgroups at risk of developing bacterial biofilms: those who have taken a significant amount of medications over their lifetimes and those who have undergone organ transplants.

Researchers in Austria have found that, in most cases, irritable bowel syndrome (IBS) is associated with bacterial biofilms in the gut that are visible under endoscopic examination, according to a press release from the Medical University of Vienna.

Although IBS is a relatively common illness, it is only possible to diagnose by process of elimination using currently available techniques. Diagnosis is further complicated because many people suffering from IBS only go to their physician when they have severe symptoms, such as constipation, diarrhea, abdominal pain, or changes in bowel motion.

“For the first time, we have managed to identify a cause of irritable bowel syndrome and, at the same time, show how this disease can be more accurately diagnosed, classified, and assessed,” said study leader Chrisoph Gasche, head of the Laboratory for Molecular Gastroenterology at Medical University of Vienna, in a press release.

According to their findings, taking a significant amount of medications over the course of a lifetime can disrupt the balance of the gut flora, resulting in a higher risk of bacterial biofilms. In addition to this subgroup of IBS patients, the researchers identified patients who have previously had organ transplants.

“Certain drugs, such as proton pump inhibitors, can upset the balance of the bacterial ecosystem,” Gasche said in the press release. “The bacteria then go into survival mode. To give themselves a better chance of surviving this stress, they band together for safety and form biofilms, a sort of protective space that makes them resistant to antibiotics and other environmental toxins.”

More than 1000 colonoscopies were performed as part of the multi-center study, which showed that two-thirds of those who had IBS symptoms also had biofilms in their small or large intestine. Notably, however, these mucosal biofilms are also found in one-third of patients with ulcerative colitis.

This bacterial matrix can be either reticular or planar and adheres like a thin layer of the mucosal lining of the gut, according to the study. The investigators compared it to dental plaque, and said it impairs the functions of the gut.

“Up until now, it has always been assumed in investigations that this sticky film is made up of residues of impurities in the gut, which were difficult to eliminate,” Gasche explained in the press release. “However, we have now been able to show that this is where the bacterial matrix adheres.”

In many cases, the researchers said it is possible to wash away these biofilms in the large intestine with the use of an endoscopic “spray gun.” Future research will investigate whether this improves the symptoms of IBS, although the researchers said this technique cannot be used to remove biofilms from the small intestine.


Irritable Bowel Syndrome Endoscopically Identifiable for the First Time from Mucosal Biofilms. News release. Medical University of Vienna. June 18, 2021. Accessed June 22, 2021.

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