Irritable bowel syndrome, urolithiasis and role of microbiota in their comorbidity

Abstract

Urolithiasis (UL) is a polyetiological disease that depends on climate, age, diet, infections, and the presence of concomitant diseases. The major risk factors for UL include inflammatory and functional bowel disease. The aim was analysis of changes in the bowel microbiota in patients with UL combined with Irritable Bowel Syndrome (IBS), as well as the effect of microbiome correction on the recurrence rates of oxalate UL in these patients. Material and Methods: We selected 320 patients with UL with oxalate stones and concomitant IBS. Small Intestinal Bacterial Overgrowth (SIBO) was assessed in all patients and microbiome analisis was performed. Patients has 3 year observation period. A breath test for SIBO was performed every 6 months. The determination of various taxa of fecal microbiota was carried out. Patients with UL+IBS were randomly divided into 2 groups. Group I involved 120 patients who were prescribed with rifaximin. Group II-control, involved 200 patients. Results: Initially, in patients with UL+IBS, the incidence of SIBO detection was 65%. The study of microbiome phylotypes has found the significant decrease in Firmicutes as well as Akkermansia muciniphila in patients with IBS-related oxalate UL. After 6 months SIBO in patients of Group I was positive in 54 (46.6%) patients, but following 3 years 15 (12.9%) patients. In Group II, following 6 months there were 123 (63.7%) patients with SIBO, following 3 years 149 (77.2%) patients. And after 3 years we found a significant decrease in the relative risk of recurrence of UL to 0.608 in Group I. Conclusions: Patients with UL have symptoms of IBS in 19.5% of cases. SIBO was diagnosed by 5.2 times more often in UL combined with IBS. Repeated courses of rifaximin, every 6 months, in patients with SIBO and persistent symptoms of IBS were accompanied by a significant decrease in recurrences of UL.