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What are the Causes of Irritable Bowel Syndrome (IBS)?

The causes of IBS are not well understood. Current and emerging research suggests bacterial imbalances in the intestine, infection, genetics, altered nutrient absorption and metabolism, brain-gut signaling, hypersensitivity, inflammation, GI motility, and psychological state may all play a role in the emergence of symptoms in patients.1

Changes in diet have been shown to alter the bacterial content of the intestines, also known as microbiota.2 By feeding bacteria with their diet, a patient increases and stabilizes bacterial numbers in the intestine. Changes in the microbiota in IBS-D patients can also occur with infection, known as bacterial gastroenteritis.3 These changes in bacterial populations can be long lasting and are directly associated with the onset of chronic symptoms in IBS-D.

There is evidence that changes in microbiota due to post-infectious IBS-D can effect levels and response to serotonin (provides feelings of well-being and affects motility) which are associated with abdominal discomfort, brain-gut signaling, hypersensitivity, and diarrhea.4-6 Interestingly, mutations in genes involved in the production of metabolites from tryptophan, the starting material to make serotonin, are particularly associated with IBS-D.7 Altered tryptophan metabolism in IBS-D patients leads to the production of chemical agents released from the intestinal mucosa into circulation that change the psychological state in IBS-D patients.8,9 Indeed, changes in microbiota can also effect tryptophan metabolism altering mood and psychological state.10 Finally, there are gene mutations that effect the synthesis, metabolism, and reabsorption of bile acids that alter motility.11

  1. Irritable Bowel Syndrome. 7/31/2013.
  2. Clemente JC et al. The impact of the gut microbiota on human health: an integrative view. Cell. 2012 Mar 16;148(6):1258-70.
  3. Ohman L, Simrén M. Intestinal microbiota and its role in irritable bowel syndrome (IBS). Curr Gastroenterol Rep. 2013 May;15(5):323. doi: 10.1007/s11894-013-0323-7.
  4. Coates MD, Mahoney CR, Linden DR, et al. Molecular defects in mucosal serotonin content and decreased serotonin reuptake transporterin ulcerative colitis and irritable bowel syndrome. Gastroenterol 2004;126:1657-1664.
  5. Foley S, Garsed K, Singh G, et al. Impaired uptake of serotonin by platelets from patients with irritable bowel syndrome correlates with duodenal immune activation. Gastroenterol 2011;140:1434-1443.
  6. Faure et al. Serotonin signaling is altered in irritable bowel syndrome with diarrhea but not in functional dyspepsia in pediatric age patients. Gastroenterol. 2010;139(1):249-58.
  7. Saito YA. The role of genetics in IBS. Gastroenterol Clin North America 2011;40(1):45-67.
  8. Clarke et al. Tryptophan degradation in irritable bowel syndrome: evidence of indoleamine 2,3-dioxygenase activation in a male cohort. BMC Gastroenterol. 2009 Jan 20;9:6.
  9. Keszthelyi D. Decreased levels of kynurenic acid in the intestinal mucosa of IBS patients: relation to serotonin and psychological state. J Psychosom Res. 2013;74(6):501-4.
  10. Forsythe P, Sudo N, Dinan T, Taylor VH, Bienenstock J. Mood and gut feelings. liain Behav Immun 2010;24:9-16.
  11. Wong BS, et al. Increased bile acid biosynthesis is associated with irritable bowel syndrome with diarrhea. Clinical Gastroenterology and Hepatology: The official clinical practice journal of the American Gastroenterological Association. 2012;10(9):1009-15 e3.

Intended Use

EnteraGam® is a medical food product intended for the dietary management of chronic diarrhea and loose stools. EnteraGam® must be administered under medical supervision.

Important Safety Information:

EnteraGam® contains beef protein: therefore, patients who have an allergy to beef or any other component of EnteraGam® should not take this product. EnteraGam® has not been studied in pregnant women, in women during labor and delivery, or in nursing mothers. The choice to administer EnteraGam® during pregnancy, labor and delivery, or to nursing mothers is at the clinical discretion of the prescribing physician.

EnteraGam® does not contain any milk-derived ingredients such as lactose, casein, or whey. EnteraGam® is gluten-free, dye-free, and soy-free.

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To report suspected adverse reactions, contact Entera Health, Inc. at 1-855-4ENTERA (1-855-436-8372), or the FDA at 1-800-FDA-1088 (1-800-332-1088) or