From IBS to ME – The dysbiotic march hypothesis, by Arnold Berstad, Olav Hauso, Ketil Berstad, Johanna ER Berstad in Medical Hypotheses Vol 140, July 2020, 109648 [https://doi.org/10.1016/j.mehy.2020.109648]

Research abstract:

Irritable bowel syndrome (IBS) is often associated with other unexplained complaints like chronic fatigue syndrome (CFS), fibromyalgia and myalgic encephalopathy (ME). The pathogenesis of the relationship is unknown.

Intestinal dysbiosis may be a common abnormality, but based on 1100 consecutive IBS patients examined over a nine years period, we hypothesize that the development of the disease, often from IBS to ME, actually manifests a “dysbiotic march”.

In analogy with “the atopic march” in allergic diseases, we suggest “a dysbiotic march” in IBS; initiated by extensive use of antibiotics during childhood, often before school age. Various abdominal complaints including IBS may develop soon thereafter, while systemic symptom like CFS, fibromyalgia and ME may appear years later.

Conclusion:

The main findings among 1100 consecutive patients with IBS are an extensive past medical history (on average 26 years), during which 80%–90% of the patients, in addition to IBS, developed joint/muscle pain and chronic fatigue, and 65% developed ME. The vast majority of the 200 patients (86%) who were asked, reported extensive treatment with antibiotics during childhood. The observations suggest that IBS and subsequent comorbidities represent “a dysbiotic march” in response to antibiotic-induced “missing microbes”

Hence, our hypothesis is that «the dysbiotic march” begins with antibiotic-induced “missing microbes”, via abdominal discomfort, food intolerance and IBS, then years later, joint/muscle pain and chronic fatigue may develop and ultimately progress to ME. The progress of the disease, i.e. the march from IBS to ME, may well be due to new microbes or other infectious agents invading and conquering the biofilm to exploit its growth conditions.