Irritable Bowel Syndrome Treatment Probiotics

Which Probiotics Species Are Best

Its difficult for IBS researchers to pinpoint just how effective probiotics are.

This is due to differences in study design, patient populations, probiotics strains and dosages used of previous clinical trials.

Generally speaking, there is emerging evidence that probiotics help to improve overall symptom response and quality of life compared to taking a dummy pill over an 8-10 week period. This goes for all type of IBS .

However, they appear less effective for specifically treating abdominal pain, excessive gas and bloating .

At the 2015 Yale University workshop, two particular probiotic varieties were identified as the best options for IBS :

• Bifantis : a group of bacteria that normally live in the intestines, but specifically the strain 35624. Its reported many people are missing this strain from their gut
• VSL#3: a probiotic mixture of eight strains .

As you can see in the the table here, the strains Lactobacillus plantarum 299V and Bifidobacterium animalis were also rated, although not as highly.

A list of probiotic strains rated for effectiveness in IBS at the 2011 and 2015 Yale University Workshops. Click to enlarge.

Note that recommendations are given as A, B or C ratings. None of the probiotic recommendations for IBS are rated A because more studies are needed first.

Summary: In 2011 Yale university rated Bifidobacterium infantis and VSL#3 as the best probiotics for IBS. Lactobacillus plantarum and Bifidobacterium animalis may also be useful.

Search Strategy And Selection Criteria

We included all eligible randomized placebo-controlled, trials of probiotics treatment in adult IBS. We searched Medline, Embase, the Cochrane Central Register of Controlled Trials, the ClinicalTrials.gov trials register, and Chinese Biomedical Literature Database for relevant trials. We used the terms probiotics and irritable bowel syndrome both as medical subject heading and free text terms. The exact search strategy in Medline was AND AND .

We used the following eligibility criteria: the studies were randomized controlled trials comparing probiotics with placebo diagnostic criteria included but were not limited to the Manning criteria, and Rome I, Rome II, or Rome III criteria. We did not exclude trials in which patients were stated to be diagnosed with IBS but no diagnostic criteria were described the age of participants were 18 years minimum treatment duration was 7 days. Studies were excluded if they met: studies with inadequate information probiotics along with other drugs control group was not placebo data were not available after contacting the authors. There were no language limitation. Articles in foreign language were translated as needed.

Data Extraction And Risk Of Bias

Two authors independently extracted the following information from each study: author, year of publication, country, sample size, age of patients, subtypes of IBS, comparison, and treatment details .

Two authors evaluated the risk of bias for each included RCT with the help of measures displayed in the Cochrane Handbook for Systematic Reviewers , which includes seven indicators: 1) random sequence generation , 2) allocation concealment , 3) blinding of patients and personnel , 4) blinding of outcome assessment , 5) incomplete outcome data , 6) selective reporting , and 7) other bias. Each indicator contained three levels: low risk, unclear risk, or high risk of bias.

If there were any inconsistencies or disagreements in the process of data extraction and quality assessment, the two authors discussed these issues or an independent expert in this field was consulted to reach a consensus.

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Efficacy Of Probiotics On Individual Symptom Scores

Twenty-nine trials reported continuous data for the effect of probiotics on bloating scores in 3,496 patients. Probiotics had effect on improving bloating and heterogeneity was found . In the subgroup of probiotics duration, 19 comparisons using a short treatment duration were found a significant benefit over placebo . Low heterogeneity was detected .There was a beneficial effect on bloating in 22 comparisons using high dose .Low heterogeneity among trials was discovered .The funnel plot suggested the existence of asymmetry , indicating possible publication bias.

Icipant Recruitment And Sample Collection

A total of 105 volunteers were enrolled for this study: 35 CFS patients, 35 patients relatives without CFS living with patients, and 35 healthy controls. The recruitment was performed according to the following inclusion criteria: CFS diagnosis according to Fukudas criteria, age between 18 to 80 years and signature of informed consent.

All participants who had used antibiotics, cortisone and non-steroidal anti-inflammatory drugs, inhibitors of proton pump inhibitors and probiotic drugs in the two months before the recruitment were excluded.

Healthy control subjects and patients relatives who had a previous history of diseases associated with chronic fatigue, bacterial and viral infections, cancer, chronic coronary diseases and allergies were also excluded.

Only the relatives who lived with the patients and shared similar dietary habits with them were enrolled. Age, sex and body mass index were matched in healthy controls.

Twenty-five patients reported gastrointestinal symptoms and showed post-exertional malaise. Moreover, eleven patients also had Irritable Bowel Syndrome diagnoses. Neither controls nor patients relatives reported this syndrome.

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Alterations In Gut Motility

Disorders in gut motility have been observed in the stomach, small intestine, colon, and rectum of IBS patients.2–5 Within the gut, there is a cyclic pattern of motility known as the major migrating complex, which consists of periodic, luminal contractions that propel intestinal contents from the stomach to the terminal ileum. Several studies in the literature have shown that patients with IBS tend to have abnormalities in these contractions. Vassallo and colleagues examined colonic tone and motility by measuring electronic barostat and perfusion manometry in 16 patients to assess for changes in IBS. The study showed that patients with IBS had a greater frequency of high amplitude prolonged contractions and greater preprandial colonic motility, which may account for the increased perception of pain in these patients.3 Another study, which used radiopaque markers to assess colonic transit times in IBS, showed that patients with diarrhea-predominant IBS had accelerated colonic transit.5 Although these alterations were seen in patients with IBS, as compared to normal controls, their findings are likely qualitative, rather than quantitative, and lack specificity. Additionally, the alteration in gut motility found in some patients with IBS appears to place them at risk for small-bowel bacterial overgrowth, which is another proposed etiology for IBS.

Primary Outcomes: Effect Of Different Probiotic Species On Straining Scores

There were only seven RCTs involved when comparing the effect of probiotics on straining scores. The network plot is shown in Figure 2F. Due to a lack of inconsistency resources, the consistency model was used. The results of the NMA showed that the patients who were administered B. coagulans had lower straining scores than those who were administered PLA. Based on the SUCRA analysis in Table S12 and Figure S13 and the league table in Table S14, B. coagulans had the best rank among all other interventions in improving straining scores of patients with IBS, followed by B. infantis and L. plantarum meanwhile, PLA ranked last.

The heterogeneity was significant across all treatment contrasts and the meta-regression analysis showed that treatment duration can significantly influence the efficacy of probiotics in improving the symptoms of straining in patients with IBS. Therefore, we performed a subgroup analysis of treatment lengths . Both the global and local inconsistency tests showed a significant inconsistency , which indicated that the inconsistency model should be used. The NMA results revealed a significant improvement in symptoms of straining in the patients who received B. coagulans compared to those who received PLA. Additionally, the SUCRA and league table showed that B. coagulans ranked first, S. boulardii ranked second, B. coagulans ranked third, while S. boulardii ranked last.

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Primary Outcomes: Effect Of Different Probiotic Species On Global Symptom Scores

A total of 13 RCTs comparing the effect of probiotics on the global symptom scores of patients with IBS were included. The network plot is shown in Figure 2B. Both the global and local inconsistency tests revealed a significant inconsistency between direct and indirect comparisons , which indicated that the inconsistency model should be used. The result of NMA revealed a significant improvement in the global symptom scores in patients who received B. coagulans and Bifidobacterium infantis compared with those who received PLA. Based on the SUCRA analysis and league table , B. coagulans, C. butyricum, and Bifidobacterium longum ranked as the top three interventions in improving the global symptom scores of patients with IBS, while L. plantarum ranked last.

Table 3 Standardized mean differences and 95% CI on global symptom scores.

In this outcome, we found obvious heterogeneity across all treatment contrasts , but no heterogeneity in the loop of NMA. Meta-regression analysis showed that treatment dose and length did not significantly influence the SMD estimates for global symptom scores .

Original Researchthe Efficacy And Safety Of Probiotics In Patients With Irritable Bowel Syndrome: Evidence Based On 35 Randomized Controlled Trials

Multi-strain probiotics have a potential to improve IBS symptoms.

Mono-strain probiotics may have no effect on improvement of IBS symptoms.

Effect of multi-strain probiotics on IBS with a longer intervention period is needed.

More knowledge about what strains are the most effective is needed.

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The Role Of The Gastrointestinal Microbiota In Irritable Bowel Syndrome

Several factors suggest that the GI microbiota might be important in the pathogenesis of IBS. First, several studies have found differences in the faecal and mucosa-associated microbiota of patients with IBS and healthy controls. As a result of the wide range of techniques used, differing patient groups and the complexity of the GI microbiota it is difficult to draw firm conclusions from this series of studies. However, there does appear to be a consistent theme of a relative reduction of the lactobacilli and bifidobacteria in patients with IBS and higher concentrations of species such as enterobacteriaceae, coliforms and bacteroides. However, what is less clear, without a greater understanding of the metabolic and immunological roles of the GI microbiota, is whether these changes are a primary or secondary phenomenon.

In addition to differences in the GI microbiota in IBS there is increasing evidence of an activation of the intestinal immune system in IBS, with studies demonstrating increased concentrations of mucosal intra-epithelial lymphocytes, mast cells and 5-hydroxytryptamine-secreting enterochromaffin cells. Given the evidence for the role of the GI microbiota in the profound inflammatory state in ulcerative colitis and Crohn’s disease, luminal antigens such as the microbiota may play a similar role in IBS.

Lactobacillus Rhamnosus Gg Lactobacillus Rhamnosus Lc705 Bifidobacterium Breve Propionibacterium Freudenreichii Sppshermanii Js

A multi-species probiotic containing Lactobacillus rhamnosus GG, L. rhamnosus LC705, Bifidobacterium breve and Propionibacterium freudenreichii spp shermanii JS has been used in two trials from the same group. The first 6-month trial of 103 patients with IBS has found a mean difference in reduction of the total symptom scores of 7·7 points . These findings were confirmed by a follow-up study of eighty-six patients, with a difference in reduction in GSS of eleven points . However, marked differences in baseline severity scores were found between treatment groups and controls, with the treatment group having greater symptom severity and therefore more likely to improve. In addition, a high percentage of both control and treatment arms were prescribed antibiotics in the treatment period. A notable feature in these trials was the longer treatment period of 5 and 6 months respectively with a consistent GSS improvement over the treatment course.

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Probiotic Therapy Knocks Down Inflammation In Chronic Fatigue Syndrome

Bifidobacterium infantis 35624 modulates host inflammatory processes beyond the gut. Groger, D., Mahony, L, Murphy, E. et. al. Gut Microbes 4, 4, 1-15

Gut bacteria are a hot topic in medical circles right now, but few studies have assessed their impact on chronic fatigue syndrome . This Irish and Swiss study asked if inflammation was present in ME/CFS, and if it was, if a single gut bacteria could reduce it. The answers were yes, and yes.

The answers, with some provisos, were yes, and yes.

Probiotics In The Treatment Of Irritable Bowel Syndrome

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Probiotics May Help Some With Chronic Fatigue

By Anne Harding, Reuters Health

3 Min Read

NEW YORK â Supplements containing good bacteria can help some people with chronic fatigue syndrome feel better, but they may make others feel worse, report Swedish researchers who conducted a small study.

I think that its worth trying, Dr. Birgitta Evengard of the Karolinska Institutet in Stockholm, study co-author, told Reuters Health. Evengard said she recommends her patients with chronic fatigue syndrome try taking the probiotics tested in her study, and stop if they start feeling worse, but stick with it for 3 weeks if they feel better or if they dont notice an immediate effect.

Evidence is increasingly pointing toward the need for individualized treatment for chronic fatigue syndrome, the researcher noted. The cause of this condition, characterized by debilitating fatigue that doesnt get better with rest and may be worsened by physical or mental activity, remains unclear, although there is evidence that dysfunction in the neurohormonal system or the immune system could be involved.

Given that there is a close connection between the gut and the immune system, as well as the central nervous system, Evengard and her colleagues decided to test whether probiotics â which can restore the normal balance of bacteria in the digestive system â might help patients with chronic fatigue syndrome.

None of the authors reported any competing interests.

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What Can You Do

My opinion is that the root cause is a static microbiome dysfunction and thus correcting the microbiome is the ideal long term approach . According to the US National Library of Medicine studies:

• Jerusalem Artichoke

A reader asked me to put together a list of test that could/should be done. I divide the tests into two categories:

• Actionable the results lead immediately to an accepted treatment with high possibility of success
• Informational this shows that there is a problem, there may be treatment of a sort typically symptom mitigations

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Herbal Supplements For Ibs

Peppermint oil may lessen diarrhea symptoms by slowing fecal transit time.

Research is fairly solid on the subject, with one group of researchers concluding that peppermint oil is more effective and benign than drugs for GI spasm and could be a drug of first choice for IBS patients with mild constipation or diarrhea.

“Peppermint oil has better research than many pharmaceuticals for IBS,” Rakel says.

For IBS patients who don’t tolerate peppermint, a chamomile-pectin combination works well, Low Dog says. Chamomile helps to relax colon muscles, Rakel says.

How Ibs Impacts Daily Life

When the symptoms of IBS are mild, they do not interfere with activities of daily life. When they are severe, they may limit activities because of the pain or the need to go to the bathroom. Patients with IBS and diarrhea need to be constantly aware of the location of the nearest bathroom. Patients even may avoid going out socially to avoid the embarrassment of frequently going to the bathroom.

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Probiotics May Relieve Symptoms Of Ibs

The American College of Gastroenterology conducted a meta-analysis of more than 30 studies, which found that probiotics may improve overall symptoms, as well as bloating and flatulence, in people with IBS. However, the overall quality of evidence of studies included in the meta-analysis was low, and specific recommendations regarding use of probiotics for IBS remained unclear.

The probiotic strain Bifidobacterium bifidum MIMBb75 has been reported to adhere particularly well to intestinal cells, and therefore may have an advantage in altering the intestinal microbiota and increasing the intestinal barrier.

In a clinical trial published in Alimentary Pharmacology & Therapeutics, once-daily Bifidobacterium bifidum MIMBb75 significantly improved overall IBS symptoms, as well as individual IBS symptoms including abdominal pain, bloating, and fecal urgency.