Patient - Irritable Bowel Syndrome (IBS) Probiotic Therapy

• Bausserman M. Michail S. "The use of Lactobacillus GG in irritable bowel syndrome in children: a double-blind randomized control trial." Journal of Pediatrics. 147(2):197-201, 2005 Aug.
  This randomized controlled study looked at whether oral use of the probiotic Lactobacillus GG improved symptoms of irritable bowel syndrome (IBS) in children. Fifty children fulfilling the Rome II criteria for IBS were given Lactobacillus GG or placebo for 6 weeks. It was found that Lactobacillus GG was not better than placebo in relieving abdominal pain (40% response rate in the placebo group vs 44% in the Lactobacillus GG group). The only gastrointestinal symptom that showed improvement with Lactobacillus was a lower occurrence of perceived abdominal distention. Lactobacillus GG was not superior to placebo in the treatment of abdominal pain in children with IBS but may help relieve such symptoms as perceived abdominal distention.
• Borody TJ, Warren EF, Leis, SH, et al. "Bacteriotherapy using fecal flora: toying with human motions." Journal of Clinical Gastroenterology. 38(6): 475-483, 2004.
  The intestinal flora may play a key role in the development of certain gastrointestinal (GI) diseases. Components of bowel flora such as Lactobacillus acidophilus and Bifidobacterium bifidus have long been used as therapeutic agents for GI disorders. More complex combinations of probiotics for therapeutic bacteriotherapy have also recently become available. However the entire fecal flora is the most elaborate mix of human-derived probiotic bacteria. Fecal bacteriotherapy uses the complete normal human flora as a therapeutic probiotic mixture of living organisms. This type of bacteriotherapy has a longstanding history in animal health and has been used sporadically against chronic infections of the bowel. Encouraging results have also been observed following infusions of human fecal flora in patients with inflammatory bowel disease, irritable bowel syndrome, and chronic constipation. The therapeutic use of fecal bacteriotherapy is reviewed here and possible mechanisms of action and potential applications explored. There are a few published reports on the results of uncontrolled open studies and case reports of fecal bacteriotherapy. Given the promising clinical responses, formal research into fecal bacteriotherapy is now warranted.
• Francavilla R, Miniello V, Magista AM, et al. A randomized controlled trial of Lactobacillus GG in children with functional abdominal pain. Pediatrics. 126(6):e1445-52, 2010.
  A total of 141 children with irritable bowel syndrome (IBS) or functional pain received either Lactobacillus GG or placebo for 8 weeks. The primary outcome was overall pain at the end of the intervention period. Lactobacillus GG, but not placebo, caused a significant reduction of both frequency and severity of abdominal pain. These differences still were significant at the end of follow-up.
• Goossens D,  Jonkers D,  Stobberningh E,  et al. "Probiotics in gastroenterology: indications and future perspectives." Scandinavian Journal of Gastroenterology - Supplement. 239:15-23, 2003.
  The use of probiotics to change intestinal bacterial flora balance has potential therapeutic benefit in several gastrointestinal conditions. Most scientific evidence is available for diarrhea patients treated with Lactobacillus GG, Lactobacillus reuteri or Saccharomyces boulardii (a yeast). Results show an overall reduction in risk of diarrhea associated with antibiotic use when treated with probiotics. Probiotics also show potential in inflammatory bowel disease, irritable bowel syndrome, lactose absorption, h. pylori eradication and constipation. Results of studies are encouraging, warranting further controlled trials on the therapeutic and preventive use of probiotics.
• Hoveyda N, Heneghan C, Mahtani KR, et al. A systematic review and meta-analysis: probiotics in the treatment of irritable bowel syndrome. BMC Gastroenterol. 9:15, 2009.
  Fourteen randomized placebo controlled trials were included in this systematic review and meta-analysis evaluating probiotics for alleviating symptoms in patients with IBS. Trials varied in length of treatment (4-26 weeks), dose, organisms and strengths of probiotics used. Overall results indicate that probiotics may alleviate some of the symptoms of IBS. However, as IBS is a condition that is chronic and usually intermittent, longer term trials focusing on the type, optimal dose of probiotics and the subgroups of patients who are likely to benefit are recommended.
• Kim HJ, Vazquez Roque MI, Camilleri M, et al. "A randomized controlled trial of a probiotic combination VSL#3 and placebo in irritable bowel syndrome with bloating." Neurogastroenterology & Motility. 17(5):687-96, 2005.
  Forty-eight patients with IBS received either the probiotic VSL#3 or placebo twice daily for 4 weeks or 8 weeks of treatment. Treatment with VSL#3 was associated with reduced flatulence over the entire treatment period and with relief of bloating, stool-related symptoms, and abdominal pain.
• Martens U, Enck P, Zieseniss E. Probiotic treatment of irritable bowel syndrome in children. Ger Med Sci. 8:Doc07, 2010.
  Two hundred three children age 4 to 18 years old with typical irritable bowel syndrome (IBS) symptoms including abdominal pain and either predominant diarrhea, constipation, or alternating stool frequency were included in this trial. Most patients under 11 years of age received a daily dose of 10 drops of Symbioflor 2 (a probiotic), while 77% of older children received this dosage and the remaining received a higher dose up to 30 drops/day for 43 days on average. Results suggest that probiotic treatment is effective in improving the key IBS symptoms (abdominal pain, stool frequency) as well as the other symptoms (bloating, mucous and blood in stool, need for straining at stools, urge to defecate). These data confirm the effectiveness and tolerability of this probiotic in children and adolescents and probiotic IBS therapy in adults.
• Moayyedi P, Ford AC, Talley NJ, et al. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut. 59(3):325-32, 2010.
  Nineteen randomized controlled trials, with at least 1 week of treatment comparing probiotics with placebo or no treatment in adults with IBS were included in this systematic review. Trial quality was generally good. Probiotics were statistically significantly better than placebo. Fifteen trials assessing 1,351 patients reported an improvement in IBS score as a continuous outcome.
• O'Mahony L,  McCarthy J,  Kelly P,  et al.  "Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles." Gastroenterology. 128(3):541-51, 2005.
  Seventy patients with IBS received either Lactobacillus salivarius, Bifidobacterium infantis or a placebo for 8 weeks. For all symptoms, with the exception of bowel movement frequency and consistency, those who received B infantis had a greater reduction in symptom scores for abdominal pain, bloating/distension and bowel movement difficulty. B infantis was found to alleviate symptoms in IBS and normalize the ratio of anti-inflammatory to pro-inflammatory cytokine, suggesting it was having an immune-modulating role in this disorder.
• O'Sullivan MA, O'Morain CA. "Bacterial supplementation in the irritable bowel syndrome. A randomised double-blind placebo-controlled crossover study." Digestive & Liver Disease. 32(4):294-301, 2000.
  In certain patients, symptoms of irritable bowel syndrome may be associated with a change in gut flora. Studies on bacterial based therapy have had mixed results. This study looked at whether oral administration of the probiotic Lactobacillus casei strain GG improves symptoms in irritable bowel syndrome patients with bloating related symptoms. A total of 25 patients with clinically confirmed irritable bowel syndrome (Rome criteria) were enrolled in the study. Lactobacillus GG was given as enterocoated tablets and symptoms were assessed by daily symptom diaries and periodic questionnaires. No significant differences were found between Lactobacillus casei strain GG and placebo mean symptom scores for pain, urgency or bloating. A trend was noted, however, for a reduction in the number of unformed bowel motions on Lactobacillus casei strain GG treatment for patients with diarrhoea. A "diarrhoea predominant" subgroup may warrant further study.
• Ringel-Kulka T, Palsson OS, Maier D, et al. Probiotic bacteria Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 versus placebo for the symptoms of bloating in patients with functional bowel disorders: a double-blind study. Journal of Clinical Gastroenterology. 45(6):518-25, 2011.
  This trial studied the use of the probiotic bacterias Lacobacillus acidophilus-NCFM and Bifidobacterium lactis-LBi07 twice a day vs. placebo over 8 weeks in 60 patients with functional bowel disorders. Abdominal bloating improved in the probiotic compared with the placebo group at 4 weeks and 8 weeks. People with irritable bowel syndrome showed similar results.
• Saggioro A. "Probiotics in the treatment of irritable bowel syndrome." Journal of Clinical Gastroenterology. 38(6 Suppl):S104-6, 2004.
  Some IBS studies have shown that abnormal fermentation in the colon may play an important part in the development of symptoms in some patients with IBS. Since this fermentation may play a key role, the use of probiotics in the treatment of IBS was studied in seventy patients who were randomly assigned to receive 4 weeks of either the active preparation containing Lactobacillus plantarum LP 01 and Bifidobacterium breve BR 03 or Lactobacillus plantarum LP 01 and Lactobacillus acidophilus LA 02 or placebo powder. After treatment, abdominal pain scores decreased in probiotics groups A and B 42% and 49% versus 25% in the placebo group after 14 days and 45% and 49% versus 29.5% after 28 days. The severity score of characteristic IBD symptoms significantly decreased in probiotic groups A and B versus placebo group after 14 days, 49.3% and 55.6% versus 8%, and these data were confirmed after 28 days (56% and 55.6% versus 14.4%. Thus, short-term therapy with Lactobacillus plantarum LP 01 and Bifidobacterium breve BR 03 or Lactobacillus plantarum LP 01 and Lactobacillus acidophilus LA 02 may be considered a promising approach for IBS therapy
• Silk DB, Davis A, Vulevic J, et al. Clinical trial: the effects of a trans-galactooligosaccharide prebiotic on faecal microbiota and symptoms in irritable bowel syndrome. Aliment Pharmacol Ther. 29(5):508-18, 2009.
  This study investigated the effectiveness of a prebiotic in improving symptoms of IBS. Forty-four patients with IBS received either 3.5 grams a day prebiotic, 7 grams a day prebiotic or 7 grams a day placebo. Changes in fecal microflora, stool frequency and form, anxiety and depression, and quality of life were monitored. The prebiotic significantly enhanced faecal bifidobacteria. The placebo had no effect on the clinical parameters monitored, while the prebiotic at 3.5 g/d significantly changed stool consistency and improved flatulence and bloating. The prebiotic at 7 g/d significantly improved global assessment and anxiety scores. These findings suggest that the prebiotic has potential as a therapeutic agent in IBS.
• Van Citters GW,  Lin HC. "Management of small intestinal bacterial overgrowth." Current Gastroenterology Reports. 7(4):317-20, 2005.
  Contamination of the small intestine with colonic bacterial flora or small intestinal bacterial overgrowth (SIBO) has been found in 78% to 84% of patients with IBS. This paper looks at the diagnostic and treatment approaches to SIBO within the context of IBS.