Probiotics for Irritable Bowel Syndrome and Constipation

by | Oct 18, 2016 | 2016, Constipation, Irritable Bowel Syndrome, Probiotics

Written by Joyce Smith, BS. After 60 days of supplementing with either a probiotic blend or a prebiotic, those in the two probiotic groups had significantly improved symptoms of constipation and significantly healthier bowel movements than those in the placebo group.

digestive healthFor a healthy gut we need a balance between beneficial bacteria such as Lactobacilli and Bifiobacteria and those considered potentially harmful such as Clostridium, E. coli, Salmonella, and Pseudomonas. Stress, whether emotional, environmental, or dietary, can play a role in altering the composition of our gut bacteria and lead to disease. Furthermore, abnormal stimulation of our immune system can lead to inflammation which may trigger changes in our gut composition and contribute to disease.1-3

Research has shown us that levels of Lactobacilli and Bifidobacteria species are lower in patients with IBS compared to healthy persons.4 Studies have also shown that supplementing with probiotic mixtures that contain species of Lactobacilli and Bifidobacterium can reduce the symptoms of IBS 5 because each bacterial species acts differently on the gastrointestinal tract; therefore, two or more species, when acting together, may have a synergistic effect.6

The objective of this study was to clarify the presence of gut microbiota abnormalities in patients with IBS and to establish appropriate endpoints that would help evaluate the benefits of probiotics as a therapeutic strategy in the management of IBS symptoms.

This randomized, double-blind, placebo controlled clinical trial evaluated the gastrointestinal benefits of 150 patients with Irritable Bowel Syndrome and constipation (IBS-C) at 10, 30, and 60 days following supplementation with probiotics. Patients were divided into 3 groups (F1, F2, and F3) given capsules of the following probiotic combinations daily for 60 days:

F130 mg L. acidophilus (5×109 CFU), 30 mg L. reuteri (5 × 109 CFU), 330 mg inulin, 5 mg silica, 5 mg talc
F212 mg L. plantarum (5×109 CFU), 20 mg L. rhamnosus (5×109 CFU) and 60mg B. animalis subsp. L. lactis (5 × 109 CFU), 298 mg inulin, 5 mg silica, 5 mg talc
F3390 mg inulin, 5 mg silica, 5 mg talc

Patients were required to record their symptoms such as abdominal pain, bloating, constipation, abdominal cramps and gas and fill out a health-related quality of life questionnaire (HR-QOL). At 10, 30, and 60 days, fecal microflora were analyzed using real time quantitative PCR on DNA from patients’ stool samples. Researchers classified the stool types and calculated the number of healthy bowel movements.

In order to determine the sustained benefits of probiotic supplementation after it was discontinued at 60 days, patients were followed up for an additional 30 days during which time symptoms, stool types, and the number of healthy bowel movements were once again recorded.

After 60 days of treatment, analysis revealed the following:

  • Symptoms decreased significantly in the F1 and F2 groups compared to the placebo group (P<0.001)
  • No significant differences were found between F1and F2.
  • F1 and F2 had significantly increased bowel movements which were characteristically healthier than the placebo group.

After 30 days of follow-up, the following observations were made:

  • F1 and F2 reported a significant decrease in symptoms of abdominal pain, cramps, bloating, gas, and constipation compared to placebo (P<0.001). However, no differences were detected between F1 and F2 except for abdominal cramps which were less significant during the 30-day follow-up.
  • There were no significant differences between groups F1 and F2 with respect to improvements in quality of life (HR-QOL) when comparing the 60-day treatment to the 30-day follow-up, thus demonstrating that the benefits derived from probiotic supplementation for 60 days persisted even after the supplementation was discontinued. However, the improvements in quality of life (HR-QOL) were significantly higher in the F1 and F2 groups compared to the placebo group (P<0.001). No significant differences in HR-QOL scores were found between F1 and F2.

The authors concluded that this clinical trial supports the role of intestinal bacteria in IBS and demonstrates that probiotics containing various species have a potential role in the treatment of IBS and related constipation.

Source:  Mezzasalma Valerio et al. A Randomized, Double-Blind, Placebo-Controlled Trial:The Efficacy of Multispecies Probiotic Supplementation in Alleviating Symptoms of Irritable Bowel Syndrome Associated with Constipation. BioMed Research International Volume 2016, Article ID 4740907, 10 pages; http://dx.doi.org/10.1155/2016/4740907

© 2016 Valerio Mezzasalma et al. Open access under the Creative Commons Attribution License.

Click here to read the full text study.

Posted October 18, 2016.

References:

  1. Abraham C, Cho JH. Inflammatory bowel disease. The New England journal of medicine. 2009;361(21):2066.
  2. Bellavia M, Damiano G, Gioviale MC, et al. Abnormal expansion of segmented filamentous bacteria in the gut: a role in pathogenesis of chronic inflammatory intestinal diseases? Reviews in Medical Microbiology. 2011;22(3):45-47.
  3. Bellavia M, Tomasello G, Romeo M, et al. Gut microbiota imbalance and chaperoning system malfunction are central to ulcerative colitis pathogenesis and can be counteracted with specifically designed probiotics: a working hypothesis. Medical microbiology and immunology. 2013;202(6):393-406.
  4. Kerckhoffs AP1 SM, van der Rest ME, de Vogel J, Knol J, Ben-Amor K, Akkermans LM. Lower Bifidobacteria counts in both duodenal mucosa-associated and fecal microbiota in irritable bowel syndrome patients.World J Gastroenterol. 2009 Jun 21;15(23):2887-92. World J Gastroenterol. 2009 Jun 21;15(23):2887-92. 2009 June 21;15(23):2887-2892.
  5. Presti I, D’Orazio G, Labra M, et al. Evaluation of the probiotic properties of new Lactobacillus and Bifidobacterium strains and their in vitro effect. Applied microbiology and biotechnology. 2015;99(13):5613-5626.
  6. Yoon JS, Sohn W, Lee OY, et al. Effect of multispecies probiotics on irritable bowel syndrome: A randomized, double‐blind, placebo‐controlled trial. Journal of gastroenterology and hepatology. 2014;29(1):52-59.