Randomized Controlled Treatment Trial of Irritable Bowel Syndrome with a Probiotic E.-coli Preparation (DSM17252) Compared to Placebo

Background and objectives: immune system alteration in irritable bowel syndrome (IBS) patients may be modulated by probiotics. We assessed the efficacy of some probiotic species in alleviating characteristic IBS symptoms.Material and methods: a meta-analysis of all identified randomized controlled trials comparing probiotics with placebo in treating IBS symptoms was performed with continuous data summarized using standardized mean differences (SMDs) with 95% confidence intervals (95% CIs), where appropriate. The random-effects model was employed in cases of heterogeneity; otherwise, fixed-effects models were used.Results: meta-analysis was performed with 10 of 24 studies identified as suitable for inclusion. Probiotics improved pain scores if they contained Bifidobacterium breve (SMD, -0.34; 95% CI, -0.66; -0.02), Bifidobacterium longum (SMD, -0.48; 95% CI, -0.91; -0.06), or Lactobacillus acidophilus (SMD, -0.31; 95% CI, -0.61; -0.01) species. Distension scores were improved by probiotics containing B. breve (SMD, 95% CI, Conclusions: some probiotics are an effective therapeutic option for IBS patients, and the effects on each IBS symptom are likely species-specific. Future studies must focus on the role of probiotics in modulating intestinal microbiota and the immune system while considering individual patient symptom profiles. INTRODUCTIONDefining and treating irritable bowel syndrome (IBS) can be challenging. Among the wide variety of treatment options, probiotics appear to be one of the best options (1). Recently, growing evidence has suggested an alteration in the immune system cell profile of IBS patients and a close relationship between the immune and nervous systems (2,3). Furthermore, several authors have studied the relationship between probiotic intake and blood cytokine levels (4) or changes in fecal microbiota (5,6). Several reviews and meta-analyses that have evaluated the role of probiotics in IBS therapy have concluded that probiotics appear to improve overall IBS symptoms (7-12). However, a meta-analysis that includes any probiotic in the evaluation of symptom relief may not be the best method for assessing the efficacy of specific probiotics (11-13). Therefore, we assessed the efficacy of each specific probiotic species in alleviating characteristic IBS symptoms. Effect of probiotic species on irritable bowel ORIGINAL PAPERSOrtiz-Lucas M, Tobias A, Saz P, Sebastián JJ. Effect of probiotic species on irritable bowel syndrome symptoms: A bring up to date meta-analysis. Rev Esp Enferm

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“…1) (4)(5)(6). Table I contains a list of excluded studies and the reason for exclusion (40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52).…”

Section: Resultsmentioning

confidence: 99%

Effect of probiotic species on irritable bowel syndrome symptoms: A bring up to date meta-analysis

Ortiz-Lucas

Tobías

Saz

et al. 2013

Rev. esp. enferm. dig.

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“…001) Nobaek et al (62) 60 L. plantarum 299V; 10 10 4 Improved flatulence only (P < 0 . 05) Enck et al (59) 298 E. Significant reduction in GSS (P < 0 . 008) Guyonnet et al (70) 274 † B. animalis DN 173 010 6 Although significant improvement over baseline, no benefit over placebo Whorwell et al (61) 362 B. infantis 35624; 10 8 4 Reduction in pain score (PEP; P < 0 .…”

Section: Lactobacillus Ggmentioning

confidence: 95%

Treating irritable bowel syndrome with probiotics: the evidence

2010

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Irritable bowel syndrome (IBS) is a disorder of chronic abdominal pain, altered bowel habit and abdominal distension. It is the commonest cause of referral to gastroenterologists in the developed world and yet current therapeutic strategies are often unsatisfactory. There is now increasing evidence linking alterations in the gastrointestinal (GI) microbiota and IBS. Changes in faecal and mucosa-associated microbiota, post-infectious IBS, a link with small intestinal bacterial overgrowth and an up-regulation of the GI mucosal immune system all suggest a role for the GI microbiota in the pathogenesis of IBS. Given this evidence, therapeutic alteration of the GI microbiota by probiotic bacteria could be beneficial. The present paper establishes an aetiological framework for the use of probiotics in IBS and comprehensively reviews randomised placebo-controlled trials of probiotics in IBS using multiple electronic databases. It highlights safety concerns over the use of probiotics and attempts to establish guidelines for their use in IBS in both primary and secondary care.Probiotics: Irritable bowel syndrome: Small bowel intestinal overgrowth: Gastrointestinal microbiota

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“…Four studies did not specify which criteria were used defining IBS patients, 56,88,105,107 which may indicate that data was collected before Rome criteria became effective and in 2 studies, this was expressed in the article (pre-Rome 98,106 ). Whilst male patients were included, females were dominant in all trials; one study exclusively recruited female patients.…”

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confidence: 99%

Probiotic Therapy of the Irritable Bowel Syndrome: Why Is the Evidence Still Poor and What Can Be Done About It?

Mazurak

Broelz²,

Storr

et al. 2015

J Neurogastroenterol Motil

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Background/AimsDespite numerous randomized clinical trials and meta-analyses, there is no increased evidence for the efficacy of probiotics in the treatment of irritable bowel syndrome (IBS). We review this evidence, identify and analyse the reasons for this lack of evidence and propose methodological improvements for future studies. MethodsBased on a literature search, we identified 56 papers that matched the purpose of our analyses. Twenty-seven studies used multi-species bacterial preparations and 29 used single-strain probiotics. They were analysed regarding patients included, treatment duration, probiotic dosage, and outcome measures. ResultsTrials in both groups suffered from heterogeneity with respect to probiotic concentration, duration of treatment, and other methodological issues (crossover design and underpowered studies). This heterogeneity did not allow the application of a meta-analytic approach and a systematic review was therefore performed instead. Multi-strain preparations combined 2 to 8 different bacterial subspecies, mostly lactobacilli or bifidobacteria, and used variable lengths of treatments. Overall, more than 50% of trials presented negative outcomes. The majority of the single-strain probiotic trials employing lactobacilli or Saccharomyces were negative, whereas trials employing bifidobacteria showed positive results. ConclusionsThe heterogeneity of the studies of probiotics in IBS questions the value of meta-analyses. The use of different bacterial strains and different mixtures of these strains, as well as different dosages, are the main contributors to this heterogeneity. Current data provides limited evidence for the efficacy of a small number of single-strain probiotics in IBS (mostly bifidobacteria) and

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Randomized Controlled Treatment Trial of Irritable Bowel Syndrome with a Probiotic E.-coli Preparation (DSM17252) Compared to Placebo

Abstract: Treatment of IBS with the probiotic Symbioflor-2 is effective and superior to placebo in reducing typical symptoms of IBS patients seen by general practitioners and by gastroenterologists.

Cited by 81 publications

References 18 publications

Effect of probiotic species on irritable bowel syndrome symptoms: A bring up to date meta-analysis

Effect of probiotic species on irritable bowel syndrome symptoms: A bring up to date meta-analysis

Treating irritable bowel syndrome with probiotics: the evidence

Probiotic Therapy of the Irritable Bowel Syndrome: Why Is the Evidence Still Poor and What Can Be Done About It?

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