Effect of a Preparation of Four Probiotics on Symptoms of Patients with Irritable Bowel Syndrome: Association with Intestinal Bacterial Overgrowth

Konstantinos Leventogiannis,Evangelos J Giamarellos-Bourboulis,Konstantinos Triantafyllou,Paraskevas Gkolfakis,Athanasios Sioulas,Georgios Spithakis,Aikaterini Tsatali,Aikaterini Pistiki

doi:10.1007/s12602-018-9401-3

Abstract

The effect of probiotics on small intestinal bacterial overgrowth (SIBO) in irritable bowel syndrome (IBS) has never been studied so far. In this prospective trial, five patients with IBS and SIBO and 21 patients with IBS without SIBO were administered an oral capsule containing Saccharomyces boulardii, Bifidobacterium lactis, Lactobacillus acidophilus, and Lactobacillus plantarum (Lactolevure®) every 12 h for 30 days. SIBO was defined by quantitative culture of the third part of the duodenum; IBS was defined by the Rome III criteria. Severity of symptoms was graded by the IBS severity scoring system (SSS). The primary study endpoint was the efficacy of probiotics in improvement of symptoms of IBS in patients with SIBO. Thirty days after the end of treatment, a 71.3% decrease of the total IBS score was detected in patients with IBS and SIBO compared to 10.6% in those without SIBO (p 0.017). A similar decrease was achieved among patients with constipation-predominant IBS without SIBO. Post-treatment satisfaction from bowel function was greater in patients with SIBO. Similar satisfaction improvement was found among patients with diarrhea-predominant IBS irrespective from SIBO; pain intensity score decreased in patients with constipation-predominant IBS irrespective from SIBO. The benefit of probiotics was greater among patients with a pro-inflammatory cytokine pattern in the duodenal fluid. This is the first study that prospectively demonstrated superior clinical efficacy of probiotics in patients with IBS with SIBO. Analysis also showed considerable benefit from probiotic intake regarding certain symptoms of patients with diarrhea-predominant and constipation-predominant IBS.Trial registration: ClinicalTrials.gov identifier NCT02204891.

Highlights

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder
The aim of the present study is to evaluate the effect of a mixture of four species of probiotics (Saccharomyces boulardii, Bifidobacterium lactis BB-12, Lactobacillus acidophilus LA-5, and Lactobacillus plantarum) on the symptoms of IBS patients with culture verified small intestinal bacterial overgrowth (SIBO) compared to those without SIBO
Since analysis for the primary efficacy endpoint conducted in December 2015 showed a trend towards statistical difference between patients with SIBO and patients without SIBO, it was allowed for the study

Summary

Introduction

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder. 3 4th Department of Internal Medicine, ATTIKON University Hospital, 1 Rimini Street, 1262 Athens, Greece intestinal microbiota the last decade led to the knowledge that many of the symptoms of IBS, mainly bloating and diarrhea, are related with the overgrowth of bacteria of colonic type in the small intestine. This overgrowth frames the syndrome of small intestinal bacterial overgrowth (SIBO) where colonic type of bacteria predominates in the proximal parts of the small intestine. The frequency of SIBO ranged between 10.6 and 17.6%

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