Abstract
PurposeDiarrhea-predominant irritable bowel syndrome (IBS-D) is a common functional gastrointestinal disorder. Probiotics and synbiotics have been shown to improve symptoms of IBS, although mechanisms of action are currently not understood.MethodsWe investigated the effects of a 4-week oral synbiotic treatment (OMNi-BiOTiC® Stress Repair) in ten IBS-D patients on gastrointestinal mucosal and fecal microbiota, mucosa-associated immune cells, and fecal short-chain fatty acids. The upper and lower gastrointestinal tracts were compared before and after a 4-week synbiotic treatment using endoscopic evaluation to collect mucosal specimens for FACS analysis and mucosal 16S rRNA gene analysis. In stool samples, analysis for fecal SCFAs using GC–MS, fecal zonulin using ELISA, and fecal 16S rRNA gene analysis was performed.ResultsSynbiotics led to an increased microbial diversity in gastric (p = 0.008) and duodenal (p = 0.025) mucosal specimens. FACS analysis of mucosal immune cells showed a treatment-induced reduction of CD4+ T cells (60 vs. 55%, p = 0.042) in the ascending colon. Short-chain fatty acids (acetate 101 vs. 202 µmol/g; p = 0.007) and butyrate (27 vs. 40 µmol/g; p = 0.037) were elevated in fecal samples after treatment. Furthermore, treatment was accompanied by a reduction of fecal zonulin concentration (67 vs. 36 ng/ml; p = 0.035) and disease severity measured by IBS-SSS (237 vs. 54; p = 0.002).ConclusionsOur findings indicate that a short-course oral synbiotic trial may influence the human gastrointestinal tract in IBS-D patients on different levels which are region specific.
Highlights
Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal (GI) tract
Their median age was 46 [37–53] years of Mucosal extract cytokine concentration was measured in mucosal specimens of the duodenum and ascending colon and results are systematically compiled in Suppl
In the present pilot study, we conducted a systematic investigation of the GI tract before and after a 4-week treatment with an open-label oral synbiotic mixture in patients with irritable bowel syndrome (IBS-D)
Summary
Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal (GI) tract. Thereby, the possible dysbiosis-triggered mucosal inflammation involves elevated pro-inflammatory cytokines that can interact with colonic nociceptive and non-nociceptive afferent nerves If activated, these afferent nerves can sensitize mechanosensory colonic c-fibers to mediate pain symptoms in IBS-D patients [4]. Activated mast, B and plasma cells accompanied with an impaired barrier function in jejunal specimens are present in IBS-D patients and the grade of mucosal inflammation is thereby associated to clinical disease activity. These microbiotaneuro-immunological interactions might, be involved in triggering intestinal hypersensitivity and pain, suggesting that IBS-D has a microbiota-dependent immune-mediated pathogenesis [8,9,10]
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