Effects of Bifidobacterium longum and Lactobacillus rhamnosus on Gut Microbiota in Patients with Lactose Intolerance and Persisting Functional Gastrointestinal Symptoms: A Randomised, Double-Blind, Cross-Over Study.

Paola Vitellio,Piero Portincasa,Maria De Angelis,Marco Gobbetti,Giuseppe Celano,Leonilde Bonfrate

doi:10.3390/nu11040886

Abstract

Functional gastrointestinal symptoms are frequent, and may be driven by several pathogenic mechanisms. Symptoms may persist in lactose intolerant (LI) patients (i.e., subjects with intestinal lactase deficiency, lactose malabsorption producing symptoms), after a lactose-free diet. Our hypothesis was that probiotic and vitamin B6 treatment may be useful to alleviate symptoms in LI patients through a positive modulation of gut microbial composition and relative metabolism. We aimed to test the efficacy of a novel formulation of Bifidobacterium longum BB536 and Lactobacillus rhamnosus HN001 plus vitamin B6 (ZR) in 23 LI subjects with persistent symptoms during a lactose-free diet. Symptoms, microbiome, and metabolome were measured at baseline and after 30 days in a crossover, randomized, double-blind study of ZR versus placebo (PL). Compared with PL, the administration of probiotics and vitamin B6 significantly decreased bloating (p = 0.028) and ameliorated constipation (p = 0.045). Fecal microbiome differed between ZR and PL. ZR drove the enrichment of several genera involved in lactose digestion including Bifidobacerium. Moreover, the relative abundance of acetic acid, 2-methyl-propanoic acid, nonenal, and indolizine 3-methyl increased, while phenol decreased. Our findings highlight the importance of selected probiotics and vitamin B6 to alleviate symptoms and gut dysbiosis in lactose intolerant patients with persistent functional gastrointestinal symptoms.

Highlights

Functional gastrointestinal diseases (FGIDs) are the most common cause of gastrointestinal disturbance in global population
Several factors are involved in the genesis of FGIDs, and include intestinal dysbiosis [2,3], genetic predisposition, perception, diets, and intestinal dysmotility [4]
The present study aimed to investigate the effects of a novel formulation of Bifidobacterium longum BB536 and Lactobacillus rhamnosus HN001 with vitamin B6 on symptoms, gut microbiota, and matabolome in a cohort of patients with persisting FGIDs on a lactose-free diet because of a prior diagnosis of Lactose intolerance (LI)

Summary

Introduction

Functional gastrointestinal diseases (FGIDs) are the most common cause of gastrointestinal disturbance in global population. Once organic (i.e., inflammatory or neoplastic) causes are ruled out, symptoms include a wide range of disorders [1] affecting the esophagus or upper gastrointestinal tract (i.e., functional dyspepsia, postprandial distress syndrome, or epigastric pain), bowel disorders (i.e., irritable bowel syndrome (IBS), constipation, diarrhea, or bloating), biliary and anorectal. Lactose intolerance (LI) (due to lactase deficiency, down-regulation of lactase activity, lactose malabsorption causing abdominal symptoms upon lactose-containing products) [5,6,7] and fructose intolerance (due to fructose malabsorption with symptoms upon ingestion of fructose-containing foods) in adults [8] can mimic several FGIDs. Self-reported perception of LI can affect the behaviour of patients in terms of diagnosis and therapeutic approaches [9,10,11]

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