Efficacy of bile salt hydrolase synthesizing probiotic bacteria in the treatment of irritable bowel syndrome with diarrhea

Abstract

Background. One of the mechanisms of the of irritable bowel syndrome with diarrhea (IBS-D) is bile acid malabsorption (BAM). In addition to the use of bile acid sequestrants, probiotic bacteria synthesizing bile salt hydrolase (BSH) are promising in the treatment of probable BAM. The purpose of the study was to compare the effectiveness of combined treatment (a probiotic based on strains of Lactobacillus, Streptococcus, Bifidobacterium, Saccharomyces boulardii and cholestyramine) with cholestyramine monotherapy in the treatment of IBS-D. Materials and methods. A 12-week randomized study included 108 patients with IBS-D divided into a control group (n = 51) receiving only cholestyra­mine and an experimental group (n = 57) receiving a combination of cholestyramine and the study probiotic. At baseline, the relative activity of BSH of the study probiotic capsules was determined. During the stages of the study, patients were examined using clinical scales. Results. The relative activity of BSH of the capsules with the studied probiotic was (2.07 ± 0.06) U/ml compared to (1.00 ± 0.04) U/ml of capsules with L.plantarum and (0.03 ± 0.01) U/ml — with L.plantarum without BSH genes. In the experimental group, the severity of bloating and visceral sensitivity index were lower after 8 and 12 weeks, and the value of the stool type according to the Bristol scale and its daily frequency — after 12 weeks compared to the control group, p < 0.05. According to the scale of IBS-adequate relief, the percentage of achieving a clinical effect was higher in the experimental group compared to the controls after 12 weeks, odds ratio was 1.31 (95% confidence interval 1.03–1.68), p = 0.038. Conclusions. Additional prescription of a probiotic with BSH synthesizing bacterial strains is more effective in improving clinical manifestations of IBS-D and achieving a therapeutic effect compared to cholestyramine monotherapy.