The Use of Probiotics in Functional Bowel Disease

Abstract

T he term functional bowel disease refers to a group of disorders that feature various gastrointestinal (GI) symptoms, such as abdominal pain or discomfort, diarrhea, constipation, bloating, and distension for which there is no obvious organic cause. Foremost among these is irritable bowel syndrome (IBS), a common disorder usually defined by the coexistence of abdominal pain or discomfort and an alteration in bowel habit [1–3]. IBS may lead to impaired social and personal function and can diminish quality of life to a degree usually associated with major organic diseases such as hypertension and diabetes [4,5]. IBS continues to represent a significant therapeutic challenge; currently available therapies provide symptomatic relief, at best, and none have been shown to alter the natural history of the disorder [1,2,6–11]. The precise pathophysiology of IBS remains unknown [12]. For some time, pathophysiological and pharmacological research efforts have focused on two principal targets: dysmotility and altered visceral sensation [13]. There is no doubt that IBS is associated with several disturbances in motor function, not only in the colon, but throughout the GI tract, as reflected by the former use of such terms as spastic colon or spastic colitis to describe this syndrome and by the continued emphasis on the use of antispasmodics in its therapy [11]. Although it remains likely that dysmotility, or spasm, may play a role in the precipitation of symptoms, the specificity of any proposed motor phenomenon for IBS has been questioned, and the primacy of dysmotility in the pathogenesis of IBS is now in doubt [14,15]. Visceral hypersensitivity, usually demonstrated by assessing the response to balloon inflation in the rectum or elsewhere, is a common phenomenon in IBS [16] and in all functional GI disorders, including functional dyspepsia and noncardiac chest pain. Visceral hypersensitivity and related phenomena, such as visceral hyperalgesia and abnormal central perception, are so common in IBS that visceral hypersensitivity, elicited