American Journal of Clinical Medicine Research
ISSN (Print): 2328-4005 ISSN (Online): 2328-403X Website: Editor-in-chief: Dario Galante
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American Journal of Clinical Medicine Research. 2015, 3(2), 18-23
DOI: 10.12691/ajcmr-3-2-1
Open AccessA Clinical Study

The Effect of a Multi-strain Probiotic on the Symptoms and Small Intestinal Bacterial Overgrowth in Constipation-predominant Irritable Bowel Syndrome: A Randomized, Simple-blind, Placebo-controlled Trial

Ivashkin V.1, Drapkina O.1, Poluektova Ye.1, Kuchumova S.1, , Sheptulin A.1 and Shifrin O.1

1Department of Internal Disease Propaedeutics, Gastroenterology and Hepatology, I.M.Sechenov First Moscow State Medical University, Moscow, Russia

Pub. Date: April 07, 2015

Cite this paper:
Ivashkin V., Drapkina O., Poluektova Ye., Kuchumova S., Sheptulin A. and Shifrin O.. The Effect of a Multi-strain Probiotic on the Symptoms and Small Intestinal Bacterial Overgrowth in Constipation-predominant Irritable Bowel Syndrome: A Randomized, Simple-blind, Placebo-controlled Trial. American Journal of Clinical Medicine Research. 2015; 3(2):18-23. doi: 10.12691/ajcmr-3-2-1


Background and aim: the qualitative and quantitative difference in the intestinal microbiota between irritable bowel syndrome (IBS) patients and healthy volunteers doesn't raise doubts. Small intestinal bacterial overgrowth(SIBO), reported in 9-35% patients with constipation-predominant of irritable bowel syndrome (IBS-C), is involved in the pathogenesis IBS. Elimination of SIBO can lead to improvement of clinical symptoms. The aim of this study was to assess the efficacy of a bifido- and lactobacillis-containing probiotic Florasan-D on the eradicating SIBO and on the severity of clinical symptoms in patients with IBS-C. Methods: this randomized (1 : 1), simple-blinded, placebo-controlled investigation conducted at one centre in Russia.33 patients with IBS-C (clinical type was determined according to ROME III criteria) were randomized to receive a multi-strainprobiotic Florasan-D containing Bifidobacteriumbifidum, Bifidobacteriumlongum, Bifidobacteriuminfantis, Lactobacillus rhamnosus or placebo for 4 weeks: 16 and 17 persons respectively. The intensity of abdominal pain and bloating was estimated by a visual analogue scale (VAS), stool consistency – by a Bristol stool form scale before and after the intervention. Quality of life was assessed by the Short Form-36 questionnaire (SF-36). All subjects were analysed by lactulose hydrogen breath test with using Gastro+ Gastrolyzer (Bedfont, UK) to determine SIBO. Results: patients treated with multi-strainprobiotic Florasan-D reported a reduction in the severity of clinical symptoms: abdominal pain decreased from 4 to 2 point (р=0,003), stool frequency – from 3 to 7 per week (р=0,001) and stoolconsistency – from type 2 to type 3 by a Bristol stool form scale (р=0,001); SIBO was found in 56,3% patients before treatment and no patients had this syndrome after therapy. Patients treated with placebo reported a reduction the severity of abdominal pain only (р=0,028). SIBO in these patients before treatment was revealed in 52,9% and remained in all patients after it. Conclusions: multi-strainprobiotic Florasan-D is significantly more effective than placebo for reduction of clinical symptoms and SIBO elimination in IBS-C patients.

irritable bowel syndrome small intestinal bacterial overgrowth probiotics treatment

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[1]  Ardatskaya M.F. The clinical significance of short-chain fatty acids in the pathology of gastrointestinal tract, thesis for a Doctor's degree, Moscow, 2006.
[2]  Clarke G., Cryan J.F., Dinan T.G., Quigley E.M. Review article: probiotics for the treatment of irritable bowel syndrome-focus on lacticacid bacteria. Aliment PharmacolTher, 35(4): 403-13; Feb 2012.
[3]  Floch M.H., Walker W.A., Madsen K., Sanders M.E., Macfarlane G.T., Flint H.J., Dieleman L.A., Ringel Y., Guandalini S., Kelly C.P., Brandt L.J. Recommendations for probiotic use – 2011 update. J ClinGastroenterol, 45: S. 168-71; 2011.
[4]  Ford A.C., Quigley E.M., Lacy B.E., Lembo A.J. et al. Efficacy of Prebiotics, Probiotics, and Synbiotics in Irritable Bowel Syndrome and Chronic Idiopathic Constipation: Systematic Review and Meta-analysis.Am J Gastroenterol,109(10): 1547-61; 2014.
[5]  Hosseini A., Nikfar S., Abdollahi M. Probiotics use to treat irritable bowel syndrome. Expert OpinBiolTher, 12: 1323-34; 2012.
[6]  Hoveyda N., Heneghan C., Mahtani K.R., Perera R., Roberts N., Glasziou P. A systematic review and meta-analysis: probiotics in the treatment of irritable bowel syndrome. BMC Gastroenterol, 9: 15; 2009.
[7]  Ivashkin V.T., PolouektovaYe. A. Functional gastrontestinal disorders, Moscow, 2013.
[8]  Kellow J.E., Eckersley G.M., Jones M. Enteric and central contributions to intestinal dysmotility in irritable bowel syndrome. Dig Dis Sci, 37: 168-74; 1992.
[9]  Kerckhoffs A.P., Samsom M., Van der Rest M.E. et al. De Vogel J., Knol J., Ben-Amor K., Akkermans L.M. Lower Bifidobacteria counts in both duodenal mucosa-associated and fecal microbiota in irritable bowel syndrome patients. World J Gastroenterol, 15: 2887-92; 2009.
[10]  Khan M.W., Kale A.A., Bere P., Vajjala S., Gounaris E., Pakanati K.C. Microbes, intestinal inflammation and probiotics. Expert Rev GastroenterolHepatol, 6: 81-94; 2012.
[11]  KuchumovaS.Yu., PoluektovaYe.A., Sheptulin A.A., Ivashkin V.T. Physiogical value of intestinal microflora, RJGHC, 21(5): 17-27; 2011.
[12]  KurbatovaА.А. Pathogenetic and clinical significance of system cytokines and claudins in patients with irritable bowel syndrome, thesis for a master's degree, Moscow, 2013.
[13]  Lee K.N., Lee O.Y. Intestinal microbiota in pathophysiology and management of irritable bowel syndrome. World J Gastroenterol. 21: 20-27; 2014.
[14]  Lewis S.J., Heaton K.W. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol, 32(9): 920-24; 1997.
[15]  Malinen E., Rinttilä T., Kajander K., Mättö J., Kassinen A., Krogius L., Saarela M., Korpela R., Palva A.Analysis of the microbiota of irritable bowel syndrome patients and healthy controls with real-time PCR. Am J Gastroenterol, 100: 373-82; 2005.
[16]  Moayyedi P., Ford A. Talley N.J., Cremonini F., Foxx-Orenstein A.E., Brandt L.J., Quigley E.M. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut, 59: 325-32; 2010.
[17]  Ng S.C., Hart A.L., Kamm M.A., Stagg A.J., Knight S.C. Mechanisms of action of probiotics: recent advances. Inflamm Bowel Dis, 15: 300-10; 2009.
[18]  Nucera G., Gabrielli M., Lupascu A., Lauritano E.C., Santoliquido A. et al. Abnormal breath tests to lactose, fructose and sorbitol in irritable bowel syndrome may be explained by small intestinal bacterial overgrowth. Aliment PharmacolTher, 21: 1391-5; 2005.
[19]  OhlandС.,MacNaughtonК. Probiotic bacteria and intestinal epithelial barrier function. Am J PhysiolGastrointest Liver Physiol, 298(6): 807-19; 2010.
[20]  Pimentel M., Chow E.J., Lin H.C. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome. A double-blind, randomized, placebo-controlled study. Am J Gastroenterol,98: 412-9; 2003.
[21]  PoluektovaYe. A., KuchumovaS.Yu., Shifrin O.S., Sheptulin A.A., Ivashkin V.T. Pathogenic role of intestinal microflora changes in patients with irritable bowel syndrome and treatment options, RJGHC, 24(3):89-97; 2014.
[22]  Quigley E.M. Intestinal dysmotility and the irritable bowel syndrome. Ir J Med Sci, 163: 560-1; 2004.
[23]  Rajilić-StojanovićМ., Biagi E., Heilig H.G., Kajander K., Kekkonen R.A., Tims S., de Vos W.M. Global and deep molecular analysis of microbiota signatures in fecal samples from patients with irritable bowel syndrome. Gastroenterology, 141: 1792-1801; 2011.
[24]  Shah E.D., Basseri R.J., Chong K., Pimentel M. Abnormal breath testing in IBS: a meta-analysis. Dig Dis Sci, 55: 2441-9; 2010.
[25]  Vorobyev А.А. Microbiology and immunology, Moscow, 1999.
[26]  Ware J.E., Snow K.K., Kosinski M., Gandek B. SF-36 Health Survey. Manual and interpretation guide. The Health Institute, New England Medical Center. Boston, Mass, 1993.
[27]  Weaver M.E., Lowe N.K. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health, 13(4): P. 227-36; 1990.
[28]  [28]Zvyagintseva T.D., Gridneva S.V. Irritable bowel syndrome, disbiosis, Enterogermina. News of medicine and pharmacy, 17(291); 2009.