Transcript Probiotics and IBS

Probiotics and IBS
Gail A. Cresci, PhD, RD, LD, CNSC
Associate Staff
Gastroenterology/Nutrition
Cleveland Clinic
Cleveland, OH
Disclosures
• Scientific Advisory Board – Advocare
• Scientific Advisory Board - Covidien
• Research Funding, Speaker’s Bureau - Metagenics
Probiotic
“Live microorganisms
which when
administered in
adequate amounts
confer a health benefit
on the host”.
Food and Agricultural Org., WHO, 2001
“Good Little Bugs”
Prebiotics
• Three Necessary Criteria of Ingredient
• Must be non-digestible by host enzymes
• Must be fermented in the GI tract by anaerobic endogenous
bacteria in colon
• Must be selective in the stimulation of intestinal microbiota
and of metabolic activity
• Demonstration of criterion is difficult
• A prebiotic is not available to all bacterial species
that inhabit GI ecosystem
• Lactobacillus and Bifidobacterium considered indicator
organisms
• Simple, naturally occurring or synthetic sugars
• Used as a carbon source by certain colonic bacteria for growth
and metabolism
• Examples: Inulin, fructooligosaccharides (FOS),
galactooligosaccharides (GOS), lactulose
Synbiotic
• Combination of probiotic and prebiotic
• Meets criteria of probiotic and prebiotic
• The prebiotic selectively supports the growth of the probiotic
component
• General Aim:
• Support the probiotic and other indigenous beneficial
organisms by providing a preferred carbon and energy
source to promote its growth
• Provide substrate for optimal or desired fermentation
byproducts of probiotic
Probiotics, Prebiotics, Synbiotics
Biologic Effects and Mechanisms of Action
Patel Clin Infect Dis 2015
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Sept 2007-December 2013
24 Clinical Trials [15 meta-analysis; 9 systematic review]
RCT, evaluating probiotic vs placebo in IBS improvement
Study quality evaluated
• Systematic review was performed to summarize noneligible clinical trials for the meta-analysis that were
excluded because of heterogeneity or different
measurement scales for IBS symptoms
• All the nine studies were classified as randomized
placebo-controlled trials. Four, six, and eight weeks of
treatment with probiotics were reported.
Results
• 1793 patients in meta-analysis
• RR of responders to therapies:
• Abdominal pain score: two trials was 1.96 (95%CI: 1.14-3.36; P =
0.01)
• Global symptom score: two trials was 2.43 (95%CI: 1.13-5.21; P =
0.02)
• Adequate improvement of general symptoms: 7 trials (six studies)
was 2.14 (95%CI: 1.08-4.26; P = 0.03)
• Distension, bloating, and flatulence were evaluated using an IBS
severity scoring system in 3 trials (two studies)
• the standardized effect size of mean differences for probiotics therapy
was -2.57 (95%CI: -13.05--7.92)
• Use of different scales to analyze mean differences of symptoms
makes analysis difficult
• Further studies needed
Summary
• Probiotics reduce pain and symptom severity scores
compared to placebo in IBS patients
• Studies inconsistent with design and outcome
measurement
• Future studies needed with standardization
• Longer treatment needed (8-12 week)
• Ideal probiotic yet to be discovered
References
Patel Clin Infect Dis 2015