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

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

Abstract

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.

Keywords

irritable bowel syndrome, small intestinal bacterial overgrowth, probiotics, treatment

Copyright

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