Gastroenterology

Gastroenterology

Volume 128, Issue 3, March 2005, Pages 541-551
Gastroenterology

Clinical-alimentary tract
Lactobacillus and bifidobacterium in irritable bowel syndrome: Symptom responses and relationship to cytokine profiles

https://doi.org/10.1053/j.gastro.2004.11.050Get rights and content

Background & Aims: The aim of this study was to compare the response of symptoms and cytokine ratios in irritable bowel syndrome (IBS) with ingestion of probiotic preparations containing a lactobacillus or bifidobacterium strain. Methods: Seventy-seven subjects with IBS were randomized to receive either Lactobacillus salivarius UCC4331 or Bifidobacterium infantis 35624, each in a dose of 1 × 1010 live bacterial cells in a malted milk drink, or the malted milk drink alone as placebo for 8 weeks. The cardinal symptoms of IBS were recorded on a daily basis and assessed each week. Quality of life assessment, stool microbiologic studies, and blood sampling for estimation of peripheral blood mononuclear cell release of the cytokines interleukin (IL)-10 and IL-12 were performed at the beginning and at the end of the treatment phase. Results: For all symptoms, with the exception of bowel movement frequency and consistency, those randomized to B infantis 35624 experienced a greater reduction in symptom scores; composite and individual scores for abdominal pain/discomfort, bloating/distention, and bowel movement difficulty were significantly lower than for placebo for those randomized to B infantis 35624 for most weeks of the treatment phase. At baseline, patients with IBS demonstrated an abnormal IL-10/IL-12 ratio, indicative of a proinflammatory, Th-1 state. This ratio was normalized by B infantis 35624 feeding alone. Conclusions: B infantis 35624 alleviates symptoms in IBS; this symptomatic response was associated with normalization of the ratio of an anti-inflammatory to a proinflammatory cytokine, suggesting an immune-modulating role for this organism, in this disorder.

Section snippets

Study population

Patients were recruited from gastroenterology clinics at Cork University Hospital and by direct advertisement on the university campus and in a local newspaper. Individuals aged between 18 and 75 years who satisfied Rome II criteria for the diagnosis of IBS3 and in whom organic gastrointestinal diseases, including inflammatory bowel disease, and clinically significant systemic diseases had been excluded were considered for inclusion in the study. Pregnant women, individuals with known lactose

Subjects

A total of 80 subjects were enrolled in the study. Two subjects (1 randomized to B infantis 35624 and 1 to placebo) were subsequently found to have taken antibiotics from the beginning of the treatment phase and were therefore determined to be nonevaluable. A further 3 subjects dropped out before the treatment phase. Therefore, 75 subjects provided some evaluable data. Of these, 3 subjects took an antibiotic during the course of the study; only data up to the commencement of antibiotic use were

Discussion

In this study, we compared, for the first time, the effects of 2 probiotic strains on symptoms in patients with IBS. We have shown superiority for bifidobacterium over both a lactobacillus and placebo for each of the cardinal symptoms of IBS and for a composite score. These symptomatic benefits were associated with parallel trends in a quality-of-life measure developed specifically for IBS.64 Furthermore, this therapy was well tolerated and free of significant adverse events. Interestingly,

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  • Cited by (0)

    Supported in part by Science Foundation Ireland in the form of a centre grant (Alimentary Pharmabiotic Centre), the Health Research Board of Ireland, the Higher Education Authority of Ireland, and the European Union (PROGID QLK-2000-00563). The authors are affiliated with a multidepartmental university campus company (Alimentary Health Ltd) that investigates host-flora interactions and the therapeutic manipulation of these interactions in various human and animal disorders. The content of this report was neither influenced nor constrained by this fact.

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