IBS
Probiotics could act as analgetics in Irritable Bowel Syndrome (IBS)?
Kerckhoffs A.
IBS is a multifactorial disease with unknown etiology. IBS is characterized by symptoms of abdominal pain and altered defecation. Treatment of IBS therefore not only has to improve the defecation pattern but also to diminish the abdominal pain.
Recently Desreumaux et al. (Nature, dec 2006) have shown that Lactobacillus acidophilus can modulate intestinal pain. In intestinal cell lines µ-opiod and cannabinoid recptors could be induced when L.acidophilus NCFM is added to the cell lines.
Moreover, in animal models increasing dosages (107 up to 109 CFU/dose for 15 days) L.acidophilus given to rats increased the threshold for visceral hypersensitivity. In this rat model, mimicking IBS, hypersensitivity improved with 44% in L.acidophilus treated rats which are comparable to the antinociceptive effect of 1 mg morphine per kg of body weight subcutaneously. These results from animal models are therefore very promising however tests of the effect of L.acidophilus on visceral hypersensitivity in human have to be performed.
In conclusion, modulation of the intestinal flora by probiotics may be a safe and relatively inexpensive new treatment for the abdominal pain in patients with irritable bowel syndrome.
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Analysis of the fecal microbiota of irritable bowel syndrome patients and healthy controls with real-time PCR
Malinen E., Rinttila T., Kajander K., Matto J., Kassinen A., Krogius L., Saarela M., Korpela R., Palva
OBJECTIVE: The gut microbiota may contribute to the onset and maintenance of irritable bowel syndrome (IBS). In this study, the microbiotas of patients suffering from IBS were compared with a control group devoid of gastrointestinal (GI) symptoms.
METHODS: Fecal microbiota of patients (n = 27) fulfilling the Rome II criteria for IBS was compared with age- and gender-matched control subjects (n = 22). Fecal samples were obtained at 3 months intervals. Total bacterial DNA was analyzed by 20 quantitative real-time PCR assays covering approximately 300 bacterial species.
RESULTS: Extensive individual variation was observed in the GI microbiota among both the IBS- and control groups. Sorting of the IBS patients according to the symptom subtypes (diarrhea, constipation, and alternating predominant type) revealed that lower amounts of Lactobacillus spp. were present in the samples of diarrhea predominant IBS patients wheras constipation predominant IBS patients carried increased amounts of Veillonella spp. Average results from three fecal samples suggested differences in the Clostridium coccoides subgroup and Bifidobacterium catenulatum group between IBS patients (n = 21) and controls (n = 15). Of the intestinal pathogens earlier associated with IBS, no indications of Helicobacter spp. or Clostridium difficile were found whereas one case of Campylobacter jejuni was identified by sequencing.
CONCLUSIONS: With these real-time PCR assays, quantitative alterations in the GI microbiota of IBS patients were found. Increasing microbial DNA sequence information will further allow designing of new real-time PCR assays for a more extensive analysis of intestinal microbes in IBS. (Am J Gastroenterol 2005;100:1-10).
Am J Gastroenterol. 2005 Feb;100(2):373-82
On Pubmed
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Treatment options in irritable bowel syndrome
Farthing M.J.
The irritable bowel syndrome (IBS) is part of the spectrum of functional bowel disorders characterised by a diverse consortium of abdominal symptoms including abdominal pain, altered bowel function (bowel frequency and/or constipation), bloating, abdominal distension, the sensation of incomplete evacuation and the increased passage of mucus. It is not surprising therefore that no single, unifying mechanism has as yet been put forward to explain symptom production in IBS.
The currently favoured model includes both central and end-organ components which may be combined to create an integrated hypothesis incorporating psychological factors (stress, distress, affective disorder) with end-organ dysfunction (motility disorder, visceral hypersensitivity) possibly aggravated by sub-clinical inflammation as a residuum of an intestinal infection. There is currently no universally effective therapy for IBS.
Standard therapy generally involves a symptom-directed approach; anti-diarrhoeal agents for bowel frequency, soluble fibre or laxatives for constipation and smooth muscle relaxants and anti-spasmodics for pain. New drug development has focused predominantly on agents that modify the effects of 5-hydroxytryptamine (5-HT) in the gut, principally the 5-HT(3) receptor antagonists for painful diarrhoea predominant IBS and 5-HT(4) agonists for constipation predominant IBS. More speculative new therapeutic approaches include anti-inflammatory agents, antibiotics, probiotics, antagonists of CCK1 receptors, tachykinins and other novel neuronal receptors.
Best Pract Res Clin Gastroenterol. 2004 Aug;18(4):773-86.
On Science Direct
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