Plain language summary
Irritable bowel syndrome (IBS) is the most common functional gut disorder with symptoms primarily of bloating and diarrhea. Recently these symptoms have been associated with small intestinal bacterial overgrowth (SIBO), which occurs when bacteria from the colon resides in the small intestine. The aim of this study was to determine the efficacy of probiotics in improvement of symptoms of IBS patients with SIBO. In this prospective trial, five patients with IBS and SIBO and 21 patients with IBS without SIBO were given probiotic capsules twice a day for 30 days. Participants completed an IBS severity questionnaire at three visits throughout the trial. At the end of the trial, a 71.3% decrease of the total IBS score was detected in patients with IBS and SIBO, compared with those without SIBO. This study found there are clinical benefits from probiotic supplementation in IBS patients with SIBO. Based on these findings, the authors conclude larger, randomised studies be undertaken based on this prospective design.
Abstract
The effect of probiotics on small intestinal bacterial overgrowth (SIBO) in irritable bowel syndrome (IBS) has never been studied so far. In this prospective trial, five patients with IBS and SIBO and 21 patients with IBS without SIBO were administered an oral capsule containing Saccharomyces boulardii, Bifidobacterium lactis, Lactobacillus acidophilus, and Lactobacillus plantarum (Lactolevure®) every 12 h for 30 days. SIBO was defined by quantitative culture of the third part of the duodenum; IBS was defined by the Rome III criteria. Severity of symptoms was graded by the IBS severity scoring system (SSS). The primary study endpoint was the efficacy of probiotics in improvement of symptoms of IBS in patients with SIBO. Thirty days after the end of treatment, a 71.3% decrease of the total IBS score was detected in patients with IBS and SIBO compared to 10.6% in those without SIBO (p 0.017). A similar decrease was achieved among patients with constipation-predominant IBS without SIBO. Post-treatment satisfaction from bowel function was greater in patients with SIBO. Similar satisfaction improvement was found among patients with diarrhea-predominant IBS irrespective from SIBO; pain intensity score decreased in patients with constipation-predominant IBS irrespective from SIBO. The benefit of probiotics was greater among patients with a pro-inflammatory cytokine pattern in the duodenal fluid. This is the first study that prospectively demonstrated superior clinical efficacy of probiotics in patients with IBS with SIBO. Analysis also showed considerable benefit from probiotic intake regarding certain symptoms of patients with diarrhea-predominant and constipation-predominant IBS.Trial registration: ClinicalTrials.gov identifier NCT02204891.
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