Abstract
OBJECTIVE To explore the changes in microbial composition and the corresponding impact after lactitol treatment in constipated patients. METHODS Altogether 29 consecutive outpatients diagnosed with chronic constipation from three centers were recruited and stratified based on their history of diabetes mellitus. All patients were administered with oral lactitol for 2 weeks, and a symptoms diary of constipation was recorded. Fecal samples were collected before and after lactitol treatment, and were analyzed by 16S rRNA sequencing and real-time polymerase chain reaction (PCR) to detect gut microbiota. RESULTS Twenty patients with diabetes mellitus and nine without, all with chronic constipation, were enrolled in this study. After 2-week administration of lactitol, their subscale scores and constipation symptoms significantly decreased (P < 0.05). An analysis of fecal flora using 16S rRNA sequencing found an increasing trend of abundance of Bifidobacterium in the post-lactitol group (P = 0.08). Actinobacteria, Actinobacteria, Bifidobacteriales, Bifidobacteriaceae and Bifidobacterium were significantly more abundant after lactitol administration. Real-time PCR showed significantly high DNA copy numbers of Bifidobacterium after lactitol treatment (1.39 × 1010 vs 2.74 × 109 copies/μL, P = 0.01). The results of 16S rRNA sequencing and real-time PCR illustrated an increasing trend of Bifidobacterium in both patients with and without diabetes. In addition, Bifidobacterium was negatively correlated with constipation subscale scores. CONCLUSIONS Alterations in fecal flora composition after lactitol supplementation, especially in terms of an increasing trend of Bifidobacterium, alleviated constipation symptoms. Lactitol may be a promising prebiotic candidate for patients with constipation, regardless of diabetes mellitus.
