|Year : 2017 | Volume
| Issue : 1 | Page : 8-11
Irritable bowel syndrome: The role of probiotics in the systematic and successful treatment of irritable bowel syndrome
Khalid I AlQumaizi1, Amir Halim2, Razique Anwer3, Kamal Halim4, Saleh AlOsaimi5
1 Department of Family Medicine, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Kingdom of Saudi Arabia
2 Department of Gastroenterology, Worthing Hospital, West Sussex, UK
3 Department of Biomedical Sciences, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Kingdom of Saudi Arabia
4 Department of Immunology, College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Kingdom of Saudi Arabia
5 Department of Family Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
|Date of Submission||28-Feb-2018|
|Date of Acceptance||17-Mar-2018|
|Date of Web Publication||27-Apr-2018|
Dr. Razique Anwer
Department of Biomedical Sciences, College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, P. O. Box No. 7544, Riyadh 13317-4233
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Background: Irritable bowel syndrome (IBS) is complicated and time sensitive symptomatic condition with a collection of painful functional disorders of the digestive tract. It has no known established cause; hence it needs the coordination of different specialties to systematically review and establish the main key causes using a broad search in various database.
Methods: A systematic IBS review of published articles past and present, were conducted using different electronic databases. The full text of all articles which met the inclusion and exclusion criteria were reviewed and data were analyzed. The diagnostic value was based on the Manning criteria to observe the major symptoms in IBS.
Results: We report an interesting IBS case in a 50-year-old female of Indian origin who was successfully treated with precision Biotic culture (Bifidobacterium infantis 35624 containing 1 billion bacteria per capsule) designed by scientists specifically for targeted action. The patient has remained asymptomatic for the last 24 months.
Conclusion: Probiotics are basically nutritional supplements that contain good germs (bacteria) which normally live in the gut and seem to be very beneficial. It may help to ward off bad bacteria that cause IBS symptoms. While our result is promising, future trials are important.
Keywords: Abdominal tenderness, bowel, irritable bowel syndrome, Metamucil, symptomatic
|How to cite this article:|
AlQumaizi KI, Halim A, Anwer R, Halim K, AlOsaimi S. Irritable bowel syndrome: The role of probiotics in the systematic and successful treatment of irritable bowel syndrome. Imam J Appl Sci 2017;2:8-11
|How to cite this URL:|
AlQumaizi KI, Halim A, Anwer R, Halim K, AlOsaimi S. Irritable bowel syndrome: The role of probiotics in the systematic and successful treatment of irritable bowel syndrome. Imam J Appl Sci [serial online] 2017 [cited 2018 Sep 20];2:8-11. Available from: http://www.e-ijas.org/text.asp?2017/2/1/8/231380
| Introduction|| |
Irritable bowel syndrome (IBS) is a functional disorder which causes discomfort in the bowel of the colon (large intestine), cramps and abdominal pain, bloating, mucus in the stool, and changes in bowel habits. Some people with IBS have constipation – infrequent stools that may be hard or loose, dry, and painful. Others may have alternating symptoms of constipation, loose stools, and diarrhea.
There are no known structural or biochemical cause that could explain the IBS symptoms. A person with IBS may sometimes have severe symptoms of cramps and urge to move the bowels but are unable to do so. Furthermore, there is no evidence of any colon disease such as ulcers or inflammation. It is often referred to as “spastic colon” or “spastic bowel.” Sometimes, it is confused with inflammatory bowel diseases (IBD) such as ulcerative colitis. In fact, IBS is not a disease, and it does not cause inflammation, bleeding, or damage to the bowel, cancer, or other serious diseases. The bowel does not work as it should and the treatment is usually symptomatic.,,
Health statistics show that between 2.5–3.5 million patients yearly visit physicians with IBS-related symptoms. It usually affects people between the ages of 20 and 30 years but could be in older people above the age of 50 years. IBS can usually affect up to one in five people at some point in their life and around twice as many women are affected as men.
It is not uncommon that treating physicians often misdiagnose IBS as spastic colon, colitis, mucous colitis, and other conditions such as Crohn's disease, coeliac disease, cancer of the ovary, gut infections, or spastic bowel (colon). Muscles in the colon normally contract a few times a day, moving feces along and ultimately resulting in a bowel movement. It is believed that in a person with IBS, these muscles are exceptionally sensitive to certain stimuli and triggers. Certain foods, medications, or stress can provoke a strong response in the colon of a person with IBS.,
Common misunderstandings do persist even though IBS is a recognized and treatable condition, but with no permanent cure. Scientists are still unable to find out why the muscles in the colon of a person with IBS are more sensitive. We are also not exactly sure whether IBS is caused by stress and strong emotion, though it is likely. However, some people may encounter their first flare-up of IBS symptoms during a stressful period in their life such as the death of a relative or loss of a job. These stresses may not cause the condition, but rather aggravate it to the point when it may become more noticeable and troublesome.
Women with IBS may have more symptoms during their menstrual periods and are more likely to complain of pelvic organ prolapsed symptoms. There are definite gender differences between patients with IBS symptoms as the disorder is more common and affects significantly more women than men. Research scientists and gastroenterologists are trying to figure out why this is so. The symptoms can usually last for a long time. There is also no known evidence that IBS could be fully cured, but there are ways to treat the symptoms.,
In some reported cases, IBS symptoms could be so severe and disruptive that it is logical to think that it must be doing some long-term damage to the body or putting the patients at greater risk for malignancy. There is no evidence to date that IBS leads to cancer and affects the overall health or life expectancy.
It has been suggested that 60% of patients are with fibromyalgia syndrome, a disorder of the musculoskeletal system, and 70% have reported experiencing symptoms of IBS. Furthermore, growth of Candida in the digestive tract has also been indicated as a possible cause and incidence of IBS., The procedures followed were in accordance with the ethical standards of the institution.
| Methods|| |
A 50-year-old female patient was presented with digestive complaints of gas, bloating, occasional diarrhea, abdominal tenderness, microscopic hematuria, irregular bowel movement, and constipation. She began experiencing severe pain in her lower abdomen, dyspepsia, and refluxes a year before. Gastroscopy was performed which showed two small acute ulcers in duodenum and mild gastric erythema and 2-cm hiatus hernia. She had campylobacter-like organism biopsy, and Helicobacter pylori was detected which was successfully treated as shown in [Table 1].
Computed tomography (CT) colonoscopy was performed and found to be unremarkable. She also had CT scan of the duodenum which showed 1.2 cm benign left adrenal adenoma. Her symptoms of bloating and gas after eating and also with bowel movements eased. Initially, she was having three to four poorly formed bowel movements daily with occasional constipation. Her symptoms that had been there for the last 2 years improved significantly when she was placed on wheat and milk product exclusion diet, but her symptoms gradually returned. Her lower type 2 diabetes is being controlled with Biguanides–Metformin hydrochloride 500 mg. She reported no family history of IBD or IBS. Physical examination was unremarkable except for occasional burning sensation in the stomach with lower abdominal tenderness and with all the other initial symptoms. Final diagnosis was based on independent clinical evaluation of the patient and manning diagnostic criteria.
| Results|| |
The patient was seen by the gastroenterologist who started her on a trial dairy-free precision biotic supplement containing live Bifidobacterium infantis (B. infantis 35624 containing 1 billion bacteria per capsule). She was instructed to take one capsule a day uninterrupted at least for 4 weeks with food. For digestive support, she was instructed to take advance sodium alginate potassium hydrogen carbonate 5–10 ml tds. In addition, she was asked to reduce her intake of simple sugars and fatty food. Follow-up visits 3 weeks later, there was considerable decrease in symptoms while bloating, gas, and pain had completely dissipated. Her diarrhea and constipation disappeared and bloating and abdominal cramping had completely resolved. She was having one or two well-formed regular bowel movements per day.
Four weeks with probiotics and 48-week postprobiotics, she reported no recurrence of IBS symptoms. She was initially asked by the doctor to continue and restart the probiotics symptomatology if there was a relapse. It is suggested that to obtain the best results, probiotics should be taken for at least 4 weeks to prime the gut and continued thereafter. It is normal but not uncommon to experience mild temporary changes in bowel habits during the first 4 weeks of use.
| Discussion|| |
IBS is regarded as a common problem, affecting up to one in five people. However, estimates of the number of people with IBS vary. The condition is often lifelong although it may improve over several years. IBS can be very uncomfortable and more severe in some individuals. However, it does not lead to serious disease, such as cancer. It also does not permanently harm the large intestine (colon). Among the majority of people with IBS, perhaps 75% are women. It is likely that IBS can be affected by menstrual cycle, risk of suffering from urinary urgency, and sexual or severe physical abuse although pregnancy and menopause result in an improvement. They may have a higher risk of being diagnosed with endometriosis and have significantly higher risk to undergo a hysterectomy and often complain of pelvic organ prolapsed symptoms. Birth control pills and hormone replacement therapy have no effect on IBS symptoms although the hormones estrogen and progesterone are linked with gastrointestinal (GI) symptoms.
Often IBS is just a mild annoyance, but for some people, it can be disabling. They may be unable to go to social events, to go out to a job, or to travel even short distances. Most people with IBS, however, are able to control their symptoms through diet, stress relief, management, and medicines. People with IBS feel severe discomfort in the upper stomach area or feeling uncomfortably full or nauseous after eating a normal size meal. High-fiber foods could help IBS symptoms. This could help IBS symptoms, but it can also help treat dehydration that sometimes happens with diarrhea. Foods do not cause IBS, but eating the right food can ease the symptoms of IBS. Further, exercising regularly is a good way to relieve stress. It also helps the bowel function better and improves overall health. Meditation, yoga, and massage may also help.,,
Psychological factors such as stress may also play a large part in IBS. General stress management is extremely important. Many people who seek care for IBS have anxiety, panic, or depression. Stress is also an issue for people with IBS because it can make the symptoms worse. Psychological therapy can help ease IBS symptoms. It may focus on in-depth discussions about the link between symptoms and emotions. The therapy may also help people identify and resolve interpersonal conflicts and hypnotherapy, where people enter an altered state of consciousness.
Physicians usually perform medical tests to rule out other diseases if there are “red flag” symptoms such as rectal bleeding, weight loss, anemia (iron deficiency), and night-time symptoms such as diarrhea during sleep. They may also look at the family history of colorectal cancer, IBD, or celiac disease. Tests may also include colonoscopy to spot inflamed tissue, abnormal growths, and ulcers. People over age 50 with IBS symptoms may have a colonoscopy to screen for colorectal cancer, even if they do not have any “red flag” symptoms. Blood tests are performed to check for celiac disease if there are certain types of IBS such as IBS-D (mostly diarrhea) or IBS-M (mixed type with diarrhea and constipation). Lactose intolerance may also be a concern for some people.
Doctors may prescribe fiber supplements such as psyllium-ispaghula powder (Metamucil) to help control constipation, anti-diarrheal medications such as loperamide (Imodium), to help control diarrhea, antispasmodic agents such as peppermint oil or dicyclomine to slow contractions in the bowel, which may help with diarrhea and pain, antidepressant medications such as a tricyclic antidepressant or a selective serotonin reuptake inhibitor if symptoms include pain or depression, and IBS medication known as lubiprostone which is approved by the Food and Drug Administration (FDA) for women with severe IBS-C (constipation).,
Clinical research studies and trials using live culture B. infantis PrecisionBiotic 35624™ which was developed for human use by scientists and gastroenterologists have been approved by FDA for human use.,,,
| Conclusion|| |
Our study was based on the Manning criteria which are regarded as a useful and a simple reliable backup tool for the diagnosis of IBS in pain-predominant subgroup. Detailed history taking prevents unnecessary investigations in the diagnosis of IBS.
Several research studies have been conducted on the usefulness of probiotics in patients with IBS but it so far has been inconclusive, and the results obtained were mixed. It is not surprising because the use of different probiotics is like using different drugs. Probiotics are basically nutritional supplements that contain good germs (bacteria) which normally live in the gut and seem to be very beneficial. It may help to ward off bad bacteria that cause IBS symptoms. While our result is promising, future trials are important.
We believe that this is the first case where probiotics have been successfully used to treat IBS resulting in a prolonged, prompt clinical improvement and resolution of all the symptoms with no side effects. This benign treatment holds great therapeutic promise where doctors can confidently prescribe precision Biotic 35624 live B. infantis on a routine basis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
The work was not supported or funded by any Source. The authors have had absolutely no interest in the company or the institute which manufactures PrecisionBiotic 35624. The treatment was initiated and was based on free samples obtained from their representative agent.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ford AC, Moayyedi P, Lacy BE, Lembo AJ, Saito YA, Schiller LR, et al.
American college of gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol 2014;109 Suppl 1:S2-26.
Sainsbury A, Ford AC. Treatment of irritable bowel syndrome: Beyond fiber and antispasmodic agents. Therap Adv Gastroenterol 2011;4:115-27.
Jeong H, Lee HR, Yoo BC, Park SM. Manning criteria in irritable bowel syndrome: Its diagnostic significance. Korean J Intern Med 1993;8:34-9.
Camilleri M. Peripheral mechanisms in irritable bowel syndrome. N
Engl J Med 2012;367:1626-35.
Cristofori F, Fontana C, Magistà A, Capriati T, Indrio F, Castellaneta S, et al.
Increased prevalence of celiac disease among pediatric patients with irritable bowel syndrome: A 6-year prospective cohort study. JAMA Pediatr 2014;168:555-60.
American College of Gastroenterology Task Force on Irritable Bowel Syndrome, Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, et al.
An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 2009;104 Suppl 1:S1-35.
Muir JG, Gibson PR. The low FODMAP diet for treatment of irritable bowel syndrome and other gastrointestinal disorders. Gastroenterol Hepatol (N
Whorwell PJ, Altringer L, Morel J, Bond Y, Charbonneau D, O'Mahony L, et al.
Efficacy of an encapsulated probiotic Bifidobacterium
infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol 2006;101:1581-90.
Brenner DM, Chey WD. Bifidobacterium
infantis 35624: A novel probiotic for the treatment of irritable bowel syndrome. Rev Gastroenterol Disord 2009;9:7-15.
Brenner DM, Moeller MJ, Chey WD, Schoenfeld PS. The utility of probiotics in the treatment of irritable bowel syndrome: A systematic review. Am J Gastroenterol 2009;104:1033-49.
Charbonneau D, Gibb RD, Quigley EM. Fecal excretion of Bifidobacterium
infantis 35624 and changes in fecal microbiota after eight weeks of oral supplementation with encapsulated probiotic. Gut Microbes 2013;4:201-11.