The Role of Lactic Acid Bacteria in the Pathophysiology and Treatment of Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is a multifactorial chronic disorder characterized by various abdominal complaints and a worldwide prevalence of 10% - 20%. Although its etiology and pathophysiology are complex and still not completely understood, aberrations along the microbe-gut-brain axis are known to play a central role. IBS is characterized by interrelated alterations in intestinal barrier function, gut microbe composition, immune activation, afferent sensory signaling and brain activity. Pharmaceutical treatment is generally ineffective and, hence, most therapeutic strategies are based on non-drug approaches. A promising option is the administration of probiotics, in which lactic acid bacteria strains are considered specifically beneficial. This review aims to provide a concise, although comprehensive, overview of the role of lactic acid bacteria in the pathophysiology and treatment of IBS.

A Simultaneous Multidisciplinary Evaluation of Irritable Bowel Syndrome in Egyptian Patients: Dietary, Psychiatric, Microbiologic and Autonomic Aspects

Background and Aim: Irritable bowel syndrome (IBS) is a common medical disorder that may be severe enough to impair the quality of life. This study aimed to assess the role of each of dietary, psychiatric, autonomic, and microbiology background and their interactions in Egyptian patients with IBS. Patients and Methods: Forty adult patients diagnosed with IBS, equally divided into 2 groups the diarrhea predominant and the constipation predominant, were recruited from the Endoscopy Unit. Dietary assessment was done by monthly food frequency questionnaire. Psychiatric assessment was done by both the Eysenck Personality Questionnaire (EPQ) and Hopkins Symptom Checklist (HSCL-90). Microbiologic evaluation was done by faecal cultures and neurophysiologic autonomic evaluation was done via the sympathetic skin response and the parasympathetic R-R interval variation. Another 20 healthy subjects were included as control group. Results: All IBS patients were young, with significant female predominance (P = 0.007), particularly in IBS-C group (20/20;100%, P = 0.003). Psychologically, abnormal scores of neuroticism, extraversion and criminality, and depression, obsessive compulsion, somatization, sensitivity and anxiety in both IBS groups with particularly extraversion, criminality and depression were significantly higher in constipation subtype. Microbiologically, Bacteroids were significantly related to IBS, while Klebsiella was significantly deficient without significant difference between its groups. On the contrary, neither diet nor autonomic activity showed any significant relation. Conclusions: IBS is a disorder induced by many factors and affected by several interacting agents, thus revealing controversial results when studied simultaneously.

Treatment of irritable bowel syndrome with multi-herbal formula: A case report

Background: Many patients with irritable bowel syndrome (IBS) try the approach of complementary or herbal medicines, as western medications do not treat IBS. The current case report presents the combine effect of four herbal components as a traditional treatment of IBS. Method: The herbal components were purchased from the local market. The components including Lipidium sativum L., Trigonella foenum-graceum L., Myristica fragrance Hoyutt. and Apium graveolens Linn were ground and mixed well (dry weight), and took orally for two days as advised by the local healer. Results: The symptoms included loose bowel movements accompanied by prolonged flatulence abdominal cramping, faecal urgency as well as mucus discharge were improved and remain suppressed for 5 to 6 months afterthe treatment with multi-herbal formula. Conclusion: The current case report showed that the multi-herbal formula might be a promising treatment for IBS-diarrhoea.

A Meta-analysis of Acupuncture Treatment for Irritable Bowel Syndrome

To assess the efficacy of acupuncture for treatment of irritable bowel syndrome through meta-analysis of randomized controlled trials in recent 20 years.Online databases,including CNKI,VIP,WANFANG,PubMed,Cochrane Library,Web of Science and Embase were searched for randomized controlled trials(RCTs)of acupuncture for IBS.Retrieval time was from January 1,2000 to January 31,2021.According to Jadad scoring criteria,the bias risk and quality assessment of each RCT included were evaluated by two researchers.RevMan 5.3 software was used for the metaanalysis.Eight RCTs were selected which include a total of 1181 patients.The control group has 425 patients and the experimental group has 756 patients.The result of meta-analysis indicates that the total effective rate for the experimental group was superior to that of the control group[OR=3.29,95%CI[2.16~5.03](P<0.01)],and the funnel plot was basically symmetric.Acupuncture therapy is shown to have a good safety and compliance record.However,the number of high-quality trials is small,and there are some deficiencies in the methodology of clinical research.Acupuncture,as a supplementary therapy for irritable bowel syndrome,has positive clinical significance and prospects for application.The methodology of clinical research needs to be further improved.

A probiotic treatment containing Lactobacillus,Bifidobacterium and Enterococcus improves IBS symptoms in an open label trial

Objective： To evaluate the efficacy and safety of live combined Bifidobacterium, Lactobacillus and Enterococcus capsules in treatment of irritable bowel syndrome, Methods： Eighty-fve patients [male 32, female 53; age （45.31±11,72） years] were given live combined Bifidobacterium, Lactobacillus and Enterococcus capsules 1260 mg/d t.i.d. ×4 weeks. Syndrome scales were used to evaluate the efficacy in gastrointestinal syndrome. Fecal flora was also measured before and after the treatment. Six bacteria were cultured and the colony forming units were counted in stool. SPSS was used for data analysis. Results： Seventy-four patients finished the follow-up. No side-effect was found. For treatment of irritable bowel syndrome, the effective rate of live combined Bifidobacterium, Lactobacillus and Enterococcus capsules was 56.8% in the second week, 74.3% in the fourth week and 73.0% in the sixth week. Single symptom was improved, especially in abdominal pain and stool character. The probiotica containing live combined Bifidobacterium, Lactobacillus and Enterococcus could increase bifidobacterium count （P〈0.01） and lactobacillus count （P〈0.05）; decrease bacteroides count （P〈0.05） and enterococci count （P〈0.01）; No obvious changes were observed in clostridium diffcile colonitis and enterobacteriaceae （P〉0.05）. Conclusion： The result of the study indicated that the administration of live combined Bifidobacterium, Lactobacillus and Enterococcus improved the symptom of irritable bowel syndrome and that there was a gradual increase of this effect. Thereafter conditions remained stable for 2 weeks. That improvement may be associated with alterations in gastrointestinal flora.

Visceral and somatic hypersensitivity, autonomic cardiovascular dysfunction and low-grade inflammation in a subset of irritable bowel syndrome patients

The pathophysiology of irritable bowel syndrome（IBS） is complex and not fully understood, so the aim of this study was to evaluate whether visceral and somatic hypersensitivity, autonomic cardiovascular dysfunction, and low-grade inflammation of the gut wall are associated with diarrhea-predominant IBS（D-IBS）. Sixty-two patients with D-IBS and 20 control subjects participated in the study. Using the ascending method of limits（AML） protocol, we demonstrated that D-IBS patients had significantly lower sensory thresholds compared with healthy controls（P〈0.001）. Using diverse methods, especially the ischemic sensitivity test, for the first time in China, we confirmed that D-IBS patients have somatic hypersensitivity. They had a significantly higher systolic blood pressure and heart rate after a cold stimulus, indicative of autonomic cardiovascular dysfunction. Compared with the control group, D-IBS patients had a significantly higher level of calprotectin（P〈0.001）. We also found significant correlations between visceral and somatic hypersensitivity, visceral hypersensitivity and autonomic cardiovascular dysfunction, and somatic hypersensitivity and autonomic cardiovascular dysfunction. Our findings may provide valuable suggestions for the treatment of D-IBS.

A cross-sectional study of irritable bowel syndrome in nurses in China: prevalence and associated psychological and lifestyle factors

The prevalence of irritable bowel syndrome （IBS） and associated factors, especially psychological and lifestyle factors, in nurses in China have not been investigated previously. The aims of this study were to assess the prevalence of IBS in nurses, to evaluate whether factors, such as psychological disorders, are associated with IBS, and to determine whether psychological disorders can influence the severity of symptoms of IBS and quality of life （QOL）. A cross-sectional study was conducted for Chinese nurses from November 2012 to February 2013. Partici- pants were asked to complete questionnaires. The prevalence of IBS was 17.4%. The revised symptom checklist 90 （SCL-90-R） scores were significantly higher for nurses with IBS than for those without IBS （P〈0.001）, and no difference in scores between IBS subtypes was found （F=1.893, P=-0.142）. The scores of QOL for nurses with and without IBS were 77.18±21.93 and 88.44±11.89 （P〈0.001）, respectively. Psychological disorders did not show statistically significant correlations with severity of symptoms of IBS or QOL. Alcohol consumption, low level of exercise, and psychological disorders were risk factors for IBS. In summary, nurses in China show a high prevalence of IBS. Psy- chological disorders and some related lifestyle factors are probably responsible for the development of IBS in nurses.

Symptoms and Their Interpretation in Patients Self-Treating Abdominal Cramping and Pain with a Spasmolytic(Butylscopolamine Bromide)—A Pharmacy-Based Survey

Background: A majority of people suffering from functional abdominal complaints treat themselves with OTC medication. Aim: To gain information on symptoms and their interpretation in patients self-treating abdominal cramping and pain with a spasmolytic (butylscopolamine). Method: 4,680 questionnaires were distributed by 306 pharmacists in Germany to patients suffering from abdominal complaints and buying butylscopolamine. Key findings: Questionnaires from 1,539 respondents were returned, and 1,417 could be evaluated. Abdominal cramping was the major reason for buying butylscopolamine. Only a minority of respondents had consulted a general practitioner (27.3%) and even less a specialist (12.5%). Only a minority of subjects met expert criteria for irritable bowel syndrome (13%). There was a large overlap between self-reported dysmenorrhoea and bowel symptoms (35%). Conclusions: Real life conditions do not seem to be well covered by expert criteria. Differentiating bowel origin from uterine origin in pelvic pain syndromes seems especially problematic. This may particularly apply to the OTC market.