Brynlee Kelmanson

HUN3800
12/22/2013
What are the benefits of using probiotics in patients with Irritable Bowel
Syndrome (IBS)?

Introduction
There are numerous benefits of using probiotics in irritable bowel syndrome
patients (IBS). IBS is a chronic gastrointestinal disorder with symptoms such as
abdominal pain, bloating, gas, and skewed bowel habits consisting of diarrhea or
constipation1,5. It is not a disease but a group of symptoms that occur together. IBS
affects 10-15 percent of the population in Western countries1,5 and it is twice as likely to
occur in women as in men1. It is also more common in patients who are under 50 years
old and in low socioeconomic groups1. The problem of IBS is overwhelming. Every year
in the United Sates, there are three to five million IBS related physician visits,
accounting over $45 billion in expenses9. This huge dilemma has caused people to do
further research on the benefits of probiotics with IBS patients1.
Probiotics are live microorganisms, which prevent harmful bacteria from
colonizing in the digestive system. In Greek pro means life; human bodies need
these living microorganisms to thrive2. When people consume probiotics, their main
goal is to survive the passage through the upper digestive tract and colonize or
establish themselves in the lower gastrointestinal tract mainly in the colon 2. Probiotics
have many beneficial effects on peoples health. People can obtain these probiotics
through various foods and beverages such as yogurt with live cultures, microalgae, and
olives. Also from fermented foods such as kefir, sauerkraut, kimchi, pickles, and a
fermented tea known as kombucha. Miso, tempeh, and some soy beverages are foods
from soy that contain probiotics. Probiotic supplements may also be consumed. A
product must have 100 million live active bacteria per gram to be called a probiotic 2.
Probiotics can be used to prevent or treat IBS, as well as other conditions. Probiotics

keep pathogenic bacteria from colonizing by strengthening the mucosal barrier to

stabilize intestinal absorbency or by competing for attachment sites on the intestinal
mucosa. They also produce fermentation products to acidify the colonic ph2.
Body
Probiotics have been deemed efficacious by many randomized clinical trials and
systematic reviews. Verna and Lucak from the Division of Digestive and Liver Diseases
concluded that probiotics may alter microflora in the intestine and exert their effects in
many different ways. Since there are so many different kinds of probiotics it is well
known that they are not equal. The effectiveness can be attributed by a single strain,
multiple strains, or a combination of different probiotics. B. infantis 35624 has
respectable evidence for its beneficial effect on IBS patients. IBS patients are
diagnosed with different symptoms. Those with acute infectious diarrhea have seen a
decrease in its duration after administration of probiotics3. According to one clinical trial
assessing the efficacy of probiotics in Irritable Bowel Syndrome, probiotics given to the
military concluded, the evidence strongly indicates that probiotics are efcacious for
the improvement of IBS symptoms in adults.7
A study published in Clinical Therapeutics documents the benefits of using
probiotics in patients with irritable bowel syndrome. The study was conducted by Alvah
C. Bittner, PhD, CPE; Robert M. Croffut, BA; and Mary C Stranahan, DO, MA. The
study used Prescript-Assist, which is a probiotic-prebiotic treatment for IBS, and a
placebo to test and compare the results with a goal of decreasing symptoms in IBS
patients1.
PrescriptAssist is a treatment that combines probiotic and prebiotic
components. The probiotic component is a combination of 29 soil based

microorganisms. The prebiotic component is a combination of many different

substances; the most recurring is leonardite, which enhances the proliferation of soil
based organisms. The treatment was developed in 1992 and was marketed as a
nutraceutical drug1.
This was a randomized placebo controlled study conducted on 25 adults ranging
from age 20 to 70, 23 of whom were women and two were men. In order to be
considered for the study, participants had to meet the minimum requirements of the
Rome II Criteria. The criteria required that participants experienced 12 weeks of
symptoms in the previous 12 months; it was not necessary to experience an IBS
episode at the time of the study. However the researchers did want candidates who
were experiencing IBS symptoms such as abdominal discomfort or pain. The patients
were asked to fill out a questionnaire that asked about 13 different IBS symptoms. They
were asked if they had the symptoms and on what scale, zero being none and five
being high. This questionnaire was given out seven days prior to the study start date.
The sample size was well selected and was well prepared for the study. The PrescriptAssist was given to 12 of the patients and the placebo was given to 13 of the patients
randomly and blindly. The 12 patients with the Prescript-Assist took one 500 mg BID
and the remaining 13 patients took one 500 mg placebo BID1.
The researchers conducted a maximum likelihood analysis to assist in their data
analysis. It was a clear way to focus the attention on certain symptoms of IBS and to
later analyze the results. After the maximum likelihood analysis, the researchers found
that the most common of the symptoms had three main factors. The first factor was
general ill feeling/nausea, the second factor was indigestion/flatulence, and the third

was colitis. The main IBS symptoms associated with the first factor were general ill
feelings/malaise, overall feeling of weakness, and drowsiness/sleepiness. The main IBS
symptoms associated with the second factor were indigestion/dyspepsia and flatulence.
The main IBS symptom associated with the third factor was colitis1.
The results of the study were clear and positive. All of the factors were reduced
significantly by the patients who were using Prescript-Assist. The patients were tested
after the first week of the study, which is when the most significant decrease was
recorded. The patients were also tested after the second week of the study and the
decrease in symptoms was not significantly noted. The study did not conclude whether
or not symptoms would continue to decrease or if the patient would need to increase his
or her dosage to continue to experience symptom relief 1.
One clinical trial portrayed that Lactobacillus plantarum 299v (DSM 9843)
improves the symptoms of patients with irritable bowel syndrome. A four week
treatment with L. plantarum 299v (DSM 9843) provided effective symptom relief,
particularly of abdominal pain and bloating, in IBS patients fulfilling the Rome III
criteria.4 Daily frequency and pain severity was substantially lowered in those taking
lactobacillus plantarum as opposed to the placebo4.
The Gut Microbiota and Irritable Bowel Syndrome: Friend or Foe? is a
systematic review article that analyzes the quantitative and qualitative microbiota
changes, the gut microbiota in health, and therapeutic manipulations targeting the
microbiota in IBS patients. Clinical characteristics of Small Intestinal Bacterial
Overgrowth (SIBO) may be caused by qualitative or quantitative changes in the
microbiota of the small intestine. This systematic article is a good summary of the

history, causes, and the symptoms of IBS. Also, it clearly states how alterations in the
gut microbiota could most likely have a beneficial relationship to IBS. The article
concludes from multiple studies that IBS patients tend to have a higher diversity of total
bacteria along with Lacto bacillus compared to the healthy control group. Several
methodologies were used during multiple studies, including PCR-based molecular
technologies, classic culture-based techniques, microarray, denaturation gradient gel
electrophoresis (DGGE), high-throughput sequencing based on 16 s r RNA, and GC
profiling6. The direct bearing on the health of the patient is that targeting the gut
microbiota using probiotics will greatly benefit patients with IBS. Probiotics may increase
the efficiency of antibiotics and reduce gastrointestinal pathogens by the production of
antibacterial molecules including bacteriocins6.
The intestinal barrier, specifically the intestinal epithelium, tends to be leaky in
patients with IBS, Crohns disease, ulcerative colitis, and food-borne infections. This
barrier can be strengthened by probiotics, such as L. plantarum, and fermented milk
with Bifidobacterium longum, Lactobacillus bulagaris, Lactobacillus acidophilus, and
Streptococcus thermophiles6.
Table 2, the summary of prevalence of SIBO in IBS patients by different
diagnostic methods, portrays that a higher percentage of SIBO was found in patients
with IBS versus those without IBS. IBS symptoms were alleviated through the
administration of antibiotics, probiotics, neomycin, and rifaximin6.
For over 100 years, humans have safely consumed probiotics through food,
beverages, or supplementation in general3. One epidemiological study, Saxelin showed

no increase in Lactobacillus infections in healthy individuals in areas with documented

large rises of use of Lactobacillus-containing products.3
There are numerous risks and disadvantages of IBS medications. Safety is one
of the major risks. Recent medications have had negative effects including increasing
the risk of IBS and harming the individual. Thus, many of these medications have been
pulled from the market3. Although probiotics have numerous health benefits, recent
studies2,3 have revealed that those with a compromised immune system should avoid
taking probiotics or talk to their doctor before taking them. A double-blind, randomized,
placebo-controlled trial showed a 16% increase in mortality and no decrease in the
infectious complications of severe acute pancreatitis hospitalized patients. Specifically,
in GI disorders in which gut permeability and gut immunity may be compromised,
adding probiotics may increase translocation of bacteria into the bloodstream.3 The
accessibility is limited in many IBS medications. Medical bills and hospital visits are
more costly than the expenses of just consuming probiotics alone. Probiotics may
enable the individual to prevent complications of IBS including unnecessary surgery,
risky diagnostic procedures, and adverse medication side effects from being prescribed
multiple medications.9
Conclusion
I chose to do this topic because all of my life I have had serious abdominal pains
that no doctor has been able to diagnose. I have attempted various medications but all
of them have given me tremendous pains and made the symptoms worse. Some of my
friends and extended family told me about IBS and I researched it. My symptoms
matched up so I decided to take matters into my own hands and changed my diet

completely. By changing my diet to a vegan diet it has alleviated my symptoms

enormously. However, I still have occasional pain. I did some more research and
discovered that probiotics are essential to the vegan diet and also bring relief to IBS
patients. This topic is important not only for me but for others who suffer from IBS or
possibly other digestive illnesses.
I have learned that certain articles tend to be biased due to the studies funding
or sponsorship. Certain medications or food companies may have a substantial stake in
the outcome of the study which then would influence buyers decisions. The process
leading up to this literature review changed the way I read research articles from
journals because it enables me to read more in depth. By reading the articles more in
depth, I can be more wary of the bias within the articles. It also allowed me to be more
aware of the details of the article. It is important for me to be wary because if I
experience the symptoms myself I would not want my buying decisions to be swayed by
certain biased studies and articles.
After my close analysis of several research based articles and systematic
reviews, I have concluded that probiotics can play a crucial part in patients with IBS to
alleviate, prevent, or treat their symptoms. This topic is significant because patients with
IBS are faced with severe symptoms and probiotics are cheaper, safer, and more
effective compared to other medications. My evidence based research through scientific
studies has supported my conclusions because probiotics have been shown to be
nutritionally beneficial for patients with IBS.
It is essential for dieticians to have a strong knowledge of probiotics in order to
deal with IBS patients. Dieticians should be able to focus on dietary management of the

individual with IBS by restricting their caffeine and alcohol intake, adjusting dietary fiber
content, avoiding fermentable carbohydrates such as onions, apples, cabbage, and
pears, and avoiding foods or beverages that are high in lactose. They should also
inform the IBS patient to not only change their diet but also incorporate specific lifestyle
changes such as stress management, exercise, and relaxation. Research from the
Gastroenterology Specialist Group (GSG) of the British Dietetics Association revealed
that diet may be significant in managing symptoms of IBS. 5
Although there have been several research studies done on probiotics and IBS,
more research done on the topic will further assure the public of probiotics
effectiveness, make its use more widespread, and reduce the usage of harmful
medications. Through evidence based research, probiotics have been shown by
scientific studies to be significantly beneficial to patients with Irritable Bowel Syndrome
(IBS).

References
1. Bittner A, Croffut R, Stranahan M. PRESCRIPT-ASSIST probiotic-prebiotic
treatment for irritable bowel syndrome: a methodologically oriented, 2-week,
randomized, placebo-controlled, double-blind clinical study. Clinical
Therapeutics [serial online]. June 2005;27(6):755-761. Accessed October 20,
2013.
2. Gropper, Sareen S., and Jack L. Smith. Advanced Nutrition and Human
Metabolism. 6th ed. Belmont, CA: Wadsworth, 2012 (141-161).
3. Verna E, Lucak S. Use of probiotics in gastrointestinal disorders: what to
recommend?. Therapeutic Advances In Gastroenterology [serial online].
September 2010;3(5):307-319. Accessed October 20, 2013.
4. Ducrott P, Sawant P, Jayanthi V. Clinical trial: Lactobacillus plantarum 299v
(DSM 9843) improves symptoms of irritable bowel syndrome. World Journal
Of Gastroenterology: WJG [serial online]. August 14, 2012;18(30):40124018.. Accessed October 07, 2013.
5. Phillips F. Managing patients with IBS - Can diet and probiotics help?.
Practice Nurse [serial online]. December 14, 2012;42(19):24-27. Accessed
October 10, 2013.
6. Ghoshal U, Shukla R, Ghoshal U, Gwee K, Ng S, Quigley E. The Gut
Microbiota and Irritable Bowel Syndrome: Friend or Foe?. International
Journal Of Inflammation [serial online]. 2012;:1-13. Accessed October 2,
2013.
7. Rogers N, Mousa S. The Shortcomings of Clinical Trials Assessing the
Efficacy of Probiotics in Irritable Bowel Syndrome. Journal Of Alternative &
Complementary Medicine [serial online]. February 2012;18(2):112-119.
Accessed October 19, 2013.
8. Thompson, Janice, Melinda Manore, and Linda A. Vaughan. The Science of
Nutrition. 2nd ed. San Francisco, CA: Pearson Benjamin Cummings, 2011
(169-199). Gropper, Sareen S., and Jack L. Smith.
9. Trinkley K, Nahata M. Treatment of irritable bowel syndrome. Journal Of
Clinical Pharmacy & Therapeutics [serial online]. June 2011;36(3):275-282.
Accessed November 11, 2013.