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Published in: BMC Gastroenterology 1/2018

Open Access 01-12-2018 | Research article

A randomized placebo-controlled clinical trial of a multi-strain probiotic formulation (Bio-Kult®) in the management of diarrhea-predominant irritable bowel syndrome

Authors: Shamsuddin M. Ishaque, S. M. Khosruzzaman, Dewan Saifuddin Ahmed, Mukesh Prasad Sah

Published in: BMC Gastroenterology | Issue 1/2018

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Abstract

Background

Accumulating evidence supports the view that an imbalance of gut bacteria contributes to IBS, and that increasing the mass of beneficial species may reduce the numbers of pathogenic bacteria and help alleviate symptoms.

Methods

In this double-blind trial 400 adult patients with moderate-to-severe symptomatic diarrhea-predominant IBS (IBS-D) were randomized to treatment with the multi-strain probiotic Bio-Kult® (14 different bacterial strains) or placebo for 16 weeks. The change in severity and frequency of abdominal pain was the primary outcome measure.

Results

Probiotic treatment significantly improved the severity of abdominal pain in patients with IBS-D. A 69% reduction for probiotic versus 47% for placebo (p < 0.001) equates to a 145 point reduction on the IBS-severity scoring system (IBS-SSS). The proportion of patients who rated their symptoms as moderate-to-severe was reduced from 100% at baseline to 14% for the multi-strain probiotic at follow-up (month 5) versus 48% for placebo (p < 0.001). Also, the number of bowel motions per day from month 2 onwards was significantly reduced in the probiotic group compared with the placebo group (p < 0.05). In addition to relieving symptoms, the probiotic markedly improved all dimensions of quality of life in the 34-item IBS-Quality of Life (IBS-QoL) questionnaire. No serious adverse events were reported.

Conclusions

The multi-strain probiotic was associated with significant improvement in symptoms in patients with IBS-D and was well-tolerated. These results suggest that probiotics confer a benefit in IBS-D patients which deserves further investigation.

Trial registration

[Clinicaltrials.gov NCT03251625; retrospectively registered on August 9, 2017].
Appendix
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Literature
1.
go back to reference Sperber AD, Dumitrascu D, Fukudo S, et al. The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: a Rome foundation working team literature review. Gut. 2017;66:1075–82.CrossRefPubMed Sperber AD, Dumitrascu D, Fukudo S, et al. The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: a Rome foundation working team literature review. Gut. 2017;66:1075–82.CrossRefPubMed
2.
go back to reference Canavan C, West J, Card T. Review article: the economic impact of the irritable bowel syndrome. Aliment Pharmacol Ther. 2014;40:1023–34.CrossRefPubMed Canavan C, West J, Card T. Review article: the economic impact of the irritable bowel syndrome. Aliment Pharmacol Ther. 2014;40:1023–34.CrossRefPubMed
3.
go back to reference Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA. 2015;313:949–58.CrossRefPubMed Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA. 2015;313:949–58.CrossRefPubMed
4.
go back to reference Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10:712–21.CrossRefPubMed Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10:712–21.CrossRefPubMed
5.
go back to reference Thompson WG, Heaton KW, Smyth GT, Smyth C. Irritable bowel syndrome in general practice: prevalence, characteristics, and referral. Gut. 2000;46:78–82.CrossRefPubMedPubMedCentral Thompson WG, Heaton KW, Smyth GT, Smyth C. Irritable bowel syndrome in general practice: prevalence, characteristics, and referral. Gut. 2000;46:78–82.CrossRefPubMedPubMedCentral
6.
go back to reference Masud MA, Hasan M, Azad Khan AK. Irritable bowel syndrome in a rural community in Bangladesh. Prevalence, symptom pattern and health seeking behavior. Am J Gastroenterol. 2001;96:1547–52.CrossRefPubMed Masud MA, Hasan M, Azad Khan AK. Irritable bowel syndrome in a rural community in Bangladesh. Prevalence, symptom pattern and health seeking behavior. Am J Gastroenterol. 2001;96:1547–52.CrossRefPubMed
7.
go back to reference Perveen I, Hasan M, Masud MA, Bhuiyan MM, Rahman MM. Irritable bowel syndrome in a Bangladeshi urban community: prevalence and health care seeking pattern. Saudi J Gastroenterol. 2009;15:239–43.CrossRefPubMedPubMedCentral Perveen I, Hasan M, Masud MA, Bhuiyan MM, Rahman MM. Irritable bowel syndrome in a Bangladeshi urban community: prevalence and health care seeking pattern. Saudi J Gastroenterol. 2009;15:239–43.CrossRefPubMedPubMedCentral
8.
go back to reference Perveen I, Rahman MM, Saha M, Rahman MM, Hasan MQ. Prevalence of irritable bowel syndrome and functional dyspepsia, overlapping symptoms, and associated factors in a general population of Bangladesh. Indian J Gastroenterol. 2014;33:265–73.CrossRefPubMed Perveen I, Rahman MM, Saha M, Rahman MM, Hasan MQ. Prevalence of irritable bowel syndrome and functional dyspepsia, overlapping symptoms, and associated factors in a general population of Bangladesh. Indian J Gastroenterol. 2014;33:265–73.CrossRefPubMed
10.
go back to reference Chang JY, Talley NJ. An update on irritable bowel syndrome: from diagnosis to emerging therapies. Curr Opin Gastroenterol. 2011;27:72–8.CrossRefPubMed Chang JY, Talley NJ. An update on irritable bowel syndrome: from diagnosis to emerging therapies. Curr Opin Gastroenterol. 2011;27:72–8.CrossRefPubMed
11.
go back to reference Bolino CM, Bercik P. Pathogenic factors involved in the development of irritable bowel syndrome: focus on a microbial role. Infect Dis Clin N Am. 2010;24:961–75.CrossRef Bolino CM, Bercik P. Pathogenic factors involved in the development of irritable bowel syndrome: focus on a microbial role. Infect Dis Clin N Am. 2010;24:961–75.CrossRef
12.
go back to reference Imperatore N, Tortora R, Morisco F, Caporaso N. Gut microbiota and functional diseases of the gastrointestinal tract. Minerva Gastroenterol Dietol. 2017;63:355–72.PubMed Imperatore N, Tortora R, Morisco F, Caporaso N. Gut microbiota and functional diseases of the gastrointestinal tract. Minerva Gastroenterol Dietol. 2017;63:355–72.PubMed
14.
go back to reference Drossman DA, Richter JE, Talley NJ. The functional gastrointestinal bowel disorders, pathophysiology and treatment: a multinational consensus. Boston: Little Brown; 1994. Drossman DA, Richter JE, Talley NJ. The functional gastrointestinal bowel disorders, pathophysiology and treatment: a multinational consensus. Boston: Little Brown; 1994.
15.
go back to reference Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45(Suppl 2):II43–7.PubMedPubMedCentral Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45(Suppl 2):II43–7.PubMedPubMedCentral
16.
go back to reference Drossman DA, Chang L, Bellamy N, et al. Severity in irritable bowel syndrome: a Rome foundation working team report. Am J Gastroenterol. 2011;106:1749–59.CrossRefPubMed Drossman DA, Chang L, Bellamy N, et al. Severity in irritable bowel syndrome: a Rome foundation working team report. Am J Gastroenterol. 2011;106:1749–59.CrossRefPubMed
17.
go back to reference Gwee KA, Graham JC, McKendrick MW, et al. Psychometric scores and persistence of irritable bowel after infectious diarrhoea. Lancet. 1996;347:150–3.CrossRefPubMed Gwee KA, Graham JC, McKendrick MW, et al. Psychometric scores and persistence of irritable bowel after infectious diarrhoea. Lancet. 1996;347:150–3.CrossRefPubMed
18.
go back to reference Gwee KA. Irritable bowel syndrome in developing countries--a disorder of civilization or colonization? Neurogastroenterol Motil. 2005;17:317–24.CrossRefPubMed Gwee KA. Irritable bowel syndrome in developing countries--a disorder of civilization or colonization? Neurogastroenterol Motil. 2005;17:317–24.CrossRefPubMed
19.
go back to reference Ghoshal UC, Park H, Gwee KA. Bugs and irritable bowel syndrome: the good, the bad and the ugly. J Gastroenterol Hepatol. 2010;25:244–51.CrossRefPubMed Ghoshal UC, Park H, Gwee KA. Bugs and irritable bowel syndrome: the good, the bad and the ugly. J Gastroenterol Hepatol. 2010;25:244–51.CrossRefPubMed
20.
go back to reference Gwee KA, Bak YT, Ghoshal UC, Asian Neurogastroenterology and Motility Association, et al. Asian consensus on irritable bowel syndrome. J Gastroenterol Hepatol. 2010;25:1189–205.CrossRefPubMed Gwee KA, Bak YT, Ghoshal UC, Asian Neurogastroenterology and Motility Association, et al. Asian consensus on irritable bowel syndrome. J Gastroenterol Hepatol. 2010;25:1189–205.CrossRefPubMed
22.
go back to reference Staudacher HM, Whelan K. Altered gastrointestinal microbiota in irritable bowel syndrome and its modification by diet: probiotics, prebiotics and the low FODMAP diet. Proc Nutr Soc. 2016;75:306–18.CrossRefPubMed Staudacher HM, Whelan K. Altered gastrointestinal microbiota in irritable bowel syndrome and its modification by diet: probiotics, prebiotics and the low FODMAP diet. Proc Nutr Soc. 2016;75:306–18.CrossRefPubMed
23.
go back to reference Saulnier DM, Riehle K, Mistretta TA, et al. Gastrointestinal microbiome signatures of pediatric patients with irritable bowel syndrome. Gastroenterology. 2011;141:1782–91.CrossRefPubMedPubMedCentral Saulnier DM, Riehle K, Mistretta TA, et al. Gastrointestinal microbiome signatures of pediatric patients with irritable bowel syndrome. Gastroenterology. 2011;141:1782–91.CrossRefPubMedPubMedCentral
24.
go back to reference Mättö J, Maunuksela L, Kajander K, Palva A, Korpela R, Kassinen A, Saarela M. Composition and temporal stability of gastrointestinal microbiota in irritable bowel syndrome--a longitudinal study in IBS and control subjects. FEMS Immunol Med Microbiol. 2005;43:213–22.CrossRefPubMed Mättö J, Maunuksela L, Kajander K, Palva A, Korpela R, Kassinen A, Saarela M. Composition and temporal stability of gastrointestinal microbiota in irritable bowel syndrome--a longitudinal study in IBS and control subjects. FEMS Immunol Med Microbiol. 2005;43:213–22.CrossRefPubMed
26.
go back to reference Quigley EM. Probiotics in irritable bowel syndrome: the science and the evidence. J Clin Gastroenterol. 2015;49(Suppl 1):S60–4.CrossRefPubMed Quigley EM. Probiotics in irritable bowel syndrome: the science and the evidence. J Clin Gastroenterol. 2015;49(Suppl 1):S60–4.CrossRefPubMed
27.
go back to reference Quigley EM, Shanahan F. The future of probiotics for disorders of the brain-gut axis. Adv Exp Med Biol. 2014;817:417–32.CrossRefPubMed Quigley EM, Shanahan F. The future of probiotics for disorders of the brain-gut axis. Adv Exp Med Biol. 2014;817:417–32.CrossRefPubMed
28.
go back to reference Lee HR, Pimentel M. Bacteria and irritable bowel syndrome: the evidence for small intestinal bacterial overgrowth. Curr Gastroenterol Rep. 2006;8:305–11.CrossRefPubMed Lee HR, Pimentel M. Bacteria and irritable bowel syndrome: the evidence for small intestinal bacterial overgrowth. Curr Gastroenterol Rep. 2006;8:305–11.CrossRefPubMed
29.
go back to reference Sisson G, Ayis S, Sherwood RA, Bjarnason I. Randomised clinical trial: a liquid multi-strain probiotic vs. placebo in the irritable bowel syndrome-a 12 week double-blind study. Aliment Pharmacol Ther. 2014;40:51–62.CrossRefPubMed Sisson G, Ayis S, Sherwood RA, Bjarnason I. Randomised clinical trial: a liquid multi-strain probiotic vs. placebo in the irritable bowel syndrome-a 12 week double-blind study. Aliment Pharmacol Ther. 2014;40:51–62.CrossRefPubMed
31.
go back to reference Zeng J, Li YQ, Zuo XL, Zhen YB, Yang J, Liu CH. Clinical trial: effect of active lactic acid bacteria on mucosal barrier function in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2008;28:994–1002.CrossRefPubMed Zeng J, Li YQ, Zuo XL, Zhen YB, Yang J, Liu CH. Clinical trial: effect of active lactic acid bacteria on mucosal barrier function in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2008;28:994–1002.CrossRefPubMed
32.
go back to reference Kabir MA, Ishaque SM, Ali MS, Mahmuduzzaman M, Hasan M. Role of Saccharomyces Boulardii in diarrhea predominant irritable bowel syndrome. Mymensingh Med J. 2011;20:397–401.PubMed Kabir MA, Ishaque SM, Ali MS, Mahmuduzzaman M, Hasan M. Role of Saccharomyces Boulardii in diarrhea predominant irritable bowel syndrome. Mymensingh Med J. 2011;20:397–401.PubMed
33.
go back to reference Rahman MZ, Chowdhury MS, Rahman MA. Efficacy of probiotics in irritable bowel syndrome-a randomized, double blind placebo controlled study. BSMMU J. 2013;6:21–8. Rahman MZ, Chowdhury MS, Rahman MA. Efficacy of probiotics in irritable bowel syndrome-a randomized, double blind placebo controlled study. BSMMU J. 2013;6:21–8.
35.
go back to reference Francis CY, Morris J, Whorwell PJ. The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Aliment Pharmacol Ther. 1997;11:395–402.CrossRefPubMed Francis CY, Morris J, Whorwell PJ. The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Aliment Pharmacol Ther. 1997;11:395–402.CrossRefPubMed
36.
go back to reference Drossman DA, Patrick DL, Whitehead WE, Toner BB, Diamant NE, Hu Y, Jia H, Bangdiwala SI. Further validation of the IBS-QOL: a disease-specific quality-of-life questionnaire. Am J Gastroenterol. 2000;95:999–1007.CrossRefPubMed Drossman DA, Patrick DL, Whitehead WE, Toner BB, Diamant NE, Hu Y, Jia H, Bangdiwala SI. Further validation of the IBS-QOL: a disease-specific quality-of-life questionnaire. Am J Gastroenterol. 2000;95:999–1007.CrossRefPubMed
37.
go back to reference Spiegel B, Bolus R, Harris LA, Lucak S, Naliboff B, Esrailian E, Chey WD, Lembo A, Karsan H, Tillisch K, Talley J, Mayer E, Chang L. Measuring irritable bowel syndrome patient-reported outcomes with an abdominal pain numeric rating scale. Aliment Pharmacol Ther. 2009;30:1159–70.CrossRefPubMedPubMedCentral Spiegel B, Bolus R, Harris LA, Lucak S, Naliboff B, Esrailian E, Chey WD, Lembo A, Karsan H, Tillisch K, Talley J, Mayer E, Chang L. Measuring irritable bowel syndrome patient-reported outcomes with an abdominal pain numeric rating scale. Aliment Pharmacol Ther. 2009;30:1159–70.CrossRefPubMedPubMedCentral
38.
go back to reference Lyra A, Hillilä M, Huttunen T, et al. Irritable bowel syndrome symptom severity improves equally with probiotic and placebo. World J Gastroenterol. 2016;22:10631–42.CrossRefPubMedPubMedCentral Lyra A, Hillilä M, Huttunen T, et al. Irritable bowel syndrome symptom severity improves equally with probiotic and placebo. World J Gastroenterol. 2016;22:10631–42.CrossRefPubMedPubMedCentral
40.
go back to reference Bixquet Jimenez M. Treatment of irritable bowel syndrome with probiotics. An etiopathogenetic approach at last? Rev Esp Dig. 2009;101:553–64. Bixquet Jimenez M. Treatment of irritable bowel syndrome with probiotics. An etiopathogenetic approach at last? Rev Esp Dig. 2009;101:553–64.
41.
go back to reference McKenzie YA, Thompson J, Gulia P, Lomer MC, (IBS Dietetic Guideline Review Group on behalf of Gastroenterology Specialist Group of the British Dietetic Association). British dietetic association systematic review of systematic reviews and evidence-based practice guidelines for the use of probiotics in the management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet. 2016;29:576–92.CrossRefPubMed McKenzie YA, Thompson J, Gulia P, Lomer MC, (IBS Dietetic Guideline Review Group on behalf of Gastroenterology Specialist Group of the British Dietetic Association). British dietetic association systematic review of systematic reviews and evidence-based practice guidelines for the use of probiotics in the management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet. 2016;29:576–92.CrossRefPubMed
42.
43.
go back to reference Staudacher HM, Irving PM, Lomer MC, Whelan K. Mechanisms and efficacy of dietary FODMAP restriction in IBS. Nat Rev Gastroenterol Hepatol. 2014;11:256–66.CrossRefPubMed Staudacher HM, Irving PM, Lomer MC, Whelan K. Mechanisms and efficacy of dietary FODMAP restriction in IBS. Nat Rev Gastroenterol Hepatol. 2014;11:256–66.CrossRefPubMed
44.
go back to reference Thaiss CA, Zmora N, Levy M, Elinav E. The microbiome and innate immunity. Nature. 2016;535:65–74.CrossRefPubMed Thaiss CA, Zmora N, Levy M, Elinav E. The microbiome and innate immunity. Nature. 2016;535:65–74.CrossRefPubMed
45.
go back to reference Honda K, Littman DR. The microbiota in adaptive immune homeostasis and disease. Nature. 2016;535:75–84.CrossRefPubMed Honda K, Littman DR. The microbiota in adaptive immune homeostasis and disease. Nature. 2016;535:75–84.CrossRefPubMed
46.
go back to reference Gwee KA. Post-infectious irritable bowel syndrome, an inflammation-immunological model with relevance for other IBS and functional dyspepsia. J Neurogastroenterol Motil. 2010;16:30–4.CrossRefPubMedPubMedCentral Gwee KA. Post-infectious irritable bowel syndrome, an inflammation-immunological model with relevance for other IBS and functional dyspepsia. J Neurogastroenterol Motil. 2010;16:30–4.CrossRefPubMedPubMedCentral
Metadata
Title
A randomized placebo-controlled clinical trial of a multi-strain probiotic formulation (Bio-Kult®) in the management of diarrhea-predominant irritable bowel syndrome
Authors
Shamsuddin M. Ishaque
S. M. Khosruzzaman
Dewan Saifuddin Ahmed
Mukesh Prasad Sah
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Gastroenterology / Issue 1/2018
Electronic ISSN: 1471-230X
DOI
https://doi.org/10.1186/s12876-018-0788-9

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