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Aliment Pharmacol Ther. 2008 Jun 4.
Review article: probiotics and prebiotics in irritable bowel syndrome (IBS).
Spiller P.
University of Nottingham, Wolfson Digestive Diseases Centre, University Hospital, C Floor South Block, Nottinghamshire NG7 2UH, UK.
Background: The human gut harbours a complex community of bacteria whose relationship with their host is normally mutually beneficial. Recent studies suggest a disturbance of this relationship in irritable bowel syndrome (IBS) and the potential to correct this using pre- and probiotics. Aims: to review the mechanisms of action of probiotics and prebiotics in IBS and to assess their performance in clinical trials. Methods: Articles relating to modes of action and randomised control trials of treatment were reviewed by searching PubMed using terms "probiotic""prebiotic" and "irritable bowel". Small uncontrolled studies in IBS have been excluded. Results: Probiotics enhance gut barrier function, inhibit pathogen binding and modulate gut inflammatory response. They also reduce visceral hypersensitivity associated with both inflammation and psychological stress. Probiotics can alter colonic fermentation and stabilise the colonic microbiota. Several large randomised, placebo-controlled trials of adequate design have shown an improvement in flatulence and abdominal distension with a reduction in composite IBS symptoms scores. Conclusions: Each probiotic has unique features and IBS patients are heterogeneous. Future efforts should be directed to identifying biomarkers of responsiveness to facilitate better targeting of treatment and hence improved efficacy.
PMID: 18532993 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/18532993?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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Br J Nutr. 2008 May 9:1-7.
Gum arabic (Acacia) establishes prebiotic functionality in healthy human volunteers in a dose-dependent manner.
Calame W, Weseler AR, Viebke C, Flynn C, Siemensma AD.
Kerry Group Nutrition Technical Center, Veluwezoom 62, 1327 AH Almere, The Netherlands.
The present study was undertaken to determine the prebiotic efficacy of gum arabic upon consumption by man for up to 4 weeks and, if any, to establish the dose-effect relationship. Human healthy volunteers consumed various daily doses (5, 10, 20, 40 g) of gum arabic (EmulGold(R)) in water for up to 4 weeks.
Daily consumption of water was taken as the negative control and that of 10 g inulin as the positive control. At 0, 1, 2 and 4 weeks quantification of bacterial numbers in stool samples was performed via real time-PCR techniques and questionnaires were filled in to account for potential drawbacks.
The genera of Bifidobacteria and Lactobacilli were taken as potentially beneficial bacteria and those of Bacteroides, Clostridium difficile and Enterococci as potentially non-beneficial, this distinction was dependent on the issue of these numbers being or becoming out of balance in the host. Compared with the negative control the numbers of Bifidobacteria and Lactobacilli 4 weeks after consumption were significantly higher for gum arabic: the optimal dose being around 10 g.
Moreover, at this dose the numbers of Bifidobacteria, Lactobacilli and Bacteroides were significantly higher for gum arabic than for inulin. No significant drawback was encountered during the study. It is concluded that gum arabic establishes prebiotic efficacy, at least as good as inulin. The optimal daily dose was found to be 10 g.
PMID: 18466655 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/18466655?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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Alimentary Health Released: Mon 25-Aug-2008, 08:00 ET
New Study Shows Health Benefits of Probiotic Could Extend Beyond Gastrointestinal System
Data from a recent study demonstrate the anti-inflammatory and pathogen protection benefits of Bifidobacterium infantis 35624 a probiotic bacterial strain of human origin. Gastrointestinal benefits of probiotics have been well-documented, but more and more research is revealing that probiotic benefits extend to the entire body. The report was published in the August issue of the Public Library of Science (PLoS) Pathogens.
Newswise — Data from a recent study demonstrate the anti-inflammatory and pathogen protection benefits of Bifidobacterium infantis 35624 a probiotic bacterial strain of human origin. Gastrointestinal benefits of probiotics have been well-documented, but more and more research is revealing that probiotic benefits extend to the entire body. The report was published in the August issue of the Public Library of Science (PLoS) Pathogens .
The inflammatory response is a key part of the immune system's battle against invaders. The normal response to infection is rapid and effective, however, the immune response may occasionally cause inflammation and damage to healthy tissue.
"Inflammation is a major factor in a number of chronic diseases affecting millions of people and can cause an unwanted impact on healthy tissue," said Dr. Liam O'Mahony, lead investigator. "Past research has shown that the probiotic Bifidobacterium infantis 35624 can positively impact the body's immune defense3, and this most recent data suggests that its benefits are not restricted to the gastrointestinal tract."
Inflammation is associated with a wide range of conditions, such as inflammatory bowel disease, arthritis, bacterial-induced colitis, type I diabetes and organ transplantation. Bifidobacterium infantis 35624 has previously shown ability to modulate the inflammatory response in a clinical trial of patients with irritable bowel syndrome.2 The new data suggests additional health benefits of this particular probiotic strain.
The published study examined the effect of Bifidobacterium infantis 35624 administration on immunity to Salmonella (Salmonella typhimurium), harmful bacteria that can cause intestinal infections and trigger the body's inflammatory response. Bifidobacterium infantis 35624, a probiotic strain isolated from healthy human gastrointestinal tissue, was administered to mice in freeze-dried powder at least three weeks prior to salmonella infection. Animals that received Bifidobacterium infantis 35624 showed dramatically increased numbers of certain immune cells that control the immune system response to harmful pathogens, in this case Salmonella.
Additionally, data show increased numbers of T-regulatory (Treg) cells, or cells that suppress inflammatory disease in a wide range of autoimmune diseases. Administration of Bifidobacterium infantis 35624 resulted in the induction of these Treg cells, which protected the host from excessive inflammation during the course of infection. Researchers concluded that the introduction of Bifidobacterium infantis 35624 results in enhanced protection from infection, while limiting pro-inflammatory damage caused by superfluous activation of the innate immune system.
About Alimentary Health
Alimentary Health is a development stage specialty biotechnology company located in Ireland. The company is focused on the discovery, development and commercialization of proprietary probiotic and pharmabiotic treatments for gastrointestinal disorders and other inflammatory conditions. Alimentary Health is the foundation industry partner of the Alimentary Pharmabiotic Center based at University College Cork, Ireland. www.alimentaryhealth.ie
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http://www.newswise.com/articles/view/543733/
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THURSDAY, Nov. 13 (HealthDay News) -- For some patients, the best therapy for irritable bowel syndrome (IBS) may be older, cheaper drugs such as fiber, antispasmodics and peppermint oil, a new study finds.
According to researchers, these simple treatments have fallen out of favor because of the availability of newer (and more expensive) drugs, some of which have been taken off the market due to safety concerns.
But more traditional therapies should become first-line treatments in guidelines for the treatment of IBS, the experts say.
"IBS can be difficult for physicians to treat," noted lead researcher Dr. Alex Ford, from McMaster University, Health Sciences Centre in Ontario, Canada.
"New drugs are always being developed, but recent ones such as alosetron and tegaserod have been withdrawn, and are now only available on a restricted basis, and renzapride has not been shown to be effective," he said. On the other hand "older drugs, which are cheap, safe, and in some cases available over the counter, appear to be effective in IBS."
The report is published in the Nov. 14 online edition of the BMJ.
As many as 45 million Americans may have IBS, the International Foundation for Functional Gastrointestinal Disorders reports. Between 60 percent and 65 percent of IBS sufferers are women.
In addition to pain and discomfort, people with IBS experience chronic or recurrent constipation or diarrhea -- or bouts of both. While the exact cause of the condition isn't known, symptoms seem to result from a disturbance in the interaction of the gut, brain and nervous system, according to the foundation.
For the study, Ford's team reviewed trials that compared IBS treatment with fiber antispasmodics and peppermint oil to a placebo or no treatment. The trials included more than 2,500 IBS patients.
The researchers found that fiber, antispasmodics and peppermint oil were effective treatments for IBS. Specifically, that meant that to prevent IBS symptoms in one patient, 11 needed to be treated with fiber, five with antispasmodics, and 2.5 with peppermint oil.
There were no serious side effects associated with any of these treatments, the researchers note.
Peppermint oil appeared to be the most effective therapy of those reviewed, the researchers found.
In trials comparing fiber with placebo, insoluble fiber such as bran was not effective. Instead, only soluble fiber, such as ispaghula husk, reduced symptoms. For antispasmodics, the most effective was hyoscine. This should be used first among antispasmodics, Ford's group advised.
"Physicians, particularly those in primary care, who are being asked to take increasing responsibility for the management of IBS, should consider the use of these agents as first-line therapies for IBS," Ford said.
Dr. Roger Jones, from Kings College London and author of an accompanying journal editorial, welcomed the study.
"These treatments might be slightly more effective than recently thought and they are worth trying," Jones said.
For some patients with pain and diarrhea the antispasmodics may be useful. Patients with constipation should try fiber and for other patients, peppermint oil may be helpful, Jones said.
"If you have IBS which is not under reasonably good control or you are not happy with your symptom profile, you should see your primary-care doc or gastroenterologist for review and perhaps remind them that there is new evidence about the effectiveness of these traditional medicines and you would like to give it a go," Jones said.
"Alternatively, if you feel sufficiently well-informed and confident, you can go do it yourself and get these treatments at the pharmacy," Jones added.
By Steven Reinberg
HealthDay Reporter
SOURCES: Alex Ford, M.D., McMaster University, Health Sciences Centre, Ontario, Canada; Roger Jones, M.D., Kings College London, London; Nov. 14, 2008, BMJ, online
http://www.washingtonpost.com/wp-dyn/content/article/2008/11/13/AR2008111303704.html
Full article: http://www.bmj.com/cgi/reprint/337/nov13_2/a2313
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Probiotic Yogurt Helps Reduce Physical Bloating by up to 78%
LONDON, December 16 /PRNewswire/ --
- First Study of its Kind Shows That Consumption of Activia(R) Helps Reduce Abdominal Distension Among People With IBS
Distension of the tummy can be reduced by up to 78% in people with Irritable Bowel Syndrome (IBS) simply by eating probiotic yogurt, according to a UK study published today in Alimentary Pharmacology & Therapeutics (http://www.apandt.org).
The research gives new hope for people with IBS (constipation predominant - IBS-C) who can experience distension of the tummy - the physical increase in waist measurement - by as much as 12cm over the course of a day.(1)
The results showed that daily consumption of yogurt (Activia(R)), containing the probiotic Bifidobacterium lactis DN-173 010, over a four week period, significantly reduced distension as well as improving gastrointestinal transit time, and reduced the overall IBS severity and associated discomfort such as abdominal pain.
The groundbreaking study carried out at the University Hospital of South Manchester, involved 34 adult women - all of whom suffered from IBS-C. Half of the women ate Activia each day, while the other half received a non-fermented dairy (control) product. All patients kept symptom diaries, for regular assessment of abdominal pain, flatulence, bloating and distension.
Commenting on the study, conducted in his Unit at Wythenshawe Hospital, Professor Whorwell said: "Constipation, bloating and distension are common and distressing features of IBS with some sufferers being so bloated by the end of the day that they have to loosen clothing. Distension is associated with delayed gastrointestinal transit and one of the mechanisms by which Activia may be helping this problem is by the acceleration of transit which we confirmed in our study. Now healthcare professionals can advise that taking this probiotic yogurt may alleviate some of the symptoms experienced by IBS sufferers. A simple step to take without any risk of side effects."
Kirsten Hamilton, who has suffered from chronic IBS symptoms, was also impressed by the positive effects she felt after consuming the yogurt. She said: "The pain, discomfort and bloating I suffered as a result of my IBS is now a thing of the past. I truly believe in the benefits of eating Activia every day and continue to do so. I'm no longer filled with dread when I pull my jeans on in the morning!"
Trevor Datson, external communications director at Danone, commented: "This study builds on previous trials that demonstrate the benefit of Activia on the management of IBS symptoms. It adds to the body of evidence that Activia can both help improve digestive comfort and improve gastrointestinal transit time.
He continued: "It is important to remember that the findings of this study are specific to Activia, which contains the unique strain Bifidobacterium lactis DN-173 010, and can't be extrapolated to other probiotic products. Different probiotic products can have very different effects, so you should always look for one that has a scientifically proven effect."
http://www.prnewswire.co.uk/cgi/news/release?id=245134
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BMC Gastroenterol. 2009 Feb 16;9(1):15.
A Systematic Review and Meta-Analysis: Probiotics in the treatment of Irritable Bowel Syndrome.
Hoveyda N, Heneghan C, Mahtani KR, Perera R, Roberts N, Glasziou P.
ABSTRACT: BACKGROUND: Irritable Bowel Syndrome (IBS) is a common chronic gastrointestinal disorder and the evidence for efficacy of most drug therapies in the treatment of IBS is weak. A popular alternative is probiotics, which have been used in several conditions including IBS. Probiotics are live microbial food supplements. The aim of this systematic review and meta-analysis of randomized trials study was to evaluate the efficacy of probiotics in alleviating symptoms in patients with irritable bowel syndrome. We searched Ovid versions of MEDLINE (1950-2007), EMBASE (1980-2007), CINAHL (1982-2007), AMED (1985-2007), the Cochrane library and hand searched retrieved papers.
RESULTS: We identified 14 randomized placebo controlled trials. Combined data suggested a modest improvement in overall symptoms after several weeks of treatment: for dichotomous data from seven trials the overall Odds Ratio (OR) was 1.6 (95% CI, 1.2 to 2.2); for continuous data from six trials the standardised mean difference (SMD) was 0.23 (95% CI, 0.07 to 0.38). For individual symptoms the results differed between the pooled dichotomous and pooled continuous data. Trials varied in relation to the length of treatment (4-26 weeks), dose, organisms and strengths of probiotics used.
CONCLUSION: Probiotics may have a role in alleviating some of the symptoms of IBS, a condition for which currently evidence of efficacy of drug therapies is weak. However, as IBS is a condition that is chronic and usually intermittent longer term trials are recommended. Such research should focus on the type, optimal dose of probiotics and the subgroups of patients who are likely to benefit the most.
PMID: 19220890 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/19220890?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
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Irritable Bowel Syndrome Does Not Respond To St. John's Wort
Article Date: 06 Jan 2010 - 0:00 PST
A Mayo Clinic research study published in the January issue of the American Journal of Gastroenterology finds that St. John's wort is not an effective treatment for irritable bowel syndrome (IBS). While antidepressants are frequently used to treat IBS, to date, no study has examined the success of using the herbal supplement St. John's wort in treating IBS.
"Our study investigated if herbal antidepressants such as St. John's wort could benefit irritable bowel disease patients," says Yuri Saito, M.D., M.P.H., gastroenterologist and lead physician scientist on the study. "Several of the chemical neurotransmitters that are in the brain are also in the colon. Therefore, it's been thought that antidepressants may affect sensation in the colon in a similar way to how they affect sensation in the brain. Our goal was to evaluate the usefulness of St John's wort in treating IBS."
In this placebo-controlled trial, 70 participants with IBS were randomized where half the patients received St. John's wort and the other half received a placebo for three months. In all, 86 percent of the participants were women, and the median age was 42 years. After three months of observing symptoms such as stomach pain, diarrhea, constipation and bloating, Mayo researchers found that the placebo group had a better response than the group taking the herbal supplement, St. John's wort.
"Because people tend to struggle with IBS for several years, patients are really looking for inexpensive, over-the-counter treatments such as St. John's wort," says Dr. Saito. "Unfortunately, our study showed that St. John's wort was not successful in helping IBS patients."
St. John's wort is an herbal supplement derived from the St. John's wort plant. It has been shown to be helpful in several medical conditions such as depression as well as other pain syndromes. Research has shown it to be as effective as conventional, prescription anti-depressants in treating mild to moderate depression.
"The challenge with IBS is that there is no cure, no one treatment tends to be wholly effective and some treatments come with significant side effects," explains Dr. Saito. "However, well-designed studies of herbal supplements are important so that physicians and patients can make informed decisions about which supplements to recommend or try. Studies of alternative treatments are generally lacking and patients are forced to use a "trial and error" approach to over-the-counter treatments for their IBS."
IBS is a common disorder that affects the colon and commonly causes cramping, abdominal pain, bloating, gas, diarrhea and constipation. Approximately 58 million people struggle with IBS, mostly women.
Other members of the Mayo Clinic research team included Enrique Rey, M.D.; Ann Almazar-Elder; W. Scott Harmsen; Alan Zinsmeister, Ph.D.; G. Richard Locke , M.D.; and Nicholas Talley, M.D., Ph.D.
Source:
Amy Tieder
Mayo Clinic
http://www.medicalnewstoday.com/articles/175151.php?nfid=79339
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By Rachael Myers Lowe
NEW YORK ' Thu Jul 8, 2010 5:23pm EDT
NEW YORK (Reuters Health) - "Stealth fiber" increasingly added to processed foods, while not a problem for most, can cause gastrointestinal discomfort for some who may not know they're consuming too much of it, Minnesota researchers warn. The fiber is called "inulin."
"Normal fiber foods like wheat bran and legumes are self-limiting, it's hard to over eat them," Joanne Slavin, a registered dietitian in the department of food science and nutrition at the University of Minnesota at St. Paul, told Reuters Health.
Inulin, she explained, may be in chocolate bars, drinks, and snacks around the house, and "before you know it, you may eat more than you can tolerate and have gastrointestinal issues you wouldn't necessarily associate" with those foods.
Inulin is a carbohydrate fiber that occurs naturally in many foods like bananas, wheat, onions and garlic. Found in high concentrations in chicory root, is can be extracted for industrial use. Unlike more familiar carbohydrates, which are broken down in the small intestines and turned into fuel for the body, inulin passes through the small intestines to the colon where it stimulates the growth of "good bacteria" and is fermented by bacteria. In some people it can cause gas, bloating, flatulence, and diarrhea.
Because of its growing popularity as a food additive, Slavin and her colleagues wanted to assess how much inulin it takes to cause gastrointestinal problems.
They designed a study involving 26 healthy men and women aged 18 to 60. After a night of fasting, once a week for five weeks, participants were fed a breakfast of a bagel with cream cheese and orange juice. The orange juice was mixed with a placebo or with 5- or 10-gram doses of two commonly used inulin products -- native inulin and shorter-chain oligofructose.
After their "fiber challenge," participants were called several times over two days and asked about symptoms such as gas/bloating, nausea, flatulence, stomach cramping, diarrhea, constipation and GI rumbling.
Those that got any dose of inulin generally reported "mild symptoms"; the highest scores in every symptom except constipation were reported by those who got 10 grams of oligofructose. The findings are in line with previous research that found the short-chain "sweet" inulin causes faster fermentation in the gut leading to more gas and gastrointestinal symptoms.
Flatulence was the most common symptom reported by all subjects who got fiber although symptoms were "highly variable" among individuals and many subjects did not experience any, the investigators say.
Slavin and colleagues conclude, based on their study, that most healthy people can tolerate up to 10 grams of native inulin and 5 grams of the "sweet" inulin a day.
Food manufacturers, faced with demands to reduce calories, fat, and sodium while increasing fiber and flavor, are increasingly turning to products like inulin. They have discovered they can chemically manipulate the chemical structure of inulin to mimic tastes and textures consumers want in food. "It's like a food manufacturer's nirvana," Slavin said.
Inulin can be found in high fiber breakfast bars, ice creams, and beverages among other processed foods. The label may list inulin, chicory root extract, oligosaccharide, or oligofructose. For example, the Fiber One Chewy Bar with 9 grams of dietary fiber lists chicory root extract as its top ingredient.
Slavin and her colleagues urge continued study of tolerance levels of food additives like inulin because their use is likely to continue to grow and "there is the potential for overuse."
The research was funded by Cargill, Inc. a maker of inulin food additives, which provided the product used in the study.
SOURCE: link.reuters.com/tur56m Journal of the American Dietetic Association, June 2010
http://www.reuters.com/article/idUSTRE6675QC20100708
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Hu ML, Rayner CK, Wu KL, Chuah SK, Tai WC, Chou YP, Chiu YC, Chiu KW, Hu TH.Effect of ginger on gastric motility and symptoms of functional dyspepsia.
World J Gastroenterol 2011 January;17(1):105-110
Effect of ginger on gastric motility and symptoms of functional dyspepsia
Hu ML, Rayner CK, Wu KL, Chuah SK, Tai WC, Chou YP, Chiu YC, Chiu KW, Hu TH.
Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan. kengliang_wu@yahoo.com.tw
AIM: To evaluate the effects of ginger on gastric motility and emptying, abdominal symptoms, and hormones that influence motility in dyspepsia.
METHODS: Eleven patients with functional dyspepsia were studied twice in a randomized double-blind manner. After an 8-h fast, the patients ingested three capsules that contained ginger (total 1.2 g) or placebo, followed after 1 h by 500 mL low-nutrient soup. Antral area, fundus area and diameter, and the frequency of antral contractions were measured using ultrasound at frequent intervals, and the gastric half-emptying time was calculated from the change in antral area. Gastrointestinal sensations and appetite were scored using visual analog questionnaires, and blood was taken for measurement of plasma glucagon-like peptide-1 (GLP-1), motilin and ghrelin concentrations, at intervals throughout the study.
RESULTS: Gastric emptying was more rapid after ginger than placebo [median (range) half-emptying time 12.3 (8.5-17.0) min after ginger, 16.1 (8.3-22.6) min after placebo, P <= 0.05]. There was a trend for more antral contractions (P = 0.06), but fundus dimensions and gastrointestinal symptoms did not differ, nor did serum concentrations of GLP-1, motilin and ghrelin.
CONCLUSION: Ginger stimulated gastric emptying and antral contractions in patients with functional dyspepsia, but had no impact on gastrointestinal symptoms or gut peptides.
http://www.wjgnet.com/1007-9327/abstract_en.asp?f=105&v=17
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Current Opinion in Gastroenterology:
January 2011 - Volume 27 - Issue 1 - p 8–12
doi: 10.1097/MOG.0b013e32833fd48a
Gastrointestinal infections: Edited by Mitchell B. Cohen
Mechanisms of action of zinc in acute diarrhea
Berni Canani, Robertoa,b; Buccigrossi, Vittoriaa; Passariello, Annalisaa,c
Purpose of review: For over a decade, the importance of zinc in the treatment of acute diarrhea has been recognized.
More recently, the mechanisms of action of zinc are becoming clearer. This review is focused on the new evidence on the mechanisms of action of zinc in acute diarrhea.
Recent findings: The vast majority of data derive from in-vitro studies using intestinal cell lines or from animal model. The positive action by zinc in acute diarrhea derives from a regulation of intestinal fluid transport, mucosal integrity, immunity, gene expression, and oxidative stress. A complex homeostatic network is also able to regulate zinc status at cellular and extracellular level.
Summary: All these data support the use of zinc in the treatment of acute diarrhea, but further clinical studies are needed to explore the selective effects of zinc against specific pathogens responsible for diarrhea.
http://journals.lww.com/co-gastroenterology/Abstract/2011/01000/Mechanisms_of_action_of_zinc_in_acute_diarrhea.3.aspx
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