The Efficacy of Probiotics in the Management of Irritable Bowel Syndrome

The Most Common Gastrointestinal Disorder

One highly prevalent gastrointestinal (GI) disorder is the irritable bowel syndrome (IBS). People with this disorder have a lot of different symptoms, including pain, bloating, and changes in the frequency or appearance of their stool. The Rome III criteria define IBS as “recurrent abdominal pain or discomfort that happens at least three days every month for the last three months.”

Conditions that Contribute to the Development of IBS

The process in the development of IBS is complicated and includes factors like genetics, dietary intolerance, changes in the gut microbiota, small intestinal overgrowth, intestinal immune activation, increased intestinal permeability, visceral hypersensitivity, and abnormal pain processing, disruption of the gut-brain axis, and behavioral pathways. Since there is no test to diagnose IBS, doctors usually use symptom-based criteria like the Rome III criteria, which look at how often and how severe the symptoms are.

Can Probiotics Help Treat Irritable Bowel Syndrome?

Many people have tried different drugs to help with their IBS symptoms, but most have not worked very well, maybe because the disease has many different causes. Some people think that a lack of good bacteria in the gut may contribute to IBS symptoms, based on the idea that when there are too many harmful bacteria in the gut, it can cause problems like diarrhea, pain, and bloating. Some researchers have observed that probiotics (good bacteria) may help reduce some of these symptoms. Although more studies are needed, some people believe that taking a probiotic supplement may help reduce IBS symptoms. 

This study was designed to find out whether a multi-strain probiotic (Bio-Kult® with 14 different bacterial strains) is more effective than a placebo at reducing IBS symptoms (especially abdominal pain and frequency) and improving the quality of life (QoL) in patients with diarrhea-predominant IBS (IBS-D).

The Study Method on Multi-Strain Probiotics for IBS Symptoms

This double-blind trial was conducted on 360 adult patients with moderate to severe symptomatic IBS-D. By randomization, 181 were treated with the multi-strain probiotic Bio-Kult® and 179 were given the placebo of microcrystalline cellulose. Patients were asked to take two capsules twice a day, before or during a meal, for 16 weeks. A follow-up was done after a month. 

Researchers did a baseline assessment on each individual to record the severity of IBS symptoms and QoL data. While on treatment and during the follow-up, the patients were required to visit the clinic monthly for reassessment. In all the visits, the IBS-Severity Scoring System (IBS-SSS) and IBS-Quality of Life (IBS-QoL) questionnaires were used to quantify the data. A physician noted any adverse reaction to the treatment.

The Results

Probiotic treatment remarkably improved the severity of abdominal pain with a highly significant difference in reduction between probiotic and placebo (69% versus 47%) at follow-up. This result relates to a 145-point decrease in the overall IBS-SSS within 30 days and a 223-point reduction at follow-up. The percentage of patients with moderate to severe symptoms was reduced from 100% at baseline to 14% for the probiotic group against 48% for placebo at follow-up. This difference was also significant. Moreover, the number of bowel movements per day from the second month onwards was significantly reduced in the probiotic group compared with the placebo group. In addition to relieving symptoms, the probiotic markedly improved all dimensions of quality of life in the 34-item IBS-QoL questionnaire. Nobody reported any serious adverse event.

The Conclusion

We found that the multi-strain probiotic Bio-Kult® was well-tolerated and superior to placebo in significantly improving GI symptoms for four months in patients with IBS-D. Furthermore, symptom improvement was comparable with statistically significant benefits in all quality of life aspects. However, it should be noted that these results only apply to Bio-Kult® and should not be generalized to other probiotics or IBS subtypes.


A Randomized Placebo-Controlled Clinical Trial of a Multi-Strain Probiotic Formulation (Bio-Kult®) in the Management of Diarrhea-Predominant Irritable Bowel Syndrome

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