TY - JOUR
T1 - Probiotics and irritable bowel syndrome
T2 - Rationale, putative mechanisms, and evidence of clinical efficacy
AU - Camilleri, Michael
PY - 2006/3
Y1 - 2006/3
N2 - The irritable bowel syndrome (IBS) follows an acute, presumably infectious diarrheal illness in ∼15% of patients. There may be a persistent, mild inflammatory state with changes in mucosal function or structure. Changes in the colonic bacterial flora reported in IBS seem related to predominant bowel. Colonic bacteria normally metabolize nutrients with the formation of gas and short chain fatty acids. The latter may induce propulsive contractions and accelerate colonic transit or they may enhance fluid and sodium absorption in the colon. This review addresses the mechanisms, rationale and current evidence for the efficacy of probiotics, including Lactobacilli, Bifidobacteria, and VSL#3, in the treatment of IBS. The mechanisms influenced by probiotics include immune function, motility, and the intraluminal milieu. Probiotics may suppress the low-grade inflammation associated with IBS or restore normal local immune function. Lactobacilli and Bifidobacteria subspecies are able to deconjugate and absorb bile acids, potentially reducing the colonic mucosal secretion of mucin and fluids that may contribute to functional diarrhea or IBS with diarrhea. Therapeutic trials show the potential benefit of Bifidobacteria or Lactobacilli species alone or in the specific probiotic combination, VSL#3, on symptoms in IBS. Colonic transit was retarded in IBS patients treated with VSL#3 without induction of significant changes in bowel function. In summary, probiotics are promising therapies in IBS.
AB - The irritable bowel syndrome (IBS) follows an acute, presumably infectious diarrheal illness in ∼15% of patients. There may be a persistent, mild inflammatory state with changes in mucosal function or structure. Changes in the colonic bacterial flora reported in IBS seem related to predominant bowel. Colonic bacteria normally metabolize nutrients with the formation of gas and short chain fatty acids. The latter may induce propulsive contractions and accelerate colonic transit or they may enhance fluid and sodium absorption in the colon. This review addresses the mechanisms, rationale and current evidence for the efficacy of probiotics, including Lactobacilli, Bifidobacteria, and VSL#3, in the treatment of IBS. The mechanisms influenced by probiotics include immune function, motility, and the intraluminal milieu. Probiotics may suppress the low-grade inflammation associated with IBS or restore normal local immune function. Lactobacilli and Bifidobacteria subspecies are able to deconjugate and absorb bile acids, potentially reducing the colonic mucosal secretion of mucin and fluids that may contribute to functional diarrhea or IBS with diarrhea. Therapeutic trials show the potential benefit of Bifidobacteria or Lactobacilli species alone or in the specific probiotic combination, VSL#3, on symptoms in IBS. Colonic transit was retarded in IBS patients treated with VSL#3 without induction of significant changes in bowel function. In summary, probiotics are promising therapies in IBS.
KW - Bifidobacteria
KW - Bloating
KW - Flatulence
KW - Immune
KW - Inflammation
KW - Irritable bowel syndrome
KW - Lactobacilli
KW - Probiotics
KW - VSL#3
UR - http://www.scopus.com/inward/record.url?scp=33748190136&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33748190136&partnerID=8YFLogxK
U2 - 10.1097/00004836-200603000-00020
DO - 10.1097/00004836-200603000-00020
M3 - Article
C2 - 16633134
AN - SCOPUS:33748190136
SN - 0192-0790
VL - 40
SP - 264
EP - 269
JO - Journal of clinical gastroenterology
JF - Journal of clinical gastroenterology
IS - 3
ER -