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Probiotics and irritable bowel syndrome: rationale, putative mechanisms, and evidence of clinical efficacy.

Abstract

The irritable bowel syndrome (IBS) follows an acute, presumably infectious diarrheal illness in approximately 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.

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  • Publisher Full Text
  • Authors+Show Affiliations

    Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN 55905, USA. camilleri.michael@mayo.edu

    Source

    MeSH

    Bifidobacterium
    Humans
    Irritable Bowel Syndrome
    Lactobacillus
    Probiotics

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    16633134

    Citation

    Camilleri, Michael. "Probiotics and Irritable Bowel Syndrome: Rationale, Putative Mechanisms, and Evidence of Clinical Efficacy." Journal of Clinical Gastroenterology, vol. 40, no. 3, 2006, pp. 264-9.
    Camilleri M. Probiotics and irritable bowel syndrome: rationale, putative mechanisms, and evidence of clinical efficacy. J Clin Gastroenterol. 2006;40(3):264-9.
    Camilleri, M. (2006). Probiotics and irritable bowel syndrome: rationale, putative mechanisms, and evidence of clinical efficacy. Journal of Clinical Gastroenterology, 40(3), pp. 264-9.
    Camilleri M. Probiotics and Irritable Bowel Syndrome: Rationale, Putative Mechanisms, and Evidence of Clinical Efficacy. J Clin Gastroenterol. 2006;40(3):264-9. PubMed PMID: 16633134.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Probiotics and irritable bowel syndrome: rationale, putative mechanisms, and evidence of clinical efficacy. A1 - Camilleri,Michael, PY - 2006/4/25/pubmed PY - 2006/9/15/medline PY - 2006/4/25/entrez SP - 264 EP - 9 JF - Journal of clinical gastroenterology JO - J. Clin. Gastroenterol. VL - 40 IS - 3 N2 - The irritable bowel syndrome (IBS) follows an acute, presumably infectious diarrheal illness in approximately 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. SN - 0192-0790 UR - https://www.unboundmedicine.com/medline/citation/16633134/Probiotics_and_irritable_bowel_syndrome:_rationale_putative_mechanisms_and_evidence_of_clinical_efficacy_ L2 - http://Insights.ovid.com/pubmed?pmid=16633134 DB - PRIME DP - Unbound Medicine ER -