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Irritable bowel syndrome (IBS) is characterized by abdominal pain with bloating and either diarrhea or constipation. Abdominal distension, flatulence (gas), borborygmi (abdominal noises), and frequent stools are common. Urgency to get to the bathroom may occur. It is a fairly common problem with unclear causes. Research shows that many people with IBS have bacterial overgrowth. Therefore, it comes as no surprise that yogurt has been found to help. Since yogurt also helps to prevent many other types of infections, eating a cup a day of plain or artificially sweetened yogurt a day is the first place to start. For people preferring to avoid yogurt or daily products, lacto/bifidobacillus 1 capsule twice a day may be a good alternative. Peppermint oil in enteric coated capsules seems like the best second choice and is very inexpensive. Metronidazole is an inexpensive antibiotic which reduces the bacterial overgrowth. Amitriptyline and SSRI (generic Prozac and others) anti-depressants have both been found of value for some patients and their benefit is equal for both depressed and non-depressed IBS patients. Clonidine is a low cost blood pressure medication which has been found to help. Two small studies report melatonin helps. Charcoal, Chinese herbal medicine, and Tibetan herbal medicine have each been found to help in single studies. Lactose intolerance is more common in IBS patients (24% vs. 6%), and many of these found relief on a lactose free diet (Eur J Gastroenterol Hepatol. 1996 Oct;8(10):1013-6). Yogurt also helps many many lactose intolerant patients. Many studies have shown that various smooth muscle relaxant medications are of some benefit. Tegaserod (Zelnorm) is an extremely expensive medication ($154/month) being heavily and successfully promoted for IBS by its manufacturer. However, it appears to be no better than any of the above treatments. It is worthwhile for those still not experiencing benefit using the less expensive and safer treatments noted above. IBS appears to have a variety of causes and no treatment approach works for a large majority. In studies, placebo response rates are fairly high. Alosetron (Lotronex) was promoted by the manufacturer in 2001 to the FDA as being effective in numerous placebo studies, but a reanalysis of the data by Public Citizens showed it was hardly any better than placebo at relieving pain. Since it had already caused 13 deaths by 2001, its use for IBS was strongly opposed, but approved by the FDA anyway. The manufacturer later withdrew it from the market due to more deaths and lawsuits. Antibiotics Helped Irritable Bowel Syndrome: IBS affects as many as 36 million Americans; diarrhea, constipation, bloating, gas and abdominal pain are not explained by medical tests such as gastrointestinal endoscopies. Ordinary bacteria normally confined to the large intestine may expand into the small intestine, prompting uncomfortable bloating and gas after meals, a change in bowel movements as well as an immune response that may account for the flu-like illness so common in the IBS patient, including such debilitating symptoms as headaches, muscle and joint pains and chronic fatigue. 92% of IBS patients report bloating after they eat, a symptom he saw again and again in his patients. 84% of IBS patients were found to have abnormal lactulose breath test results suggesting small intestinal bacterial overgrowth. In a DB PC study, 75% given antibiotic therapy reported improvement in symptoms. Small intestinal bacterial overgrowth allows gut bacteria to cross the mucosal barrier, which is the lining of the gut, and enter the body. This activates the patient's immune system as evidenced by increased numbers of inflammatory cells in tissues of IBS patients. The immune response to bacterial antigens may then explain the flu-like symptoms that can greatly diminish the quality of life such as chronic fatigue and pain. Henry C. Lin, USC, JAMA 8/18/04. Acupuncture: Very Small Study Doesn't Find Clear Results: In a DB PC 25-patient trial of real vs. sham acupunture, the real acupunture tended to work better but the differences were not statistically significant. Acupuncture treatment for irritable bowel syndrome. A double-blind controlled study. Fireman Z, Segal A, Kopelman Y, Sternberg A, Carasso R. Hadera, Israel. Alosetron Favored Over Placebo in DB: In a very large 801 patient DB PC 12-week trial, alosetron 1 mg b.id. resulted in 69% of patients satisfied or very satisfied vs. 46% with placebo (p < 0.001). This included relief of urgency (68% alosetron vs. 41% placebo), speed of relief (71% vs. 40%), time to return to normal activities (75% vs. 49%), relief of abdominal pain (62% vs. 44%), and prevention of return of urgency (68% vs. 42%). Patient satisfaction with alosetron for the treatment of women with diarrhea-predominant irritable bowel syndrome. Olden K, DeGarmo RG, Jhingran P, Bagby B, Decker C, Markowitz M, Carter E, Bobbitt W, Dahdul A, DeCastro E, Gringeri L, Johanson J, Levinson L, Mula G, Poleynard G, Stoltz RR, Truesdale R, Young D; Lotronex Investigator Team. Mayo Clinic Alverine Citrate No Better than Placebo for Treating IBS: Although alverine citrate has been used in the treatment of irritable bowel syndrome for many years in England, a 107-aptient DB PC study of alverine citrate, a 120-mg capsule, with placebo given three times daily for 12 weeks found it no better than placebo. The severity and frequency of abdominal pain improved in 66% and 68% of patients treated with alverine citrate vs. 58% and 69% of the placebo group. These differences were not significant. The mean percentage reduction in the scores for abdominal pain from baseline to the final assessment, although greater in the alverine citrate group (43.7%) compared with the placebo group (33.3%), was not statistically significant. Alverine citrate fails to relieve the symptoms of irritable bowel syndrome: results of a double-blind, randomized, placebo-controlled trial. Mitchell SA, Mee AS, Smith GD, Palmer KR, Chapman RW. Oxford, UK. Aliment Pharmacol Ther. 2002 Jun;16(6):1187-95 Amitriptyline Helped in DB: In a 12-week, 40-patient DB PC trial, half received 25 mg amitriptyline for the first week, 50 mg for the second week and 75 mg nightly thereafter until the end of the 12th week. Amitriptyline was found to be significantly more effective than placebo in producing global improvement, increasing feelings of well-being, reducing abdominal pain and increasing satisfaction with bowel movements. Younger age and increasing extroversion predicted a better response to amitriptyline. Severity of depressive and anxiety symptoms and other personality variables did not influence outcome. Symptom relief with amitriptyline in the irritable bowel syndrome. Rajagopalan M, Kurian G, Victoria, Australia. J Gastroenterol Hepatol. 1998 Jul;13(7):738-41 Bran Makes IBS Bloating Worse: In a 4-week DB PC crossover trial of 12 IBS patients and 12 normals of rice pudding meal with 15 g of either placebo or coarse bran, researchers found the bran increase small bowel transit time in both groups, but increased pain and bloating only in the IBS group. Abnormalities of GI transit in bloated irritable bowel syndrome: effect of bran on transit and symptoms. Hebden JM, Blackshaw E, D'Amato M, Perkins AC, Spiller RC. University Hospital Nottingham, United Kingdom. Am J Gastroenterol. 2002 Sep;97(9):2315-20 Charcoal Used in German Study: In a 284-patient 12-week DB PC study, a type of activated charcoal tablets (Eucarbon) did slightly better than nonactivated charcoal (carbo ligni [CL]) in 284 patients alleviating symptoms in 60% and 51% respectively. Charcoal tablets in the treatment of patients with irritable bowel syndrome. Hubner WD, Moser EH. Neuenhagen, Germany. Adv Ther. 2002 Sep-Oct;19(5):245-52. Ed: Without a placebo control group, it is hard to tell what the real benefit was. Chinese Herbal Medicine Helped: In a 116-patient 16-week DB PC trial, IBS patients received 5 capsules 3 times daily for 16 weeks and were evaluated regularly by a traditional Chinese herbalist and by a gastroenterologist. Compared with patients in the placebo group, patients in the active treatment groups (standard and individualized CHM) had significant improvement in bowel symptom scores as rated by patients (P=.03) and by gastroenterologists (P=.001), and significant global improvement as rated by patients (P=.007) and by gastroenterologists (P=.002). Patients reported that treatment significantly reduced the degree of interference with life caused by IBS symptoms (P=.03). Chinese herbal formulations individually tailored to the patient proved no more effective than standard CHM treatment. On follow-up 14 weeks after completion of treatment, only the individualized CHM treatment group maintained improvement. Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial. Bensoussan A, Talley NJ, Hing M, Menzies R, Guo A, Ngu M. University of Western Sydney Macarthur, New South Wales, Australia. JAMA. 1998 Nov 11;280(18):1585-9 Cisapride No Value: Cisapride improves symptoms in patients with idiopathic constipation. In a 70-patient, 12-week DB PC trials of 5 mg cisapride three times daily or placebo and the dose could be doubled after 4 weeks in patients without satisfactory improvement, the patients' mean VAS score for global evaluation of IBS symptoms in the cisapride and placebo groups was 73 and 71 mm, respectively, at the start of treatment and 47 and 41 mm at the end non-significantly favoring the placebo. The symptomatic effect of cisapride in patients with irritable bowel syndrome and constipation. Farup PG, Hovdenak N, et al. Norway. Clonidine Helped in DB: In a 44-patient DB PC 4-week study of clonidine 0.05,or 0.1 mg or placebo twice a day, proportion with satisfactory relief of IBS was 0.46, 0.42, and 0.67 with placebo, 0.05 mg, and 0.1 mg clonidine, respectively. Relief was sustained through 4 weeks of treatment, and bowel dysfunction (firmer stools and easier stool passage [P < 0.05]) was reduced with clonidine, 0.1 mg twice a day. Clonidine did not significantly alter gastrointestinal transit or gastric volumes. Drowsiness, dizziness, and dry mouth were the most common adverse events with the 0.1-mg dose; severity of adverse effects subsided after the first week of treatment. A randomized, controlled exploratory study of clonidine in diarrhea-predominant irritable bowel syndrome. Camilleri M, Kim DY, et al. Mayo Clinic. Clin Gastroenterol Hepatol. 2003 Mar;1(2):111-21 Curcuma and Fumaria Didn't Help: In a 106-patient DB PC 18-week study of: 1) Curcuma xanthorriza 60 mg daily (n=24), 2) Fumaria officinalis 1500 mg daily (n=24) and 3) placebo (n=58), neither fumitory nor curcuma showed any therapeutic benefit over placebo. Herbal medicine with curcuma and fumitory in the treatment of irritable bowel syndrome: a randomized, placebo-controlled, double-blind clinical trial. Brinkhaus B, et al. Charite University, Berlin, Germany. . Scand J Gastroenterol. 2005 Aug;40(8):936-43 Loperamide (Lomotil) Helps Some, But Nightly Pain Increased: In a 5-week, 90-patients DB PC trial, an improved stool consistency (32%), reduced defecation frequency (36%), and reduced intensity of pain (30%) were found in the loperamide group. An increase in nightly pain was observed in the loperamide group. A double-blind placebo-controlled trial with loperamide in irritable bowel syndrome. Efskind PS, Bernklev T, Vatn MH. Fredrikstad, Norway. Scand J Gastroenterol. 1996 May;31(5):463-8. Melatonin: Irritable Bowel Syndrome Helped: In a 2-week, DB PC study of 30 IBS patients with sleep disturbances, melatonin 3 mg/night significantly decreased abdominal pain, reduced bloating, and enhanced the rectal pain threshold. There was no difference in stool type, frequency of defecation, and anxiety and depression between the treatment groups. Melatonin did not influence total sleep time, sleep latency, sleep efficiency, sleep onset latency, number of awakenings, duration of stage 1-4, REM sleep and REM onset latency. Melatonin improves bowel symptoms in irritable bowel syndrome patients who have sleep disturbances. Gut 2004; 53 (Suppl VI) A69 Melatonin: In a 2-week DB PC study of 40 Irritable Bowel Syndrome adults with sleep disturbances, melatonin 3 mg at before bedtime significantly decreased mean abdominal pain score (2.35 vs 0.70, p<0.001), and increased mean rectal pain threshold (24.8 vs 33.7 mmHg, p<0.01). Bloating, stool type, stool frequency, anxiety and depression scores did not significantly differ. Melatonin did not influence sleep including total sleep time, sleep latency, sleep efficiency, sleep onset latency, arousals, duration of stage 1-4, REM sleep and REM onset latency. Melatonin improves abdominal pain in irritable bowel syndrome patients who have sleep disturbances: a randomised double blind placebo controlled study. Song GH, Leng PH, et al. National University of Singapore. Gut. 2005 May 24. Metronidazole Antibiotic Helped in Large DB: 202 patients with IBS found 157 had increased hydrogen in breath, a sign of bacterial overload in small intestine. A Bombay study in 1997 found metronidazole markedly improved although others find some relapse after a few months. Neomycin Antibiotic Helped in DB: In a 111-patient DB PC study, neomycin resulted in a 35.0% improvement in a composite score, compared with 11.4% for placebo (p < 0.05). Additionally, patients reported a percent bowel normalization of 35.3% after neomycin, compared with 13.9% for placebo (p < 0.001). Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome. a double-blind, randomized, placebo-controlled study. Pimentel M, Chow EJ, Lin HC. Cedars-Sinai Medical Center. Am J Gastroenterol. 2003 Feb;98(2):412-9 Oligofructose No Benefit: In an 8-week DB crossover trial of oligofructose (Raftilose P95) 2 g three times daily against sucrose (1 g) three times daily was performed in patients suffering from irritable bowel syndrome, oligofructose at a dose of 6 g/d had no therapeutic value in patients with irritable bowel syndrome. Controlled trial of oligofructose in the management of irritable bowel syndrome. Hunter JO, Tuffnell Q, Lee AJ. Cambridge, England. Otilonium Bromide Found to Help Some: The colon-selective spasmolytic otilonium bromide inhibits muscarinic M3 receptor-coupled calcium signals. In a large 378-patient DB PC 15-week trial of 40 mg otilonium bromide or placebo three times daily, the rate of response to treatment within 2-4 months (the primary efficacy outcome measure) was significantly higher in the otilonium bromide group (36.9%) than in the placebo group (22.5%; P = 0.007). The total monthly and weekly responses to the single endpoints (intensity and frequency of pain and discomfort, meteorism/abdominal distension, severity of diarrhea or constipation and mucus in the stool) were significantly more frequent in the group treated with otilonium bromide than in the placebo-treated group, with differences ranging from 10% to 20%. The subgroup analysis of the intestinal habits endpoint indicates that patients with diarrhoea have an additional benefit. Extended analysis of a double-blind, placebo-controlled, 15-week study with otilonium bromide in irritable bowel syndrome. Glende M, Morselli-Labate AM, Battaglia G, Evangelista S. Eur J Gastroenterol Hepatol. 2002 Dec;14(12):1331-8. Ed: I don't think otilonium bromide is on the market at this point. Padma Lax Helped in DB: Padma Lax, a complex Tibetan herbal formula for constipation was evaluated for safety and effectiveness in treating constipation-predominant irritable bowel syndrome in a 3-month 61-patient DB PC trial. Significantly more improvement in constipation, severity of abdominal pain, and its effect on daily activities, incomplete evacuation, abdominal distension and flatus/flatulence occurred with the Padma Lax. Side effects, primarily loose stools in 7 Padma Lax patients responded well to lowering treatment dosage from 2 to 1 capsule/day. A novel treatment for constipation-predominant irritable bowel syndrome using Padma Lax, a Tibetan herbal formula. Sallon S, Ben-Arye E, Davidson R, Shapiro H, Ginsberg G, Ligumsky M. Hadassah University Jerusalem. Digestion. 2002;65(3):161-71 Peppermint Oil Helped Children: In a DB PC trial, 42 children with irritable bowel syndrome (IBS) were given pH-dependent, enteric-coated peppermint oil capsules or placebo. After 2 weeks, 75% of those receiving peppermint oil had reduced severity of pain associated with IBS. Enteric-coated, pH-dependent peppermint oil capsules for the treatment of irritable bowel syndrome in children. Kline RM, Kline JJ, Di Palma J, Barbero GJ. University of Missouri-Columbia. J Pediatr. 2001 Jan;138(1):125-8 Peppermint Oil Likely to be of Value: Eight DB PC trials suggest peppermint oil could be efficacious for symptom relief in IBS. A metaanalysis of the 5 best trials seems to support this notion. The authors state that in view of the methodological flaws associated with most studies, no definitive judgment about efficacy can be given. Peppermint oil for irritable bowel syndrome: a critical review and metaanalysis. Pittler MH, Ernst E. University of Exeter, United Kingdom. Am J Gastroenterol. 1998 Jul;93(7):1131-5 Peppermint Oil Helped in DB: In a DB PC 110-patient trials of one capsule (Colpermin or placebo) three to four times daily, 15-30 min before meals, for 1 month, 79% on Colpermin (79%) experienced an alleviation of the severity of abdominal pain (29 were pain-free); 43 (83%) had less abdominal distension, 43 (83%) had reduced stool frequency, 38 (73%) had fewer borborygmi, and 41 (79%) less flatulence. For the placebo: 21 patients (43%) reported reduced pain (4 were pain-free), 14 (29%) with reduced distension, 16 (32%) with reduced stool frequency, 15 (31%) with fewer borborygmi, and 11 (22%) with less flatulence. One patient on Colpermin experienced heartburn (because of chewing the capsules) and one developed a mild transient skin rash. Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. Liu JH, Chen GH, Yeh HZ, Huang CK, Poon SK. Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan. J Gastroenterol. 1997 Dec;32(6):765-8 Peppermint Oil Meta-Analysis Favorable: In a literature search 16 clinical trials investigating 180-200 mg enteric-coated peppermint oil (PO) in irritable bowel syndrome (IBS) or recurrent abdominal pain in children (1 study) with 651 patients were found. Nine of the 16 studies were randomized double blind cross over trials with (n = 5) or without (n = 4) run in and/or wash out periods, five had a randomized double blind parallel group design and two were open labeled studies. Placebo served in 12 and anticholinergics in three studies as comparator. Eight out of 12 placebo controlled studies show statistically significant effects in favor of PO. Average response rates in terms of "overall success" are 58% (range 39-79%) for PO and 29% (range 10-52%) for placebo. The three studies versus smooth muscle relaxants did not show differences between treatments hinting for equivalence of treatments. Adverse events reported were generally mild and transient, but very specific. PO caused the typical GI effects like heartburn and anal/perianal burning or discomfort sensations, whereas the anticholinergics caused dry mouth and blurred vision. PO (1-2 capsules t.i.d. over 24 weeks) may be the drug of first choice in IBS patients with non-serious constipation or diarrhea to alleviate general symptoms and to improve quality of life. Peppermint oil in irritable bowel syndrome. Grigoleit HG, et al. . Phytomedicine. 2005 Aug;12(8):601-6. Smooth Muscle Relaxants of Some Benefit: A total of 23 DB PC trials of smooth muscle relaxants were reviewed. Six drugs were analyzed: cimetropium bromide (five trials), hyoscine butyl bromide (three trials), mebeverine (five trials), otilium bromide (four trials), pinaverium bromide (two trials) and trimebutine (four trials). The total number of patients included was 1888. The mean percentage of patients with global improvement was 38% in the placebo group (n=925) and 56% in the myorelaxant group (n=927), in favour of myorelaxants with a mean odds ratio of 2.13, P < 0.001. The percentage of patients with pain improvement was 41% in the placebo group (n=568) and 53% in the myorelaxant group (n=567). There was no significant difference for adverse events. Meta-analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome. Poynard T, Regimbeau C, Benhamou Y. Paris, France. Aliment Pharmacol Ther. 2001 Mar;15(3):355-61 SSRI Added to High Fiber Diet Helps: In a DB PC study of 81 IBS patients put on high-fiber diets, have received paroxetine, an SSRI anti-depressant. Overall well-being improved in 26% patients, and abdominal pain and bloating decreased in 22% and 26% patients, respectively, with an HFD. Overall well-being improved still more with paroxetine than with placebo (63.3%vs 26.3%; p= 0.01), but abdominal pain, bloating, and social functioning did not. With paroxetine, food avoidance decreased (p= 0.03) and work functioning was marginally better (p= 0.08). Before unblinding, more paroxetine recipients than placebo recipients wanted to continue their study medication (84%vs 37%; p < 0.001). Paroxetine to treat irritable bowel syndrome not responding to high-fiber diet: a double-blind, placebo-controlled trial. Tabas G, Beaves M, Wang J, Friday P, Mardini H, Arnold G. University of Pittsburgh. Am J Gastroenterol. 2004 May;99(5):914-20 Tegaserod (Zelnorm) Helped IBS a Little: Tegaserod is the only medicine ever approved by the FDA for IBS. The selective 5-hydroxytryptamine type 4 receptor partial agonist is a promotile agent. It costs an incredible $154 per month (drugstore.com). Its benefit over placebo seems quite minor and there is a controversy about whether side-effects are worth the limited potential benefit. In a DB PC study of 647 patients with half given tegaserod 6 mg b.i.d. for a 12-week with 54% more relief for the medication than the placebo. Headache was the most commonly reported adverse event (8.0% tegaserod versus 4.7% placebo). Diarrhea was reported by 9.2% of patients on tegaserod (1.3% on placebo). A double-blind, placebo-controlled, randomized study to evaluate the efficacy, safety and tolerability of tegaserod in patients with irritable bowel syndrome. Nyhlin H, Bang C, Elsborg L, Silvennoinen J, Holme I, Ruegg P, Jones J, Wagner A. Stockholm, Sweden. Scand J Gastroenterol. 2004 Feb;39(2):119-26. Ed: This study used an odd way to report benefit. If placebo gave a slight benefit, 54% more than slight sure doesn't seem like very much. Tegaserod (Zelnorm) Mild Benefit for IBS: In a 520-patient 12-week DB PC study of tegaserod 6 mg twice daily, "satisfactory relief" was reported during weeks 1-12 by 62% vs. 44% with placebo; p<0.0001. Reductions in the number of days with at least moderate abdominal pain/discomfort, bloating, no bowel movements, and hard/lumpy stools were greater in the tegaserod group compared with the placebo group. An Asia-Pacific, double blind, placebo controlled, randomised study to evaluate the efficacy, safety, and tolerability of tegaserod in patients with irritable bowel syndrome. Kellow J, Lee OY, Chang FY, Thongsawat S, Mazlam MZ, Yuen H, Gwee KA, Bak YT, Jones J, Wagner A. Sydney, Australia. Gut. 2003 May;52(5):671-6. Probiotics: Yogurt Said to Improve Irritable Bowel Syndrome: In a very small, uncontrolled Italian report of giving yogurt bacteria to 10 patients with IBS, the authors report that they clinical symptoms improved. Effects of probiotic administration upon the composition and enzymatic activity of human fecal microbiota in patients with irritable bowel syndrome or functional diarrhea. Brigidi P, Vitali B, Swennen E, Bazzocchi G, Matteuzzi D. Res Microbiol. 2001 Oct;152(8):735-41 Probiotics: Yogurt Helped in Small DB: In a small DB PC crossover study in Poland, there was a slight but significant reduction in the severity of abdominal pain in individuals receiving L. plantarum. Niedzielin K., Kordecki H. Therapeutic usefulness of "ProViva" solution in the treatment of irritable bowel syndrome and hemorrhoids 1996 Presented at the Symposium of Gastroenterology Heiligenstadt, Germany. Probiotics: Yogurt-Like Bacteria Helps in DB: n a BD PC 4-week study of 40 patients with IBS Lactobacillus plantarum 299V (LP299V) in liquid suspension, all patients given L. plantarum reported resolution of their abdominal pain as compared to 11 of 20 patients from a placebo group (P = 0.0012). There was also a trend towards normalization of stools frequency in constipated patients in six out of 10 patients treated with LP299V compared with two out of 11 treated with placebo (P = 0.17). With regards to all IBS symptoms an improvement was noted in 95% of patients in the LP299V group vs 15% of patients in the placebo group (P < 0.0001). A controlled, double-blind, randomized study on the efficacy of Lactobacillus plantarum 299V in patients with irritable bowel syndrome. Niedzielin K, Kordecki H, Birkenfeld B. M. Curie Regional Hospital, Szczecin, Poland. Probiotics: Yogurt-Like Bacteria Helped in DB: In a DB PC 4-week trial, one group received 400 ml per day of a rose-hip drink containing 5 x 10(7) cfu/ml of Lactobacillus plantarum (DSM 9843) and 0.009 g/ml oat flour, and the other a plain rose-hip drink, comparable in color, texture, and taste. Twelve months after the end of the study all patients were asked to complete the same questionnaire regarding their symptomatology as at the start of the study. There were no major changes of Enterobacteriaceae in either group, before or after the study, but the Enterococci increased in the placebo group and remained unchanged in the test group. Flatulence was rapidly and significantly reduced in the test group compared with the placebo group. Abdominal pain was reduced in both groups. At the 12-month follow-up, patients in the test group maintained a better overall GI function than control patients. There was no difference between the groups regarding bloating. Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Nobaek S, Johansson ML, Molin G, Ahrne S, Jeppsson B. Lund University Hospital, Sweden. Am J Gastroenterol. 2000 May;95(5):1231-8 Probiotics: Cheese-Type Bacteria in Capsules Didn't Help in Very Small Study: In a DB PC 24-patient trials of Lactobacillus casei strain GG enterocoated tablets only 19 patients finished the trial. No significant differences were found between Lactobacillus casei strain GG and placebo mean symptom scores for pain, urgency or bloating. A trend was noted, however, for a reduction in the number of unformed bowel motions on Lactobacillus casei strain GG treatment for patients with diarrhea. Bacterial supplementation in the irritable bowel syndrome. A randomised double-blind placebo-controlled crossover study. O'Sullivan MA, O'Morain CA. Dublin, Ireland. Probiotic Not Impressive: In a DB PC 10-week study of 25 diarrheal IBS patients, VSL#3 powder (450 billion lyophilized bacteria/day) caused. Only abdominal bloating was reduced (P = 0.046) with VSL#3. A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. Kim HJ, Camilleri M, et al. Mayo. Aliment Pharmacol Ther. 2003 Apr 1;17(7):895-904 Probiotic Said Helpful in Odd Study: In a very small, industry-funded, 2-week DB PC study of 25 IBS patients, a probiotic combining at least 12 strains of bacteria (Prescript-Assist) 1 capsule twice a day was reported to do much better than the placebo group, although some of the data appears to have been gathered under open trial conditions with no data reported for the placebo in the abstract. Prescript-Assist probiotic-prebiotic treatment for irritable bowel syndrome: a methodologically oriented, 2-week, randomized, placebo-controlled, double-blind clinical study. Bittner AC, et al. Battelle Seattle Research Center, Washington, USA. . Clin Ther. 2005 Jun;27(6):755-61 |