Indications and Recommendations by Societies and Institutions for the Use of Probiotics and Prebiotics in Paediatric Functional Intestinal Disorders.

PURPOSE OF REVIEW: To report the indications and/or recommendations by Societies and Institutions for the use of probiotics and prebiotics in functional intestinal disorders in childhood. RECENT FINDINGS: A position by Societies and Institutions is available only for infant colic, irritable bowel syndrome and constipation. Supplementation with the probiotic L reuteri DSM 17938 in breastfed term infants with colic appears to be effective in reducing crying, while still debated is its role in the prevention of colic. Irritable bowel syndrome is a common disorder in children and at present no specific treatments are available; existing data show that although high-quality studies are still needed, some evidence support the efficacy of LGG and VSL#3 in paediatric IBS. At present there is no evidence for the use of pre- or probiotics in childhood constipation. SUMMARY: Probiotics in a near future may have a definite role is some FGIDs of infants and children. The main limitations for the recommendation by Societies and Institutions are the methodological issues that limit the quality of the evidence and the heterogeneity of treatments (probiotic strain and dose, mode, dose and duration of supplementation, primary outcomes, etc). Some specific strains are promising for infant colic (L. reuteri DSM 17938) and irritable bowel syndrome (LGG) while at present there is no indication for their use in the treatment of childhood constipation.

Preschool physical activity and functional constipation: the Generation R study.

OBJECTIVES: Decreased physical activity levels in children may partly explain the rising prevalence of functional constipation in childhood. The aim of the present study, therefore, was to examine the association between physical activity and functional constipation during the preschool period. METHODS: This study was embedded in the Generation R study, a large prospective birth-cohort study in Rotterdam, The Netherlands. Physical activity was measured by an Actigraph accelerometer in 347 children (182 boys, 165 girls; mean age 25.1 months) and data were expressed as counts per minute. Data were categorized into light activity (302-614 counts/15 seconds), moderate activity (615-1230 counts/15 seconds), and vigorous activity (≥1231 counts/15 seconds). Functional constipation in the third and fourth year of life was defined according to the Rome II criteria. RESULTS: Children spending time in the highest tertile of light (adjusted odds ratio [OR] 0.34; 95% confidence interval [CI] 0.13-0.87), moderate (adjusted OR 0.37; 95% CI 0.14-0.97), and total activity (adjusted OR 0.37; 95% CI 0.15-0.92) at the age of 2 years had significantly less functional constipation in the fourth year of life. For functional constipation in the third year of life, the results were in similar direction but not statistically significant. Additionally, children with physical activity of more than the WHO recommendation of 60 min/day had significantly less functional constipation in the fourth year of life (adjusted OR 0.48; 95% CI 0.24-0.97). CONCLUSIONS: Physical activity is associated with a decreased risk of functional constipation in the preschool period, but this may be time dependent.

Rectal irrigation for patients with functional bowel disorders.

Functional bowel disorders encompass a number of symptoms including abdominal, pelvic and/or anal pain, bloating, nausea, disturbed bowel function, faecal urgency or incontinence, straining to evacuate bowels, incomplete emptying and constipation. This article examines the causes and effects of functional bowel problems on patients' quality of life. It provides an overview of the treatment options and clinical management of these conditions, focusing on biofeedback and rectal irrigation. The author reports results from a small scale audit at her hospital and concludes that rectal irrigation is a valuable treatment option for patients with functional bowel disorders.

Rectal irrigation in the management of functional bowel disorders: a review.

Faecal incontinence and constipation are examples of functional bowel disorders that can lead to distressing psychological and physical symptoms which seriously impact upon quality of life. Rectal irrigation has been introduced as a treatment option for such patients. This article critically reviews and evaluates the current evidence on the effectiveness of rectal irrigation as a management option for functional bowel disorders. The review was conducted using BIOSIS, AHMED, CINAHL, MEDLINE, and Web of Knowledge. From 1051 articles identified through the literacy search, only nine were specifically concerned with the evaluation of rectal irrigation as a treatment option for functional bowel disorders. The results of the literature review do indicate that rectal irrigation could be a successful treatment option for some people, however, variations between studies and methodological limitations mean evidence of the effectiveness of rectal irrigation is lacking.

Effect of ramosetron on conditioned emotional stress-induced colonic dysfunction as a model of irritable bowel syndrome in rats.

The aim of this study was to establish a pathophysiologic model of irritable bowel syndrome, and then to evaluate the pharmaceutical efficacy of ramosetron, a potent serotonin 3 (5-HT(3)) receptor antagonist, and other anti-irritable bowel syndrome agents in this model. Rats stressed by a conditioned stress procedure exhibited marked prolongation of freezing time, an index of fear level, and an increase in the frequency of defecation (P<0.01). A corticotropin-releasing factor (CRF) antagonist, alpha-helical CRF, inhibited both defecation and freezing behavior, while the antidiarrheal loperamide inhibited defecation only. The 5-HT(3) receptor antagonists ramosetron, cilansetron and alosetron also inhibited defecation (ED(50) values: 0.012, 0.094, 0.078 mg/kg p.o., respectively) without affecting freezing behavior. Ramosetron showed longer-lasting effect on defecation than cilansetron. Stress also resulted in increases in both proximal and distal colonic transit rates. Ramosetron and other 5-HT(3) receptor antagonists at doses inhibiting stress-induced defecation also ameliorated both stress-stimulated colonic transit rates. These results suggest that ramosetron, as well as agents used for the treatment of irritable bowel syndrome with diarrhea, has beneficial effects against emotional stress-induced colonic dysfunction. Furthermore, this emotional stress model may be useful in evaluation of drugs to treat irritable bowel syndrome presenting with diarrhea.

Impact of sex and gender on irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a common functional bowel disorder characterized by abdominal pain and change in defecation pattern. This review addresses the topic of possible sex (genetic, biological) and gender (experiential, perceptual) differences in individuals with and without IBS. Several observations make the topic important. First, there is a predominance of women as compared to men who seek health care services for IBS in the United States and other industrialized societies. Second, menstrual cycle-linked differences are observed in IBS symptom reports. Third, women with IBS tend to report greater problems with constipation and nongastrointestinal complaints associated with IBS. Fourth, serotonin (5-HT3) receptor antagonist and 5-HT4 partial agonist drugs appear to more effectively diminish reports of bowel pattern disruption in women with IBS as compared to men. This review examines sex and gender modulation of gastrointestinal motility and transit, visceral pain sensitivity, autonomic nervous system function, serotonin biochemistry, and differences in health care-seeking behavior for IBS.

Who gets irritable bowel syndrome and does seeing a gastroenterologist affect its course?

A review of studies involving patients with irritable bowel syndrome is presented. This review looks at the impact of gastroenterology consultation on health care utilization patterns and the well-being of the patient when followed up over a two-year period. A structured gastroenterological consultation between the physician and patient may decrease the number of office visits for gastrointestinal-related problems.

Irritable bowel syndrome in twins: heredity and social learning both contribute to etiology.

BACKGROUND & AIMS: Heredity has been suggested to explain the finding that irritable bowel syndrome (IBS) tends to run in families. Research in this area has been limited. The aim of the present study was to assess the relative contribution of genetic and environmental (social learning) influences on the development of IBS by comparing concordance rates in monozygotic and dizygotic twins to concordance between mothers and their children. METHODS: Questionnaires soliciting information on the occurrence of more than 80 health problems, including IBS, in self and other family members were sent to both members of 11,986 twin pairs. RESULTS: Analysis is based on 10,699 respondents representing 6060 twin pairs. Concordance for IBS was significantly greater (P = 0.030) in monozygotic (17.2%) than in dizygotic (8.4%) twins, supporting a genetic contribution to IBS. However, the proportion of dizygotic twins with IBS who have mothers with IBS (15.2%) was greater than the proportion of dizygotic twins with IBS who have co-twins with IBS (6.7%, P < 0.001), and logistic regression analysis showed that having a mother with IBS and having a father with IBS are independent predictors of irritable bowel status (P < 0.001); both are stronger predictors than having a twin with IBS. Addition of information about the other twin accounted for little additional predictive power. CONCLUSIONS: Heredity contributes to development of IBS, but social learning (what an individual learns from those in his or her environment) has an equal or greater influence.

The patient's perspective of irritable bowel syndrome.

OBJECTIVE: The researchers wanted to understand how irritable bowel syndrome (IBS) affects patients' lives and their interactions with physicians and the health care system. STUDY DESIGN: A qualitative study was performed using focus groups of people with physician-diagnosed IBS. Immersion/crystallization was used to identify overriding themes. POPULATION: Adult volunteers with a previous physician diagnosis of IBS were included. OUTCOMES MEASURED: The outcomes were patient-reported symptoms, episode triggers, treatments, lifestyle changes, and interactions with their physicians that were related to IBS, and overriding themes identified from the focus groups. RESULTS: The subjects described IBS as a chronic episodic illness that affects their daily lives. Interaction with the medical community seldom clarified understanding of the condition or improved its management. Three overriding themes emerged from the groups: a sense of frustration, a sense of isolation, and a search for a niche in the health/sick role continuum. Frustration was evident in the perceived inability to control symptoms, prevent episodes, identify episode triggers, and obtain medical validation of the condition. The constant anticipation of the next IBS episode, the need for immediate access to toilet facilities, and the nature of the bowel symptoms often required withdrawal from social activities and resultant isolation. CONCLUSIONS: IBS is perceived as a chronic condition resulting in frustration and social isolation, and physicians are perceived to be providing inadequate medical information or support to patients with IBS.

Control of irritable bowel syndrome with polyamine analogs: a structure-activity study.

The evaluation of a group of polyamine analogs as agents to ameliorate diarrhea-predominant irritable bowel syndrome is described. Each compound was assessed when administered subcutaneously in a psychological stress-induced model of irritable bowel syndrome in rodents for its ability to reduce stool output in a dose-dependent manner. The spermine pharmacophore is shown to be an excellent platform from which to construct compounds to treat irritable bowel syndrome. The activity of the compounds is very dependent on both the nature of the terminal alkyl groups and the geometry of the methylene spacers separating the nitrogens. In addition to the subcutaneous studies, several compounds, N1,N11-diethylnorspermine, N1,N12-diethylspermine, N1,N12-diisopropylspermine, N1,N14-diethylhomospermine, N,N'-bis[5-(ethylamino)pentyl]-1,4-butanediamine, N,N'-bis[2-(4-piperidinyl)ethyl]-1,4-diaminobutane, and N,N'-bis[3-(ethylamino)propyl]-trans-1,4-cyclohexanediamine, were subsequently evaluated for oral efficacy. The remarkable activity of N,N'-bis[3-(ethylamino)propyl]-trans-1,4-cyclohexanediamine underscores the need to explore this framework further as a pharmacophore for the construction of other analogues to relieve the symptoms of diarrhea-predominant IBS.

Diet triggers symptoms in women with irritable bowel syndrome. The patient's perspective.

The purpose of this phenomenological analysis was to describe perceptions of women with irritable bowel syndrome regarding the relationship of diet to their symptoms. Thirty-five women ages 18-45 with a medical diagnosis of irritable bowel syndrome or symptoms compatible with a diagnosis of irritable bowel syndrome were interviewed and completed questionnaires as part of a larger study. During the interview, the women were asked what they thought caused their symptoms. Overall, women tried to adjust their diet to achieve a "Range of Comfort" so their symptoms were tolerable or manageable. To do this, women used a process of "Trial and Error." If a link could be made to diet, then women developed "Self-care Strategies" to maintain a "Healthy Diet." Women who failed to find a relationship during the "Trial and Error" process either felt the frustration of "Uncertainty" or, for a few women, decided that adjusting their diet was not worth the bother. This study suggests diet and eating behaviors are an important starting point for many women as they try to manage their irritable bowel syndrome symptoms.

The dietary combination of germinated barley foodstuff plus Clostridium butyricum suppresses the dextran sulfate sodium-induced experimental colitis in rats.

BACKGROUND: Recent studies have suggested that dietary fiber exerts a therapeutic effect on IBD patients. The aim of this study was to evaluate the effects of a dietary combination of germinated barley foodstuff (GBF), derived from the aleurone and scutellum fraction of germinated barley, plus Clostridium butyricum against dextran sulfate sodium (DSS)-induced experimental colitis in rats. METHODS: Sprague-Dawley rats were fed a 3% DSS diet containing GBF only, GBF plus C. butyricum, cellulose only (control) or cellulose plus C. butyricum for 8 days. The mucosal damage (macroscopic and microscopic inflammation) and fecal short-chain fatty acid (SCFA) levels were then determined. RESULTS: The combination of GBF plus C. butyricum most effectively prevented bloody diarrhea and mucosal damage. The GBF-only diet also showed some preventive effects. With respect to fecal SCFAs, the combination of GBF plus C. butyricum most effectively increased the fecal SCFA level. CONCLUSION: The dietary combination of GBF plus C. butyricum most effectively suppressed DSS-induced experimental colitis in rats. These effects may be closely associated with its high activity to increase SCFA levels in the gut lumen. The potential clinical efficacy of GBF in IBD patients is also discussed.

Carbohydrate malabsorption and the effect of dietary restriction on symptoms of irritable bowel syndrome and functional bowel complaints.

BACKGROUND: Carbohydrate malabsorption of lactose, fructose and sorbitol has already been described in normal volunteers and in patients with functional bowel complaints including irritable bowel syndrome. Elimination of the offending sugar(s) should result in clinical improvement. OBJECTIVE: To examine the importance of carbohydrate malabsorption in outpatients previously diagnosed as having functional bowel disorders, and to estimate the degree of clinical improvement following dietary restriction of the malabsorbed sugar(s). METHODS: A cohort of 239 patients defined as functional bowel complaints was divided into a group of 94 patients who met the Rome criteria for irritable bowel syndrome and a second group of 145 patients who did not fulfill these criteria and were defined as functional complaints. Lactose (18 g), fructose (25 g) and a mixture of fructose (25 g) plus sorbitol (5 g) solutions were administered at weekly intervals. End-expiratory hydrogen and methane breath samples were collected at 30 minute intervals for 4 hours. Incomplete absorption was defined as an increment in breath hydrogen of at least 20 ppm, or its equivalent in methane of at least 5 ppm. All patients received a diet without the offending sugar(s) for one month. RESULTS: Only 7% of patients with IBS and 8% of patients with FC absorbed all three sugars normally. The frequency of isolated lactose malabsorption was 16% and 12% respectively. The association of lactose and fructose-sorbitol malabsorption occurred in 61% of both patient groups. The frequency of sugar malabsorption among patients in both groups was 78% for lactose malabsorption (IBS 82%, FC 75%), 44% for fructose malabsorption and 73% for fructose-sorbitol malabsorption (IBS 70%, FC 75%). A marked improvement occurred in 56% of IBS and 60% of FC patients following dietary restriction. The number of symptoms decreased significantly in both groups (P < 0.01) and correlated with the improvement index (IBS P < 0.05, FC P < 0.025). CONCLUSIONS: Combined sugar malabsorption patterns are common in functional bowel disorders and may contribute to symptomatology in most patients. Dietary restriction of the offending sugar(s) should be implemented before the institution of drug therapy.

Uso de probióticos, prebióticos y simbióticos en patología humana: efectos preventivos y terapéuticos / Use of probiotics, prebiotics and synbiotics in human pathology: preventive and therapeutic efects

Los probióticos son microorganismos vivos que al ser ingeridos producen un efecto favorable sobre la salud humana, al poder prevenir o tratar determinadas patologías (diarrea aguda, diarrea del viajero, diarrea por antibióticos, alergia gastrointestinal, colon irritable, candidiasis vaginal, helicobacter pylori, enfermedad inflamatoria intestinal, sobrecrecimiento bacteriano intestinal, prevención del cáncer, reducción del colesterol, intolerancia a la lactosa, enterocolitis necrotizante).Deben poseer una serie de condiciones: procedencia humana, no ser patógenos, alta resistencia a su paso por el intestino, capacidad de adhesión a las mucosas, supervivencia en el ecosistema intestinal, respuesta inmune, prevención de la adhesión y colonización de patógenos, poder ser utilizados tecnológicamente.Los prebióticos son moléculas fermentables que poseen un efecto favorable sobre la flora intestinal, al estar dirigidos selectivamente al crecimiento y/o actividad de los probióticos.Los simbióticos son una mezcla de probióticos y prebióticos, mejorando la supervivencia, el crecimiento y la efectividad de los probióticos (AU)

Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome.

OBJECTIVES: Irritable bowel syndrome is the most common gastrointestinal diagnosis. The symptoms of irritable bowel syndrome are similar to those of small intestinal bacterial overgrowth. The purpose of this study was to test whether overgrowth is associated with irritable bowel syndrome and whether treatment of overgrowth reduces their intestinal complaints. METHODS: Two hundred two subjects in a prospective database of subjects referred from the community undergoing a lactulose hydrogen breath test for assessment of overgrowth were Rome I criteria positive for irritable bowel syndrome. They were treated with open label antibiotics after positive breath test. Subjects returning for follow-up breath test to confirm eradication of overgrowth were also assessed. Subjects with inflammatory bowel disease, abdominal surgery, or subjects demonstrating rapid transit were excluded. Baseline and after treatment symptoms were rated on visual analog scales for bloating, diarrhea, abdominal pain, defecation relief, mucous, sensation of incomplete evacuation, straining, and urgency. Subjects were blinded to their breath test results until completion of the questionnaire. RESULTS: Of 202 irritable bowel syndrome patients, 157 (78%) had overgrowth. Of these, 47 had follow-up testing. Twenty-five of 47 follow-up subjects had eradication of small intestinal bacterial overgrowth. Comparison of those that eradicated to those that failed to eradicate revealed an improvement in irritable bowel syndrome symptoms with diarrhea and abdominal pain being statistically significant after Bonferroni correction (p < 0.05). Furthermore, 48% of eradicated subjects no longer met Rome criteria (chi2 = 12.0, p < 0.001). No difference was seen if eradication was not successful. CONCLUSIONS: Small intestinal bacterial overgrowth is associated with irritable bowel syndrome. Eradication of the overgrowth eliminates irritable bowel syndrome by study criteria in 48% of subjects.