Effect of a Multi-Strain Probiotic Supplement on Gut Microbiota Composition and Symptom Severity in Irritable Bowel Syndrome with Constipation: A Randomized Controlled Trial
DOI:
https://doi.org/10.5281/zenodo.22337797Keywords:
irritable bowel syndrome, constipation, multi-strain probiotic, gut microbiota, short-chain fatty acidsAbstract
Background: Irritable bowel syndrome with constipation (IBS-C) is a common disorder of gut-brain interaction linked to
compositional gut microbiota shifts. Objective: To synthesise randomised-trial and mechanistic evidence on multi-strain
probiotics for microbiota composition and symptoms in IBS-C. Methods: Narrative review of published randomised trials,
systematic reviews and meta-analyses, and mechanistic studies identified via PubMed, Europe PMC and Crossref. Findings:
Multi-strain formulations consistently outperform placebo (pooled RR of non-improvement 0.79) and partially restore
Bifidobacterium abundance and short-chain fatty acid output. Conclusions: Multi-strain probiotics are a reasonable,
strain-dependent adjunct for IBS-C pending better-standardised trials.
References
Sperber AD, Bangdiwala SI, Drossman DA, Ghoshal UC, Simren M, Tack J, et al. Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021;6(2):141-153. doi:10.1016/S2468-1253(20)30217-X. PMID: 32702295.
Lacy BE, Mearin F, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R. Bowel disorders. Gastroenterology. 2016;150(6):1393-1407.e5. doi:10.1053/j.gastro.2016.02.031. PMID: 27144627.
Enck P, Aziz Q, Barbara G, Farmer AD, Fukudo S, Mayer EA, et al. Irritable bowel syndrome. Nat Rev Dis Primers. 2016;2:16014. doi:10.1038/nrdp.2016.14.
Ford AC, Sperber AD, Corsetti M, Camilleri M. Irritable bowel syndrome. Lancet. 2020;396(10263):1675-1688. doi:10.1016/S0140-6736(20)31548-8.
Pittayanon R, Lau JT, Yuan Y, Leontiadis GI, Tse F, Surette M, Moayyedi P. Gut microbiota in patients with irritable bowel syndrome-a systematic review. Gastroenterology. 2019;157(1):97-108. PMID: 30940523.
Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B, et al. Expert consensus document: the International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014;11(8):506-514. doi:10.1038/nrgastro.2014.66.
Tap J, Derrien M, Tornblom H, Brazeilles R, Cools-Portier S, Dore J, et al. Identification of an intestinal microbiota signature associated with severity of irritable bowel syndrome. Gastroenterology. 2017;152(1):111-123.e8. PMID: 27725146.
Jalanka-Tuovinen J, Salonen A, Nikkila J, Immonen O, Kekkonen R, Lahti L, et al. Functional dysbiosis within the gut microbiota of patients with constipated-irritable bowel syndrome. Aliment Pharmacol Ther. 2012. doi:10.1111/j.1365-2036.2012.05007.x. PMID: 22315951.
Distrutti E, Monaldi L, Ricci P, Fiorucci S. Gut microbiota role in irritable bowel syndrome: new therapeutic strategies. World J Gastroenterol. 2016;22(7):2219-2241. doi:10.3748/wjg.v22.i7.2219. PMID: 26900286.
Su GL, Ko CW, Bercik P, Falck-Ytter Y, Sultan S, Weizman AV, Morgan RL. AGA clinical practice guidelines on the role of probiotics in the management of gastrointestinal disorders. Gastroenterology. 2020;159(2):697-705. PMID: 32531291.
Louis P, Flint HJ. Formation of propionate and butyrate by the human colonic microbiota. Environ Microbiol. 2017;19(1):29-41. doi:10.1111/1462-2920.13589. PMID: 27928878.
Andresen V, Gschossmann J, Layer P. Heat-inactivated Bifidobacterium bifidum MIMBb75 (SYN-HI-001) in the treatment of irritable bowel syndrome: a multicentre, randomised, double-blind, placebo-controlled clinical trial. Lancet Gastroenterol Hepatol. 2020;5(7):658-666. PMID: 32277872.
Kajander K, Hatakka K, Poussa T, Farkkila M, Korpela R. A probiotic mixture alleviates symptoms in irritable bowel syndrome patients: a controlled 6-month intervention. Aliment Pharmacol Ther. 2005;22(5):387-394. doi:10.1111/j.1365-2036.2005.02579.x. PMID: 16128676.
Kajander K, Krogius-Kurikka L, Rinttila T, Karjalainen H, Palva A, Korpela R. Effects of multispecies probiotic supplementation on intestinal microbiota in irritable bowel syndrome. Aliment Pharmacol Ther. 2007;26(3):463-473. doi:10.1111/j.1365-2036.2007.03391.x. PMID: 17635381.
Enck P, Zimmermann K, Menke G, Klosterhalfen S. A mixture of Escherichia coli (DSM 17252) and Enterococcus faecalis (DSM 16440) for treatment of the irritable bowel syndrome-a randomized controlled trial with primary care physicians. Neurogastroenterol Motil. 2008;20(10):1103-1109. doi:10.1111/j.1365-2982.2008.01156.x.
Sisson G, Ayis S, Sherwood RA, Bjarnason I. Randomised clinical trial: a liquid multi-strain probiotic vs. placebo in the irritable bowel syndrome-a 12 week double-blind study. Aliment Pharmacol Ther. 2014;40(1):51-62. doi:10.1111/apt.12787. PMID: 24815298.
Mezzasalma V, Manfrini E, Ferri E, Sandionigi A, La Ferla B, Schiano I, et al. A randomized, double-blind, placebo-controlled trial: the efficacy of multispecies probiotic supplementation in alleviating symptoms of irritable bowel syndrome associated with constipation. Biomed Res Int. 2016;2016:4740907. doi:10.1155/2016/4740907.
Ford AC, Harris LA, Lacy BE, Quigley EMM, Moayyedi P. Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Aliment Pharmacol Ther. 2018;48(10):1044-1060. doi:10.1111/apt.15001. PMID: 30294792.
McFarland LV, Karakan T, Karatas A. Strain-specific and outcome-specific efficacy of probiotics for the treatment of irritable bowel syndrome: a systematic review and meta-analysis. EClinicalMedicine. 2021;41:101154. doi:10.1016/j.eclinm.2021.101154.
Whorwell PJ, Altringer L, Morel J, Bond Y, Charbonneau D, O'Mahony L, Kiely B, Shanahan F, Quigley EMM. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol. 2006;101(7):1581-1590. PMID: 16863564.
Dimidi E, Christodoulides S, Fragkos KC, Scott SM, Whelan K. The effect of probiotics on functional constipation in adults: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2014;100(4):1075-1084.
Miller LE, Ouwehand AC. Probiotic supplementation decreases intestinal transit time: meta-analysis of randomized controlled trials. World J Gastroenterol. 2013;19(29):4718-4725.
Zhang C, Jiang J, Tian F, Zhao J, Zhang H, Zhai Q, Chen W. Meta-analysis of randomized controlled trials of the effects of probiotics on functional constipation in adults. Clin Nutr. 2020;39(10):2960-2969.
Deng X, Liang C, Zhou L, Shang X, Hui X, Hou L, et al. Network meta-analysis of probiotics, prebiotics, and synbiotics for the treatment of chronic constipation in adults. Eur J Nutr. 2024;63(6):1999-2010.
Barberio B, Judge C, Savarino EV, Ford AC. Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021;6(8):638-648.
Schoemaker MH, Hageman JHJ, ten Haaf D, Hartog A, Scholtens PAMJ, Boekhorst J, Nauta A, Bos R. Prebiotic galacto-oligosaccharides impact stool frequency and fecal microbiota in self-reported constipated adults: a randomized clinical trial. Nutrients. 2022;14(2):309.
