THERAPEUTIC EFFECTS OF LACTOBACILLUS IN TREATING IRRITABLE BOWEL SYNDROME: A META ANALYSISBian Tiequn, Chao Guanqun, and Zhang Shuo

Interna Medicine

2015 The Japanese Society of Internal Medicine

Ika KrastanayaI11109002

SMF Penyakit DalamRS Abdul Aziz Singkawang

INTRODUCTIONIrritable bowel syndrome (IBS)

is a functional disorder of the digestive tract that causes chronic symptoms, such as abdominal pain and discomfort, and abnormal bowel movements, including diarrhea and constipation, with no organic abnormalities.

INTRODUCTIONmost frequent digestive tract

disorders encountered by general practitioners and gastroenterologists.

its etiology remains unknown.The most popular

pathogenetic theory involves : •a combination of dysregulated gastrointestinal (GI) motility and heightened visceral sensitivity in the context of chronic life stressors •other psychological factors.

INTRODUCTION constipation can be acute or chronic, with chronic constipation

defined as that with a duration greater than three months. The Rome III criteria for chronic constipation include the presence

of two or more of six symptoms for at least 12 weeks within the preceding six months

there is currently no universally accepted satisfactory treatment protocol for this condition.

a. straining at defecation on at least 1/4 occasions; b. lumpy/hard stools on at least 1/4 occasions;c. the sensation of incomplete evacuation on at least

1/4 occasions;d. the need for manual maneuvers to facilitate

defecation on at least 25% of occasions;e. the sensation of anorectal obstruction/blockage on

at least 25% of occasions; f. fewer than three bowel movements a week

INTRODUCTIONPROBIOTICRecently, the administration of probiotics,

defined as live microorganisms. That, when administered in adequate amounts, confer a health benefit on the host has been proposed as a treatment for functional gastrointestinal disorders.

Probiotics have been shown to have beneficial effects on various aspects of human health, as well as several gastrointestinal disorders, including adult and pediatric diarrhea, antibiotic associated diarrhea and pouchitis.

Four meta-analyses have previously evaluated the effects of probiotics for the treatment of IBS different conclusions.

Currently, Lactobacilli and Bifidobacteria are among the most commonly studied probiotics in patients with IBS.

a Cochrane systematic review concluded that there is no evidence that Lactobacillus supplementation is effective in managing children with recurrent abdominal pain.

INTRODUCTION

MATERIALS AND METHODS

SEARCH STRATE

GY

•We searched MEDLINE, PubMed, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials for studies investigating the efficacy of Lactobacillus supplementation for treating IBS.

STUDY SELECTI

ON

•The studies were screened for inclusion through a review of the published articles based on the following criteria: randomization, controls and reported measurable outcome

MATERIALS AND METHODS

METHODOLOGY QUALITY

ASSESSMENT

• THE JADAD SCORE to assess the quality of each article.

• The quality scale ranged from 0 to 5 points,• - low quality report indicated

by a score of ≤2• - high quality report

indicated by a score of≥ 4.

DATA SYNTHESIS

AND STATISTICAL

ANALYSIS

•The studies were screened for inclusion through a review of the published articles based on the following criteria: randomization, controls and reported measurable outcome

RESULTArticle Selection

RESULTJadad score assessment

RESULT

Table 2. All subtypes of IBS (diarrhea predominant, constipation-predominant and alternating) were incorporated in the included studies. The meta-analysis included 440 IBS patients (273 adults and 167 children) randomized to receive either Lactobacillus or a placebo.

RESULT

RESULTHeterogeneity testWe performed the heterogeneity analysis using the

χ2test and found heterogeneity in the metaanalysis.Therefore, a random-effects model was used for

the meta-analysis. The cause of heterogeneity the limited number of studies and small sample sizes.

RESULTPublication bias assessment

We performed Begg’s test and Egger’s test , both of which showed no publication bias in the meta-analysis (Begg’s test, p= 1.000; Egger’s test, p=0.932).

Merging and meta-analysisThe meta-analysis showed that the heterogeneity among the six studies was statistically significant (p<0.0001),the random-effects model for the metaanalysis.

In the forest plot, the diamond was on the right, OR was 7.69 (95%CI: 2.33-25.43, z=3.35, p=0.0008) indicated that Lactobacillus supplementation had an effect on irritable bowel syndrome

RESULT

We used the random effects model for the meta-analysis (p=0.10), the OR was 17.62 (95%CI: 5.12-60.65, z=4.55, p<0.00001) indicated that Lactobacillus treatment had an effect in the adult irritable bowel syndrome patients.

RESULT

We applied the random-effects model for the meta-analysis (p=0.04) and found an OR of 3.71 (95%CI: 1.05-13.11, z=2.04, p=0.04) indicated that Lactobacillus therapy had an effect in the pediatric irritable bowel syndrome patients.

RESULT

DISCUSSIONIBS functional bowel disorder

characterized by chronic and relapsing abdominal pain or discomfort associated with altered bowel habits.

The primary aim of treatment to relieve abdominal pain.

Affected patients experience recurrent abdominal pain and/or discomfort with alterations in bowel habits in addition to a range of other features, including bloating, distension, flatulence, borborygmi and disturbances in the defecatory function

DISCUSSIONThe therapeutic efficacy of IBS

treatment is likely impacted by the heterogeneous pathogenesis of the disease,

which includes alteredintestinal motility,visceral hypersensitivity,abnormal brain-gut interactions,food intolerance,altered intestinal permeability post-infectious and/or inflammatory changes.

Due to its obscure pathophysiology, treating IBS difficult prompting interest in the identification of new and safe treatment options.

According to published guidelines, the primary treatment options for abdominal pain include antispasmodics or antidepressants at low doses, while anti-diarrheal and/or laxative drugs are given to improve transit disturbances .

DISCUSSION

DISCUSSIONprobiotics composed of normal

gut flora, and adverse events associated with these agents are very rare.

probiotics are good candidates for controlling the symptoms associated with IBS, especially when treatment safety is paramount in non-lethal disorders, such as IBS .

While the exact mechanisms by which probiotics exert their effects in patients with IBS are not fully understood, several potential mechanisms have been suggested.

As Lactobacillus is currently a popular probiotic, we accumulated data and conducted an analysis of the treatment efficacy of Lactobacillus supplementation.

DISCUSSIONIn our research, we found six

articles that met the inclusion criteria, including three articles about children and three articles about adults.

According to the results of the manalysis, Lactobacillus treatment has an effect in both children and adults with IBS, without any side effects.

DISCUSSIONFurthermore, this metaanalysis showed that

Lactobacillus therapy is beneficial in IBS patients.

While IBS is likely multifactorial in etiology, recent findings in both experimental animal and clinical studies suggest that disturbances in gut flora, as observed in the setting of small-intestinal bacterial overgrowth, occur in patients with irritable bowel syndrome and that such abnormalities contribute to the development of IBS-type symptoms.

Physiologic Benefits of Probiotics in Irritable Bowel Syndrome

Probiotics have a beneficial effect on intestinal mucosa via several proposed mechanisms that include:

- suppression of the growth and binding of pathogenic bacteria

- improvement of the barrier function of the epithelium, and alteration of the immune activity of the host.

- secrete short chain fatty acids, an action that results in decreased luminal pH and production of bactericidal proteins.29 

- The DNA of probiotic organisms has also been shown to inhibit apoptosis of epithelial cells.

- In addition, probiotics may improve bowel dysmotility.30

CONCLUSIONLactobacillus is a good candidate for

assessment in a large multicenter trial of IBS patients, including both adults and children.

With respect to the limitations of this metaanalysis, there is a strong need for further research to confirm the effects of probiotic treatment. As the exact mechanism of action of Lactobacillus supplementation is not known, further experimental studies are needed.