Exploring the potential of probiotics in the treatment of IBS

18-Jul-2022

Despite its prevalence, IBS is a largely under-diagnosed health issue. With no long-term solution currently available and the prevalence of incorrect therapeutic approaches, including antidepressants, one area that’s showing promise as a way to manage gastrointestinal disorders is probiotics. Jordi Riera, Chief Business Development Manager, Kaneka Probiotics/AB-BIOTICS (part of KANEKA Corp.) reports

One of the most commonly diagnosed gastrointestinal conditions, irritable bowel syndrome (IBS) can have a huge impact on the quality of an individual’s day-to-day life. Defined as the presence of abdominal pain with altered bowel habits, IBS also presents symptoms such as bloating, which can be exacerbated by malabsorption conditions such as fructose or lactose intolerance, making it extremely hard to identify.1–3

Healthcare practitioners generally refer to a series of criteria put together by a panel of international experts referred to as “the Rome IV criteria,” but a definitive diagnosis still remains challenging, especially as the symptoms vary significantly and are similar to several other conditions. As such, a diagnosis is reached (on average) between the third and sixth consultation, which can cause unnecessary stress for patients and may further exacerbate the symptoms.

IBS: the current state of affairs

Experts are still unsure about the exact cause of IBS, but research points to several potential key factors. Studies suggest that it could be the result of increased intestinal permeability, which may be a result of low-grade micro-inflammation in the gut.

The gut microbiota is also thought to play an important role in the pathogenesis of IBS, as the condition can be aggravated following an intestinal infection or antibiotic treatment. And as IBS is often associated with high levels of stress and anxiety, a growing number of studies show that it could be caused by altered brain-gut interaction and is closely linked with mental well-being.4,5

Finding an effective treatment can be challenging. Most conventional IBS treatments only target one symptom at a time, leading many patients to combine several at once. For example, constipation is usually treated with laxatives or enemas, whereas pain can be managed by antispasmodics.6

It’s trial and error, however, as physicians must ensure that treatments do not interact with each other or aggravate other symptoms. With no medical treatment available that’s sustainable in the long-term, it’s clear that a solution is needed.

Spotlight on probiotics

A growing body of scientific literature demonstrates the beneficial effects of probiotics and their growing popularity among the general population. Studies suggest that microbiota modulation using probiotics can support a healthy gut and digestive tract by creating a more favourable local environment (via mechanisms shared by most strains).

However, as the science of probiotics advances, it is becoming increasingly clear how many of the health benefits delivered are strain specific. Modern and Western lifestyles have caused a loss of microbial diversity in humans — and generic probiotic solutions that focus on microbiota modulation aren’t always sufficient to reintegrate the health benefits of the strains lost.

Our work is now focused on developing probiotic solutions that reintegrate the lost strains with outstanding phenotypic characteristics; those that are able to perform specific functions that help to address specific health problems are extremely rare.

For example, when it comes to improving the most concerning IBS symptoms, there are three probiotic strains that show particular promise. The efficacy of Pediococcus acidilactici KABP 021, Lactobacillus plantarum KABP 022 and Lactobacillus plantarum KABP 023 have been shown in randomised, placebo-controlled clinical trials to exhibit a multifactorial mechanism of action.7–9

Not only can these strains be used as a standalone treatment for IBS, they can also be used to support medical therapies (such as antispasmodics).8

Uncovering the science

A growing bank of evidence suggests that the combined properties of these three probiotic strains address IBS symptoms in a multifactorial way. Studies show that they can reduce intestinal permeability, correct dysbiosis by inhibiting the micro-organisms associated with IBS and reduce inflammation through the production of acetate and acetylcholine.10,11

Certain probiotics strains could make a tangible difference to individual lives. Research shows a clinical improvement in IBS-related quality of life with Pediococcus acidilactici KABP 021, Lactobacillus plantarum KABP 022 and Lactobacillus plantarum KABP 023 when compared with a placebo.

One study, for example, found that 55% of probiotic-treated subjects achieved a high response in the IBS-related quality of life test compared with only 17% of the placebo-treated subjects.7

A second study showed similar results, with 50% of probiotic-treated and 17% of placebo-treated subjects being “good responders.” The probiotic-treated group had reduced abdominal pain and diarrhoea compared with the placebo and, in combination with antispasmodics, produced much higher response ratios.8

Clinical evidence also supports the use of these three probiotic strains in lactose-intolerant patients. One study found that they can reduce flatulence and diarrhoea.9 As lactose intolerance symptoms are often linked to local inflammation and bloating, resulting in pain for patients, this backs up the hypothesis that these strains could help to improve intestinal permeability.

Similarly, in fructose intolerant patients, a clinical study highlights the potential of Lactiplantibacillus plantarum CECT 7484 and 7485 and Pediococcus acidilactici CECT 7483 to manage gastrointestinal symptoms.3

A defective mucosal barrier, which could be caused by a variety of reasons, may result in increased intestinal permeability and result in higher exposure to the non-tolerated nutrient, which in turn triggers an immunological response that promotes intestinal inflammation. The correct probiotic strains have the potential to act at the level of gut permeability and inflammation, breaking the vicious circle between gut permeability and inflammation.

One note: when we talk about “the crucial role of microbial dysbiosis on the onset of intolerance symptoms,” it’s not the dysbiosis that’s linked to the intolerance symptoms, it’s a connection between gut permeability and inflammation — related to greater exposure to non-tolerated nutrients — which worsens symptoms and inflammation (IBS).

As the probiotic acts at the level of gut permeability and inflammation (with the result of less pain and bloating), it’s good for both conditions.

Initial research has also found that the benefits of these strains extend beyond the gut by producing neurotransmitters that act on a physiological anti-inflammatory body response. The clinical study showed a statistically significant and clinically relevant improvement in visceral hypersensitivity using the Visceral Sensitivity Index (VSI).7

Recognised by the latest Rome IV criteria as a hallmark of functional gastrointestinal diseases, this is another indication of the gut-brain axis link to IBS.

A step in the right direction

Given the prevalence of IBS and its impact on patients’ quality of life, finding a long-term treatment is crucial. Although probiotics present a viable opportunity, not all strains are created equal. It is important to first determine the intended health goal and then identify the best strain for the required outcome.

It is also not effective to simply include a high number of strains together in one probiotic formulation; clinical proof is needed to determine the efficacy of a particular combination. Probiotics must also undergo strict quality controls to ensure that products are safe for consumption.

Tailored formulation support is therefore key to success. AB-BIOTICS, for example, provides a portfolio of precision probiotic solutions using certain strains for the treatment of specific health conditions.

As more evidence comes to light about the use of particular strains in the treatment of IBS, it could open the door to a variety of other applications — possibly alleviating the symptoms of conditions such leaky gut syndrome and Crohn’s disease, with the potential to change patients’ lives for the better.

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References

  1. K. Hod, et al., “Bloating in Irritable Bowel Syndrome is Associated with Symptoms Severity, Psychological Factors, and Comorbidities,” Dig. Dis. Sci. 64, 1288 (2019).
  2. P. Varjú, et al., “Lactose Intolerance But Not Lactose Maldigestion is More Frequent in Patients with Irritable Bowel Syndrome Than in Healthy Controls: A Meta‐Analysis,” J. Neurogastroenterol Motil. 31, e1352 (2019).
  3. P. Portincasa, et al., “Clinical and Metabolomic Effects of Lactiplantibacillus plantarum and Pediococcus acidilactici in Fructose Intolerant Patients,” Nutrients 14, 2488 (2022).
  4. M.J. Schmulson, et al., “What Is New in Rome IV,” J. Neurogastroenterol Motil. 23(2), 151–163 (2017).
  5. D. Drossman, et al., “Rome IV — Functional GI Disorders: Disorders of Gut-Brain Interaction,” Gastroenterology 150(6), 1257–1261 (2016).
  6. W.D. Chey, et al., “Irritable Bowel Syndrome: A Clinical Review,” JAMA 313(9), 949–958 (2015).
  7. V.L. Zúñiga, et al., “I.31, a New Combination of Probiotics, Improves Irritable Bowel Syndrome-Related Quality of Life,” World Journal of Gastroenterology 20(25), 8709–8716 (2014).
  8. D.A. Barraza-Ortiz, et al., “Combination of a Probiotic and an Antispasmodic Increases Quality of Life and Reduces Symptoms in Patients with Irritable Bowel Syndrome: A Pilot Study,” Dig. Dis. 39(3), 294–300 (2021).
  9. A.D. Cano-Contreras, et al., “Efficacy of Probiotic i3.1 Symptomatic Improvement in Patients with Lactose Intolerance,” J. Clin. Gastroenterol. 56(2), 141–147 (2022).
  10. S. Segawa, et al., “Probiotic-Derived Polyphosphate Enhances the Epithelial Barrier Function and Maintains Intestinal Homeostasis through Integrin–p38 MAPK Pathway,” Plos ONE 6(8), e23278 (2011).
  11. http://patentados.com/patente/composicion-probiotica-uso-tratamiento-inflamacionintestino.

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