Acidophilus or Bifidobacterium Infantis - IBS

[Guest guest]

> Many patients with irritable bowel syndrome in fact

> may have a disturbed intestinal flora which can be

> treated with re-introducing the proper flora by way of

> acidophilus or bifidobacterium infantis. In other

> cases there is bacterial overgrowth and certain

> antibiotics specifically targeting these bacteria can

> be used.

***

What's the determining factor(s) that would influence one's decision

between the two? Is one basing one's choice on the symptoms of the

client?

Are there any particular brands more reliable than others?

Members may be interested in the following excerpts from various

articles on medscape:

New Developments in the Treatment of Irritable Bowel Syndrome by

Philip S. Schoenfeld, MD, MSEd, MSc (Epi)

http://www.medscape.com/viewarticle/540226_6

Bifidobacterium infantis 35624

If subtle changes in colonic bacterial flora contribute to mucosal

inflammation, then the use of probiotics may also be helpful in the

treatment of IBS symptoms. Probiotics are defined as " preparations

that contain viable microorganisms (ie, specific strains of bacteria)

that confer potential health benefits by preventing or treating

specific pathologic conditions. "

Patients with IBS have abnormal interleukin ratios consistent with a

proinflammatory state.[2] Bifidobacterium infantis strain 35624,

which is marketed as a supplement in the United States, reverses

abnormal interleukin ratios in IBS patients to the normal levels seen

in healthy controls. More important, this change is correlated with

improvement in abdominal discomfort and bloating but not improvement

in bowel stool frequency or stool consistency. This is " proof of

concept " that a probiotic will be beneficial for improvement of IBS

symptoms.

Whorwell and colleagues[11] presented data from large RCTs of

patients with IBS who received B infantis 35624 in an encapsulated

form vs placebo daily for 4 weeks. Improvement in symptoms was

measured on a 5-point Likert scale. B infantis-treated patients were

more likely to demonstrate improvement in abdominal discomfort,

bloating, and global IBS symptoms compared with placebo-treated

patients. Similar to the rifaximin data,[9] it is not entirely clear

whether the numerical improvements seen in this study correlate with

clinically important improvement in IBS symptoms. Nevertheless, these

data are quite promising regarding the potential utility of

adjunctive treatments for the management of refractory IBS patients.

Unfortunately, the appropriate duration for the use of these

probiotics remains unclear, and it is not known whether symptoms

return after probiotics are discontinued. Adverse events were similar

in probiotic-treated patients and placebo-treated patients, and no

clinically important safety issues were identified in this trial.

-------------

Advances in the Use of Nonbiologic Agents to Treat Inflammatory Bowel

Disease

Bret A. Lashner, MD

Probiotics

Probiotics have been used in patients with IBD with variable success.

In a study presented during this year's DDW meeting, 157 ulcerative

colitis patients in steroid-induced remission were given 109

probiotic organisms (Lactobacillus salivarius* or Bifidobacterium

infantis*) vs placebo for 1 year.[16] Remission off steroid therapy

was observed in about half of patients in all 3 treatment groups, and

the risk for relapse was similar among groups. The risk for relapse

was higher in younger patients regardless of maintenance therapy. The

probiotic Escherichia coli Nissel 1917* has been administered orally

to ulcerative colitis patients in the past with mixed results.

Perhaps topical administration will have a more consistent effect. In

a study presented during these meeting proceedings, 90 patients with

ulcerative proctosigmoiditis were randomized to receive 40-mL, 20-mL,

or 10-mL enemas containing E coli Nissel 1917* at 108 organisms/mL or

placebo once daily for 4 weeks.[17] Remission was achieved in 18% of

placebo-treated patients, in 27% of those receiving the 10-mL

formulation, in 44% of those receiving the 20-mL enema, and in 53% of

patients receiving the 40-mL enema. There were no differences in

adverse effects seen between the groups. This topical probiotic shows

promise for patients with mildly to moderately active ulcerative

colitis.

-----------

The Brain, the Gut, the Food, and the Bacteria? Update on Treatment

of Functional Gastrointestinal Disorders

http://www.medscape.com/viewarticle/456987

Yehuda Ringel, MD A. Drossman, MD

Probiotics vs Antibiotics

In a small (n = 44) study, Faber[8] examined the effect of

probiotics* alone (n = 20) and in combination with antibiotics (n =

24) on GI symptoms and QOL in an uncontrolled trial of unselected

(all subtypes) patients with IBS. Antibiotic treatment included

ciprofloxacin* 500 mg twice daily per week, and probiotic treatment

included Lactobacillus acidophilus NCFM (10 billion/g) and

Bifidobacteria infantis (10 billion/g) daily for 4 weeks. Both groups

showed significant improvement following treatment: In the

probiotic/antibiotic group, a decrease in symptom frequency index

scores from 35 to 18 (P < .001) and an increase in IBS-QOL scores

from 67.6 to 87.8 (P < .001) were seen; in the probiotic-only group,

a decrease in symptom frequency index scores from 39 to 17 (P < .001)

and an increase in IBS-QOL scores from 69.3 to 86.4 (P < .001) were

seen. The predominant IBS type did not alter the response to therapy.

Commentary. As a small uncontrolled study, these results may reflect,

at least in part, a placebo response. Nevertheless, the findings

emphasize the need for additional clinical studies to evaluate the

role of probiotics and antibiotics in IBS patients.

-------------

Irritable Bowel Syndrome: New and Emerging Therapies

Lucinda A ; Lin Chang

Antibiotics and Probiotics

http://www.medscape.com/viewarticle/524223_4

It has recently been proposed that many IBS patients have symptoms on

the basis of the presence of small bowel bacterial intestinal

overgrowth measured by lactulose breath test.[70] Both neomycin and

rifaximin have been shown to improve IBS symptoms in short-term,

placebo-controlled experimental studies.[71,72] While this is a

potentially effective treatment at least in a subgroup of IBS

patients, high-quality studies are needed to determine the exact role

of small intestinal bacterial overgrowth in IBS, the mechanisms by

which this may be related to symptoms, and the long-term effect of

antibiotics on symptom relief. Until more supportive data are

available, routine testing of bacterial overgrowth and administration

of antibiotics is not being performed on a widespread basis.

There are a limited but growing number of studies evaluating the

efficacy of probiotics in IBS. The beneficial effect of probiotics

appears to be dependent on the particular strain. Studies have looked

at single strains of Lactobacillus or Bifidobacteria, mixtures of

Bifidobacteia and Lactobacillus, and one probiotic additionally mixed

with Streptoccocus (VSL #3). Results are mixed, but six out of nine

studies show some beneficial results[21**,73-80] with the most

impressive results being associated with Bifidobacterium infantis.

[21**] Probiotic-related improvements include daily symptom scores,

[21**,73,74] flatulence,[75] bloating[78,79] and abdominal pain.

[74,75] O'Mahoney et al.[21**] suggested that the mechanism by which

probiotics may produce their beneficial effects is immune modulated

by normalizing the ratio of antiinflammatory to proinflammatory

cytokines. More prospective research with probiotics is needed to

study both relief of symptoms and their possible immune-modulating

effects.

------------

Many thanks in advance

Carruthers

Wakefield, UK

[Guest guest]

A stool analysis may be helpful for objective markers.

Afzal Rashid

Bradford, United Kingdom

Acidophilus or Bifidobacterium Infantis - IBS

>

>

>> Many patients with irritable bowel syndrome in fact

>> may have a disturbed intestinal flora which can be

>> treated with re-introducing the proper flora by way of

>> acidophilus or bifidobacterium infantis. In other

>> cases there is bacterial overgrowth and certain

>> antibiotics specifically targeting these bacteria can

>> be used.

>

> ***

> What's the determining factor(s) that would influence one's decision

> between the two? Is one basing one's choice on the symptoms of the

> client?

>

> Are there any particular brands more reliable than others?

>

> Members may be interested in the following excerpts from various

> articles on medscape:

>

> New Developments in the Treatment of Irritable Bowel Syndrome by

> Philip S. Schoenfeld, MD, MSEd, MSc (Epi)

>

> http://www.medscape.com/viewarticle/540226_6

>

> Bifidobacterium infantis 35624

>

> If subtle changes in colonic bacterial flora contribute to mucosal

> inflammation, then the use of probiotics may also be helpful in the

> treatment of IBS symptoms. Probiotics are defined as " preparations

> that contain viable microorganisms (ie, specific strains of bacteria)

> that confer potential health benefits by preventing or treating

> specific pathologic conditions. "

>

> Patients with IBS have abnormal interleukin ratios consistent with a

> proinflammatory state.[2] Bifidobacterium infantis strain 35624,

> which is marketed as a supplement in the United States, reverses

> abnormal interleukin ratios in IBS patients to the normal levels seen

> in healthy controls. More important, this change is correlated with

> improvement in abdominal discomfort and bloating but not improvement

> in bowel stool frequency or stool consistency. This is " proof of

> concept " that a probiotic will be beneficial for improvement of IBS

> symptoms.

>

> Whorwell and colleagues[11] presented data from large RCTs of

> patients with IBS who received B infantis 35624 in an encapsulated

> form vs placebo daily for 4 weeks. Improvement in symptoms was

> measured on a 5-point Likert scale. B infantis-treated patients were

> more likely to demonstrate improvement in abdominal discomfort,

> bloating, and global IBS symptoms compared with placebo-treated

> patients. Similar to the rifaximin data,[9] it is not entirely clear

> whether the numerical improvements seen in this study correlate with

> clinically important improvement in IBS symptoms. Nevertheless, these

> data are quite promising regarding the potential utility of

> adjunctive treatments for the management of refractory IBS patients.

> Unfortunately, the appropriate duration for the use of these

> probiotics remains unclear, and it is not known whether symptoms

> return after probiotics are discontinued. Adverse events were similar

> in probiotic-treated patients and placebo-treated patients, and no

> clinically important safety issues were identified in this trial.

> -------------

>

> Advances in the Use of Nonbiologic Agents to Treat Inflammatory Bowel

> Disease

>

> Bret A. Lashner, MD

>

> Probiotics

>

> Probiotics have been used in patients with IBD with variable success.

> In a study presented during this year's DDW meeting, 157 ulcerative

> colitis patients in steroid-induced remission were given 109

> probiotic organisms (Lactobacillus salivarius* or Bifidobacterium

> infantis*) vs placebo for 1 year.[16] Remission off steroid therapy

> was observed in about half of patients in all 3 treatment groups, and

> the risk for relapse was similar among groups. The risk for relapse

> was higher in younger patients regardless of maintenance therapy. The

> probiotic Escherichia coli Nissel 1917* has been administered orally

> to ulcerative colitis patients in the past with mixed results.

> Perhaps topical administration will have a more consistent effect. In

> a study presented during these meeting proceedings, 90 patients with

> ulcerative proctosigmoiditis were randomized to receive 40-mL, 20-mL,

> or 10-mL enemas containing E coli Nissel 1917* at 108 organisms/mL or

> placebo once daily for 4 weeks.[17] Remission was achieved in 18% of

> placebo-treated patients, in 27% of those receiving the 10-mL

> formulation, in 44% of those receiving the 20-mL enema, and in 53% of

> patients receiving the 40-mL enema. There were no differences in

> adverse effects seen between the groups. This topical probiotic shows

> promise for patients with mildly to moderately active ulcerative

> colitis.

>

> -----------

>

> The Brain, the Gut, the Food, and the Bacteria? Update on Treatment

> of Functional Gastrointestinal Disorders

>

> http://www.medscape.com/viewarticle/456987

>

> Yehuda Ringel, MD A. Drossman, MD

>

> Probiotics vs Antibiotics

> In a small (n = 44) study, Faber[8] examined the effect of

> probiotics* alone (n = 20) and in combination with antibiotics (n =

> 24) on GI symptoms and QOL in an uncontrolled trial of unselected

> (all subtypes) patients with IBS. Antibiotic treatment included

> ciprofloxacin* 500 mg twice daily per week, and probiotic treatment

> included Lactobacillus acidophilus NCFM (10 billion/g) and

> Bifidobacteria infantis (10 billion/g) daily for 4 weeks. Both groups

> showed significant improvement following treatment: In the

> probiotic/antibiotic group, a decrease in symptom frequency index

> scores from 35 to 18 (P < .001) and an increase in IBS-QOL scores

> from 67.6 to 87.8 (P < .001) were seen; in the probiotic-only group,

> a decrease in symptom frequency index scores from 39 to 17 (P < .001)

> and an increase in IBS-QOL scores from 69.3 to 86.4 (P < .001) were

> seen. The predominant IBS type did not alter the response to therapy.

> Commentary. As a small uncontrolled study, these results may reflect,

> at least in part, a placebo response. Nevertheless, the findings

> emphasize the need for additional clinical studies to evaluate the

> role of probiotics and antibiotics in IBS patients.

>

> -------------

> Irritable Bowel Syndrome: New and Emerging Therapies

>

> Lucinda A ; Lin Chang

>

> Antibiotics and Probiotics

> http://www.medscape.com/viewarticle/524223_4

>

> It has recently been proposed that many IBS patients have symptoms on

> the basis of the presence of small bowel bacterial intestinal

> overgrowth measured by lactulose breath test.[70] Both neomycin and

> rifaximin have been shown to improve IBS symptoms in short-term,

> placebo-controlled experimental studies.[71,72] While this is a

> potentially effective treatment at least in a subgroup of IBS

> patients, high-quality studies are needed to determine the exact role

> of small intestinal bacterial overgrowth in IBS, the mechanisms by

> which this may be related to symptoms, and the long-term effect of

> antibiotics on symptom relief. Until more supportive data are

> available, routine testing of bacterial overgrowth and administration

> of antibiotics is not being performed on a widespread basis.

> There are a limited but growing number of studies evaluating the

> efficacy of probiotics in IBS. The beneficial effect of probiotics

> appears to be dependent on the particular strain. Studies have looked

> at single strains of Lactobacillus or Bifidobacteria, mixtures of

> Bifidobacteia and Lactobacillus, and one probiotic additionally mixed

> with Streptoccocus (VSL #3). Results are mixed, but six out of nine

> studies show some beneficial results[21**,73-80] with the most

> impressive results being associated with Bifidobacterium infantis.

> [21**] Probiotic-related improvements include daily symptom scores,

> [21**,73,74] flatulence,[75] bloating[78,79] and abdominal pain.

> [74,75] O'Mahoney et al.[21**] suggested that the mechanism by which

> probiotics may produce their beneficial effects is immune modulated

> by normalizing the ratio of antiinflammatory to proinflammatory

> cytokines. More prospective research with probiotics is needed to

> study both relief of symptoms and their possible immune-modulating

> effects.

>

> ------------

>

> Many thanks in advance

> Carruthers

> Wakefield, UK

[Guest guest]

My first preference would be bifidobacterium infantis

if it is available. This species is found in the

intestines of infants and is no longer found in older

children or adults. It seems to work best in some

patients with irritable bowel syndrome.

I have been using it with some success for the past

two+ years. However it is not readily available at

most of the local pharmacies. I had to ask the

pharmacy closest to my office to stock this particular

bifidobacterium and whenever I write a prescription I

direct my patients to this one pharmacy. (It is over

the counter but it is easier just to write a script

for the patients- no difference in cost but they will

give to the pharmacist who know exactly what I want

them to get). Acidophilus may work in some patients

with irritable bowel syndrome. It is probably best

for patients who have had a bout of diarrhea not

related to irritable bowel syndrome.

As far as a stool marker to decide which is best,

there are no stool markers for irritable bowel

syndrome and there are no stool markers for small

bowel intestinal bacterial overgrowth. At least there

are none that I am aware of.

Irritable bowel syndrome is a syndrome which may have

many causes and the diagnosis is may based on clinical

judgment and by process of elimination of known causes

of abdominal pain and dysfunction. There are no

direct tests. The diagnosis is based on the Rome II

criteria.

Furthermore there is not a single therapeutic strategy

to treat this syndrome. For some patients

bifidobacterium infantis may work, for others stress

management is important. I find very little use in

dietary changes other than the usual importance of

proper balance in diet and proper eatig habits.

Patients who have food allergies by definition do not

have irritable bowel syndrome.

By definition irritable bowel syndrome has no known

specific cause. I will not discuss during this post

the known pathophysiological basis of irritable bowel

syndrome.

It is very important to take a detailed history going

back to childhood and including psycho-social

situations both present and past.

There are two medications which have therapeutic

medications. The first is Lotrenex which is used to

treat intractable diarrhea in irritable bowel syndrome

patients but it is restricted to use by

Gastroenterologists. I won't go into to the reasons

for this in this post.

The other is Zelnorm which is indicated in irritable

bowel syndrome patients in which constipation is the

presenting symptom.

Of all the diseases that a Gastroenterologist has to

treat this is probably the most difficult and very

common.

+++++++++++++++++++++++++++++++++

Rome Diagnostic Criteria for Irritable Bowel Syndrome

------------------------------------------------------------------------

At least 3 months of continuous or recurrent symptoms

of the following:

Abdominal pain or discomfort

Relieved with defecation, or

Associated with a change in frequency of stool, or

Associated with a change in consistency of stool

Two or more of the following, at least on one-fourth

of occasions or days:

Altered stool frequency (for research purposes

altered may be defined as more than three bowel

movements each day or less than three bowel movements

each week), or

Altered stool form (lumpy/hard or loose/watery

stool), or

Altered stool passage (straining, urgency, or

feeling of incomplete evacuation), or

Passage of mucus, or

Bloating or feeling of abdominal distention.

I hope this is of some help

Ralph Giarnella MD

Southington, CT

--- Afzal Rashid wrote:

> A stool analysis may be helpful for objective

> markers.

>

> Afzal Rashid

> Bradford, United Kingdom

>

>

> Acidophilus or

> Bifidobacterium Infantis - IBS

>

>

> >

> >

> >> Many patients with irritable bowel syndrome in

> fact

> >> may have a disturbed intestinal flora which can

> be

> >> treated with re-introducing the proper flora by

> way of

> >> acidophilus or bifidobacterium infantis. In

> other

> >> cases there is bacterial overgrowth and certain

> >> antibiotics specifically targeting these bacteria

> can

> >> be used.

> >

> > ***

> > What's the determining factor(s) that would

> influence one's decision

> > between the two? Is one basing one's choice on

> the symptoms of the

> > client?

> >

> > Are there any particular brands more reliable than

> others?

[Guest guest]

>

> My first preference would be bifidobacterium infantis

> if it is available. This species is found in the

> intestines of infants and is no longer found in older

> children or adults. It seems to work best in some

> patients with irritable bowel syndrome.

>

> I have been using it with some success for the past

> two+ years. However it is not readily available at

> most of the local pharmacies.

***

Very helpful indeed. When bifidobacterium infantis treatment is

discontinued how quickly do patients symptoms return?

Carruthers

Wakefield, UK

[Guest guest]

The problem with irritable bowel syndrome is not a

lack of bacteria. I would be very suprised to find a

sterile stool in any patient. The normal stool

contains a large variety of bacteria.

The type of patient who might respond from the

addition of bifidobacterium is the patient who has

what is known as post infectious irritable bowel

syndrome.

***************************

<< " Proposed mechanisms

 

As IBS is a heterogenous disorder, there is likely

more than one pathway by which a trigger such as

infection prompts the development of symptoms.

Anecdotal data suggest that IBS due to infection

commonly presents as diarrhea, although not all IBS-D

can be traced to gastroenteritis.1 About 25% of

patients with IBS report that a bout of infectious

diarrhea precipitated symptoms.2

 

Chronic inflammatory cells have been identified in

rectal mucosal tissue of patients recovering from

Campylobacter-caused enteritis.1 It is possible that

patients with IBS are genetically predisposed to

produce less of the anti-inflammatory cytokine,

interleukin-10, in response to infection, leaving them

exposed to the effects of low-grade inflammation.

Consequently, the inability to downregulate an

inflammatory response in a timely manner may

predispose these individuals to IBS.2

 

Additionally, post-infection IBS (PI-IBS) patients

have been shown to have elevated enteroendocrine cells

(EC) when compared to other patients with IBS. In

fact, serotonin-containing enteroendocrine cells may

be elevated for months after a bout of infection;

according to Dunlop et al, “these cells act as

transducers of luminal stimuli, which stimulate

release of serotonin to act on sub-mucosal nerves and

hence play a key role in peristalsis, pain perception,

and intestinal secretions.”3

 

Earlier research by this group showed that EC cell

numbers increase in the weeks following an infection

and then usually decline over the next three months.

This mechanism may persist over a period of years,

however, in individuals with PI-IBS. The researchers

say that the reason for this is unclear, but that

research in mice suggests that EC cells exist in both

‘long acting’ and ‘short acting’ forms. Whether this

finding translates to humans is unknown, but the

increased action of EC cells and mast cells—which

release multiple sensitizing agents, including

prostaglandins— may prompt the visceral

hypersensitivity indicative of IBS.

Neal KR, Barker L, Spiller RC. Prognosis in

post-infective irritable bowel syndrome: a six year

follow up study. Gut 2002; 51:410.

Gwee K-A, , SM, Read, NW, et al. Increased

rectal mucosal expression of interleukin 1? in

recently acquired irritable bowel syndrome. Gut 2003;

52:523.

Ji S, Park H, Lee D, et al. Post-infectious

irritable bowel syndrome in patients with Shigella

infection. J Gastro Hepatol 2005; 20:381.

Wang LH, Fang XC, Pan GZ. Bacillary

dysentary as a causative factor of irritable bowel

syndrome and its pathogenesis. Gut 2004; 53:1390.

O’Mahony L, McCarthy J, P, et al.

Lactobacillus and bifidobacterium in irritable bowel

syndrome: Symptom responses and relationship to

cytokine profiles. Gastroenterology 2005; 128:541. >>

**************************

As for real world results I have been treating

patients with Irritable bowel syndrome for the the

past 30+ years and have had good results with various

treatments based on the patients presenting symptoms

and evaluation of the background information on the

patient.

Ralph Giarnella MD

Southington, CT

--- Afzal Rashid wrote:

> With reference to stool analysis and objective

> marker; if the analysis

> indicates you have little or no growth then

> supplement with the appropriate

> beneficial bacterium. Real world results from those

> suffering with IBS

> would be most welcome.

>

> Such stool analysis are costly, therefore, it may be

> cheaper to simply

> supplement with one then the other. Then compare in

> a real world manner.

>

> Afzal Rashid,

> Bradford, UK

>

>

> Acidophilus or

> >> Bifidobacterium Infantis - IBS

> >>

> >>

> >> >

> >> >

> >> >> Many patients with irritable bowel syndrome in

> >> fact

> >> >> may have a disturbed intestinal flora which

> can

> >> be

> >> >> treated with re-introducing the proper flora

> by

> >> way of

> >> >> acidophilus or bifidobacterium infantis. In

> >> other

> >> >> cases there is bacterial overgrowth and

> certain

> >> >> antibiotics specifically targeting these

> bacteria

> >> can

> >> >> be used.

> >> >

> >> > ***

> >> > What's the determining factor(s) that would

>

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