It’s no easy feat to diagnose Irritable bowel syndrome (IBS) as it is a difficult constellation of symptoms consisting of cramps, abdominal pain, bloating, constipation, and urgent diarrhea.
Your gut health & irritable bowel syndrome
Irritable bowel syndrome is difficult to diagnose. Probiotics are not be as optimal. Your standard ‘workup’ for IBS will not show obvious or even physiologic abnormalities.
Conditions are first excluded, then dietary restrictions, avoidance of caffeine, alcohol, and tobacco.
Antispasmodics and bulking agents may be helpful. Probiotics have been studied in the context of IBS and we will discuss that as well! Spoiler: consider different alternatives to probiotics as new postbiotics are entering the gut health arena right now.
Diarrhea and IBS
Diarrhea is a common complaint when it comes to gut health and disorders like IBS and is usually a self-limited symptom of infectious gastroenteritis. As diarrhea can actually be chronic or is accompanied by bleeding or abdominal pain, further investigation is needed.
- Bloody diarrhea and pain are characteristic of colitis; the infectious causes can be:
- Invasive E coli
- Entamoeba histolytica, or C difficile
- Inflammatory bowel disease (ulcerative colitis or Crohn’s colitis), or ischemia
Blood tests or Stool wet-mount and culture diagnose the infectious causes.
Sigmoidoscopy or colonoscopy can be helpful in diagnosing inflammatory bowel disease or ischemia. Importantly, if the someone has abdominal tenderness, particularly with peritoneal signs, or any other evidence of perforation, an endoscopy will be contraindicated (not used).
Chronic diarrhea may present a more difficult diagnostic problem. The causes of chronic diarrhea include:
Chronic ulcerative colitis (large intestine)
Short gut syndrome
Carcinoid syndrome (rarely – colon cancer)
Islet Cell Tumors
All of the above cause a change in bowel habits.
IBS with diarrhea can cause havoc on even the most toughened digestive system. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) suggest the following for IBS Treatment:
Probiotic therapy for irritable bowel syndrome
Research has in the past suggested probiotics may be useful in the treatment of people with IBS. The exact mechanism for exactly how probiotics reduction of symptoms commonly found in IBS is at the present moment, largely unknown. It is speculated that the effects of probiotics on alterations in gut bacteria are involved. The cause of this syndrome is traditionally thought to be multifactorial.
Several of these factors include:
Alterations in gut motility
Within the gut, there is a cyclic pattern of motility known as the major migrating complex, which consists of periodic, luminal contractions that propel intestinal contents from the stomach to the terminal ileum. Several studies in the literature have shown that patients with IBS tend to have abnormalities in these contractions.
Small-bowel bacterial overgrowth
A large study of 202 patients with IBS found that 78% patients had evidence of bacterial overgrowth via breath testing. 25 of 47 patients experienced eradication of bacterial overgrowth on follow-up after treatment with antibiotics. Analysis of this subset of patients revealed that those who were successful in the eradication of bacterial overgrowth reported improvement in their IBS symptoms. (2)
It has been postulated that the release of certain inflammatory mediators, including interleukins and histamine, may affect nearby enteric nerves, causing alteration in gut function and sensory perception.
Visceral hypersensitivity is recognized as a candidate. VH contributes pain associated with this syndrome.
Pathophysiology of IBS and how we view probiotics
First, disordered physiological processes associated with disease or injury or – pathophysiology of IBS – will be discussed. Then, the we will review evidence for the use of probiotics in the treatment of irritable bowel syndrome (IBS). Finally, an alternative to probiotics in the form of postbiotics (specifically, Tributyrate) will be presented.
IBS is the most common GI condition which accounts for approximately 30 percent of all referrals to GI doctors! The kicker? The actual process remains uncertain!
Despite multiple investigations, data have been conflicting and no abnormality has been found to be specific for this disorder. (1)
Probiotics and the evidence in IBS
According to a recent publication analysis by the Canadian Society of Intestinal Research, multiple studies on probiotics in patients with IBS still show that the results are mixed. This is not surprising, they society concludes, as different probiotics are like different drugs. And they are correct!
Here is the summary:
- Lactobacillus plantarum 299V; overall symptoms improved for patients in one of two studies where pain and gas improved in one of two studies. There was no significant improvement in constipation.
- Lactobacillus acidophilus SDC 2012 and 2013 strains; improvement in pain and straining, but no change in frequency.
- Lactobacillus acidophilus LB strain; all 18 patients and found improvement in “overall symptoms” after 6 weeks.
- Lactobacillus acidophilus species in combination with other probiotics; probiotic mix was significantly more effective in improving overall IBS symptoms, pain, and gas but not bloating.
- Lactobacillus rhamnosis strains (GG and Lc705) plus Propionibacterium freudenreichii (subspecies shermanii JS) plus a strain of Bifidobacterium; One study showed an improvement in gas or quality of life. Both studies showed an improvement in IBS symptoms and pain. There was no change in constipation/diarrhea.
- Bifidobacterium infantis 35624; No quality of life improved with one ‘overall symptoms improved’ and one of two studies reported positive effects on bowel movement frequency.
- Bifidobacterium animalis DN 173010 (Activia® yogurt); overall results were negative however the study should remain inconclusive.
- Escherichia coli DSM 17252; improvement in overall symptoms and pain. One study showed an improvement in bloating.
- Bacillus coagulans GBI-30 6086; First, after treatment in IBS patients first we note that abdominal pain scores were improved in all 7 weeks in the treatment group next, bloating improved with treatment in all 7 weeks where finally, none of 7 weeks with placebo.
Conclusion and what can be done about IBS now?
This blog post covers what is reported to date. The report is for a total of nine probiotic organisms. The nine probiotic species spans 14 studies. On a large scale, research is required over a longer period of time.
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NOTE: this does not replace the advice of your physician, whom you should always consult with for specific treatment recommendations.
Citations & References:
3. Increased rectal mucosal expression of interleukin 1beta in recently acquired post-infectious irritable bowel syndrome. Gwee KA, Collins SM, Read NW, Rajnakova A, Deng Y, Graham JC, McKendrick MW, Moochhala SM Gut. 2003 Apr; 52(4):523-6.