Irritable Bowel Syndrome (IBS) is the most common gastrointestinal condition in the world, yet it remains one of the most difficult for patients to find relief from. The chronic and often debilitating symptoms of IBS include abdominal pain, bloating, constipation, and/or diarrhea. Treating IBS can be a daunting process for doctors – and a frustrating one for patients – because a treatment that works for one person may not be beneficial for another.
For example, while one IBS sufferer may experience frequent attacks of diarrhea, another may have the complete opposite problem and be constipated for days. Other symptoms can consist of intestinal spasms, excessive gas, or mucus in the stool. Factors such as stress, diet, or hormone replacement therapy may make symptoms worse.
Someone diagnosed with IBS needs treatment that is specific to his or her personal symptoms. Because multiple symptoms often co-exist, patients might need more than one therapy to combat each symptom. It can be an exasperating and stressful experience.
Also referred to as spastic colon, spastic colitis, mucous colitis, nervous stomach, and nervous diarrhea, IBS is the number one digestive disease in North America with an estimated 30 to 50 million sufferers. IBS affects approximately 6 million Canadians, representing up to 20% of the population. Although not typical, IBS prevalence in some populations might even be as high as 30%.Surprisingly, most people do not seek medical attention for their symptoms, and only 10-25% of sufferers consult a physician.
IBS can have a significant effect on a patient’s quality of life and greatly reduce their physical, social, and emotional well-being. Some patients are hesitant to leave their homes because they are embarrassed by their bowel habits or don’t feel comfortable being very far from a bathroom.
IBS appears to be significantly more common in women than in men but there is speculation that this is because men could be less likely to seek treatment. There is no cure for the condition so the goal of treatment is to control symptoms.
Estimates show the economic cost of IBS to be more than $80 billion a year to the North American economy, due to time off work and the loss of productivity.
Current Medical Therapies
Sometimes, the symptoms of IBS respond well to prescription medications, For example, Dicetel® a gastrointestinal smooth muscle relaxation drug is used for abdominal pain and to get the digestive tract working more consistently – helping diarrhea, constipation, and bloating – by positively affecting peristalsis. Peristalsis is the normal wavelike involuntary muscular contractions that move food and liquids through the digestive tract. Modulon®, an older medication, is a lower gastrointestinal tract motility regulator that also addresses bowel pain.
Other therapies include anti-spasmodics that work to stop intestinal spasms and reduce pain. Anti-diarrheals can produce good short-term results. Laxatives may provide temporary relief from constipation but shouldn’t be used as a long-term solution since the body can become dependent on these medications. Anti-depressants in small doses may be helpful in managing the pain of IBS. Treatments such as hypnotherapy and cognitive therapy might also provide relief for some patients.
Although medical treatment helps some people with IBS, others may require a different solution. One such natural option that has stimulated considerable interest lately is probiotic therapy. Although doctors have been looking at the potential therapeutic benefits of the Lactobacilli and Bifidobacteria probiotic species for more than a century, some recent investigations of specific probiotics strains show potential benefit for irritable bowel syndrome.
In probiotic therapy, humans ingest living, non-pathogenic, or ‘friendly’ organisms to help restore an appropriate balance of intestinal flora. Probiotics are the microorganisms, or flora, naturally present in the human gut and contain ‘friendly’ bacteria and yeasts that are essential in maintaining normal gastrointestinal function. Probiotics have a particular appeal since the bacterial strains commonly used – Lactobacilli, Bifidobacteria, and Enterococci – are already present in the gut, thus attesting to their co-existence in humans. An example of friendly yeast is that found in the peels of the litchi fruit, Saccharomyces boulardii lyo, sold commercially as Florastor™.
Probiotics also help to decrease ‘unfriendly’ bacteria and yeasts that can cause opportunistic infections. According to research, probiotics help strengthen the body’s natural defences. If the intestinal flora becomes unbalanced, by the use of antibiotics or some other medications, alcohol, stress, or disease, then the intestinal tract may not function normally. This abnormality may cause some gastrointestinal difficulties. Experts have conducted many studies over the years and agree that the benefits of probiotics are strain-specific. The results suggest that certain probiotics are capable of preventing infection by pathogens, either by stimulating the immune system or by other modes of action such as competitive exclusion or by direct killing of pathogens.
Let’s Look at the Research
Several small double-blind, randomized, controlled studies have been performed to assess the effectiveness of various probiotics in patients with IBS. These studies have used different types of bacteria for variable treatment lengths. The results have not been consistent, and sometimes have been conflicting.
Researchers treating IBS patients with Bifidobacterium infantis 35624 noticed significant improvement in abdominal pain, abdominal distension, and bowel motion difficulty as compared to placebo. In this study of 75 patients, published in the journal, Gastroenterology, the authors noted that supplementation of these patients with Lactobacillus salivarius UCC4331 did not improve symptoms or lab markers of inflammation as did the B. infantis 35624.1
Another study of 48 IBS patients looked at the commercial product VSL#3, which is composed of a set combination of several probiotic bacteria that had shown prior good results for ulcerative colitis and pouchitis. Researchers demonstrated a significant reduction in flatulence but no improvement in perceived abdominal distension or pain.2 VSL#3 contains these probiotics: Bifidobacterium breve, Bifidobacterium longum, Bifidobacterium infantis Lactobacillus acidophilus, bacillus plantarum, Lactobacillus paracasei, Lactobacillus bulga-ricus, and Streptococcus thermophilus.
The use of another combination probiotic (Lactobacillus rhamnosus GG, Lactobacillus rhamnosus LC705, Bifidobacterium breve Bb99, and Propionibacterium freudenreichii ssp. shermanii JS) was associated with improvement in intestinal noises but not abdominal pain, abdominal distension, or flatulence in a study involving 103 IBS patients.3
A study of Lactobacillus reuteri for 54 subjects, over a six-month period, showed a marked improvement in both the treatment group and the placebo group – failing to demonstrate any benefit in IBS patients over placebo.4
Researchers tested the efficacy of the probiotic, Lactobacillus GG in 50 children with IBS, who took the product or a placebo for six weeks, resulting in improvement in the perception of abdominal bloating only, with no effect on other IBS symptoms.5
Swedish researchers, looking at a group of 60 IBS patients showed that those who took Lactobacillus plantarum 299v over a four-week period had a decrease in pain and flatulence compared with the placebo group. At the 12-month follow up, patients in the test group maintained better overall gastrointestinal function than did those patients in the placebo group.6
Patients should be aware that although there are a number of probiotic products marketed as treatments for gastrointestinal diseases, including ‘specially formulated’ yogurts, studies have demonstrated that many of these products might not have the capacity to exert a significant therapeutic benefit. This could be because they contain insufficient probiotics to do the job or the probiotics might no longer be active in the product when sold.
In a 2001 study, 40 IBS patients received Lactobacillus plantarum 299v or a placebo daily for 4 weeks. At the end of the study, all Lp299v patients reported resolution of abdominal pain. In the placebo group, 80% of patients still suffered from pain. When looking at the whole range of IBS symptoms, 95% of patients in the treatment group noted improvement compared to only 15% of the patients in the placebo group.7