Do probiotics improve symptoms in patients with irritable bowel syndrome?

Hypnobiome: A New, Potential Frontier of Hypnotherapy in the Treatment of Irritable Bowel Syndrome-A Narrative Review of the Literature

Increasing evidence suggests that the gut-brain axis may play a key role in health and disease via a bidirectional communication network involving neural and immunoendocrine pathways. This complex interplay deeply influences both gut microbiota and brain behavior. Pathobiome or gut dysbiosis is relevant for the pathogenesis of functional gastrointestinal disorders, such as IBS, chronic pain syndromes, and neurological and mental disorders. As a consequence, targeting the gut microbiota is emerging as a novel, effective therapeutic perspective. Among many treatment options, psychological interventions, including hypnosis, have been used to target the so-called psychobiome and its hypnotic analogue, i.e., hypnobiome, referring to their potential efficacy to modulate the mind-gut axis in IBS patients. A narrative review of the recent literature is provided and circumstantial evidence suggests that hypnobiome may represent a new promising frontier of hypnotherapy.

Inflammation-driven brain and gut barrier dysfunction in stress and mood disorders

Regulation of emotions is generally associated exclusively with the brain. However, there is evidence that peripheral systems are also involved in mood, stress vulnerability vs. resilience, and emotion‐related memory encoding. Prevalence of stress and mood disorders such as major depression, bipolar disorder, and post‐traumatic stress disorder is increasing in our modern societies. Unfortunately, 30%–50% of individuals respond poorly to currently available treatments highlighting the need to further investigate emotion‐related biology to gain mechanistic insights that could lead to innovative therapies. Here, we provide an overview of inflammation‐related mechanisms involved in mood regulation and stress responses discovered using animal models. If clinical studies are available, we discuss translational value of these findings including limitations. Neuroimmune mechanisms of depression and maladaptive stress responses have been receiving increasing attention, and thus, the first part is centered on inflammation and dysregulation of brain and circulating cytokines in stress and mood disorders. Next, recent studies supporting a role for inflammation‐driven leakiness of the blood–brain and gut barriers in emotion regulation and mood are highlighted. Stress‐induced exacerbated inflammation fragilizes these barriers which become hyperpermeable through loss of integrity and altered biology. At the gut level, this could be associated with dysbiosis, an imbalance in microbial communities, and alteration of the gut–brain axis which is central to production of mood‐related neurotransmitter serotonin. Novel therapeutic approaches such as anti‐inflammatory drugs, the fast‐acting antidepressant ketamine, and probiotics could directly act on the mechanisms described here improving mood disorder‐associated symptomatology. Discovery of biomarkers has been a challenging quest in psychiatry, and we end by listing promising targets worth further investigation.

Adiponectin Role in Neurodegenerative Diseases: Focus on Nutrition Review

Adiponectin is an adipokine produced by adipose tissue. It has numerous beneficial effects. In particular, it improves metabolic effects and glucose homeostasis, lipid profile, and is involved in the regulation of cytokine profile and immune cell production, having anti-inflammatory and immune-regulatory effects. Adiponectin’s role is already known in immune diseases and also in neurodegenerative diseases. Neurodegenerative diseases, such as Alzheimer’s disease and Parkinson’s disease, are a set of diseases of the central nervous system, characterized by a chronic and selective process of neuron cell death, which occurs mainly in relation to oxidative stress and neuroinflammation. Lifestyle is able to influence the development of these diseases. In particular, unhealthy nutrition on gut microbiota, influences its composition and predisposition to develop many diseases such as neurodegenerative diseases, given the importance of the “gut-brain” axis. There is a strong interplay between Adiponectin, gut microbiota, and brain-gut axis. For these reasons, a healthy diet composed of healthy nutrients such as probiotics, prebiotics, polyphenols, can prevent many metabolic and inflammatory diseases such as neurodegenerative diseases and obesity. The special Adiponectin role should be taken into account also, in order to be able to use this component as a therapeutic molecule.

Nutritional modulation of the intestinal microbiota; future opportunities for the prevention and treatment of neuroimmune and neuroinflammatory disease

The gut-brain axis refers to the bidirectional communication between the enteric nervous system and the central nervous system. Mounting evidence supports the premise that the intestinal microbiota plays a pivotal role in its function and has led to the more common and perhaps more accurate term gut-microbiota-brain axis. Numerous studies have identified associations between an altered microbiome and neuroimmune and neuroinflammatory diseases. In most cases, it is unknown if these associations are cause or effect; notwithstanding, maintaining or restoring homeostasis of the microbiota may represent future opportunities when treating or preventing these diseases. In recent years, several studies have identified the diet as a primary contributing factor in shaping the composition of the gut microbiota and, in turn, the mucosal and systemic immune systems. In this review, we will discuss the potential opportunities and challenges with respect to modifying and shaping the microbiota through diet and nutrition in order to treat or prevent neuroimmune and neuroinflammatory disease.

Effect of Bifidobacterium infantis 35624 (Align) on the Lactulose Breath Test for Small Intestinal Bacterial Overgrowth

BACKGROUND

Small intestinal bacterial overgrowth (SIBO) may cause symptoms in patients with abdominal bloating, distension, and gas. SIBO can be assessed using the lactulose breath test (LBT). A commonly used probiotic supplement is Align containing Bifidobacterium infantis 35624. The aim of this study was to determine the effect of B. infantis 35624 on hydrogen and methane excretion during LBT.

METHODS

Healthy subjects underwent LBT before and after 2 weeks of daily Align administration. Hydrogen and methane concentrations were measured for each breath sample. Results are expressed as mean ± SE and analyzed using repeated measures ANCOVA. A breath test was considered positive if hydrogen and/or methane increased > 20 ppm above baseline by 90 min of the test or if a dual hydrogen peak was present.

RESULTS

Nineteen healthy subjects were studied. Hydrogen levels were similar pre- and post-probiotic across the 3-h study (p = 0.768). In contrast, methane levels were significantly higher with probiotic administration (p = 0.012). A rise in methane > 20 ppm was seen in three subjects pre-probiotic but six post-probiotic. Of the 19 subjects, an "abnormal" LBT pre-probiotic was present in ten subjects and during the probiotic, 13 were abnormal.

CONCLUSIONS

This study found that 2 weeks of B. infantis 35624 (Align) supplementation affects LBT assessment for SIBO by significantly increasing methane, but not hydrogen, excretion after lactulose administration. Methane levels reached values that would be considered positive for SIBO patients. This study suggests that patients undergoing LBT should discontinue probiotics prior to the test as these supplements may alter the test results.

Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome

Irritable bowel syndrome (IBS), which is characterized by recurrent abdominal pain and disordered bowel habits, is one of the most common functional bowel disorders. IBS is a substantial burden on both patient health-related quality of life and healthcare costs. Several pathophysiologic mechanisms have been postulated for the occurrence of IBS, including altered gastrointestinal motility, visceral hypersensitivity, changes in gut permeability, immune activation, gut-brain dysregulation, central nervous system dysfunction, and changes in the gut microbiota. Of note, both qualitative and quantitative differences have been observed in the gut microbiota of a population with IBS versus a healthy population. Because of the substantial interest in the gut microbiota and its role as a therapeutic target in IBS, this article provides an overview of specific interventions with the potential to modulate the gut microbiota in IBS, including elimination diets, prebiotics, probiotics, synbiotics, and nonsystemic antibiotics. Although probiotics and synbiotics are generally well tolerated, differences in the composition and concentration of different bacterial species and inclusion or exclusion of prebiotic components varies widely across studies and has prevented strong recommendations on their use in IBS. For nonsystemic antibiotics, rifaximin is indicated in the United States for the treatment of IBS with diarrhea in adults and has been shown to be efficacious and well tolerated in well-designed clinical trials. Overall, more consistent evidence is needed regarding the efficacy and safety of elimination diets, prebiotics, probiotics, and synbiotics for the treatment of patients with IBS. Furthermore, additional well-designed studies are needed that examine alterations in the gut microbiota that occur with these interventions and their potential associations with clinical symptoms of IBS.

Probiotic Lactic Acid Bacteria and Skin Health

Human skin is the first defense barrier against the external environment, especially microbial pathogens and physical stimulation. Many studies on skin health with Lactic acid bacteria (LAB) have been published for many years, including prevention of skin disease and improvement of skin conditions. LAB, a major group of gram-positive bacteria, are known to be beneficial to human health by acting as probiotics. Recent studies have shown that LAB and their extracts have beneficial effects on maintenance and improvement of skin health. Oral administration of Lactobacillus delbrueckii inhibits the development of atopic disease. In addition, LAB and LAB extracts are known to have beneficial effects on intestinal diseases, with Lactobacillus plantarum having been shown to attenuate IL-10 deficient colitis. In addition to intestinal health, L. plantarum also has beneficial effects on skin. pLTA, which is lipoteichoic acid isolated from L. plantarum, has anti-photoaging effects on human skin cells by regulating the expression matrix meralloprotionase-1 (MMP-1) expression. While several studies have proposed a relationship between diseases of the skin and small intestines, there are currently no published reviews of the effects of LAB for skin health through regulation of intestinal conditions and the immune system. In this review, we discuss recent findings on the effects of LAB on skin health and its potential applications in beauty foods.

Irritable bowel syndrome: the problem and the problem of treating it - is there a role for probiotics?

The aim of this review is to highlight the impact of irritable bowel syndrome (IBS) in those patients who consult the medical profession and examine the therapeutic potential of probiotics in this condition, where there is a strong need for new treatment options. Traditionally, IBS is frequently regarded as a trivial condition which is certainly not life threatening and mainly psychological in origin. However, these preconceptions are misplaced, as in some patients the condition can be devastating with the pain being as severe as that of childbirth coupled with incapacitating bowel dysfunction. In addition, patients suffer from a variety of non-colonic symptoms such as low backache, constant lethargy, nausea and genito-urinary problems, all of which lead to these patients having extremely poor quality of life. Unfortunately, the treatment of IBS is very unsatisfactory with only one new medication being developed for this condition in the last 25 years. It is now recognised that IBS is a multifactorial condition with symptoms being triggered by a variety of factors, some of which appear to be influenced by probiotics, resulting in speculation that they may have therapeutic potential in this condition. There have been over thirty controlled clinical trials of probiotics in IBS with approximately two-thirds of these studies showing evidence of an improvement in symptoms. However, not all probiotics appear to be effective with different symptoms being improved by different strains and some improving symptoms more than others. Consequently, the ideal probiotic for the treatment of IBS has yet to be defined, but the evidence is good enough to encourage further research with the aim of identifying an optimal strain or strains.

Irritable bowel syndrome: a concise review of current treatment concepts

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders causing patients to seek medical treatment. It is relatively resource intensive and the source of significant morbidity. Recent insights into the pathophysiology and treatment of IBS has given clinicians more options than ever to contend with this disorder. The purpose of our paper is to review older, "classic" treatments for IBS as well as newer agents and "alternative" therapies. We discuss the evidence base of these drugs and provide context to help develop appropriate treatment plans for IBS patients.

Chronic constipation and treatment options (Review)

Chronic constipation (CC) is a highly prevalent heterogeneous disorder. Although CC is not known to be associated with the development of serious disease or with excess mortality, it considerably reduces the patients quality of life. In addition, it represents an economic burden to patients and society. The majority of patients with CC successfully manage the disorder by dietary management and the use of laxatives. Patients with functional CC (slow‑transit and non‑slow transit constipation) do not respond to laxatives and are a small fraction of the total population complaining of constipation. Regardless of the low number of these patients, the intractability of their symptoms causes psychological and social stress and greatly impairs their quality of life. Furthermore, these patients consume a disproportionate quantity of medical resources. It appears that these patients have a disturbance in the serotonin transmission system, which results in a cascade of alterations in a number of gut neuroendocrine hormones/transmitters. The effect of prucalopride, a serotonin receptor agonist, in this category of patients appears to be not only a pharmacological prokinetic action, but also a correction of a pre‑existing disturbance. Linaclotide, a member of the guanylin peptide family, binds to the ligand‑binding region of guanylate cyclase‑C on the luminal surface of gastrointestinal epithelia resulting in increased fluid secretion. This drug has also been found to be effective for the treatment of functional CC. In addition, biofeedback and sacral nerve stimulation are effective in the treatment of CC caused by pelvic floor disorders.

Refractory inflammatory bowel disease-could it be an irritable bowel?

Patients with IBD who are apparently in remission-as indicated by normal blood tests, endoscopic findings and ultrasonography results-often continue to experience symptoms. Furthermore, despite these negative findings, there is a temptation to increase their anti-inflammatory medication in the hope that this approach would lead to some improvement. However, this strategy often seems to fail and can sometimes lead to adverse events. Consequently, when evidence of continuing inflammatory activity is lacking it might be appropriate to consider the possibility of co-existent IBS in these patients and to treat them for this condition. Dietary manipulation, antispasmodic agents, antidepressants (especially of the tricyclic variety) and even behavioural treatments might result in a worthwhile improvement of symptoms.

Probiotics use to treat irritable bowel syndrome

INTRODUCTION

Irritable bowel syndrome (IBS) is a common chronic gastrointestinal (GI) tract disorder with significant disability and a considerable financial burden to health service due to the consumption of resources including investigations, physician time, and cost of treatment. Despite availability of multiple treatment options, there is still poor functional recovery.

AREAS COVERED

Probiotics has been investigated as a promising treatment for IBS, and have demonstrated beneficial effects in some patients. There are many clinical trials investigating the therapeutic benefits of probiotics in IBS but most of them are heterogenic in terms of dose or species used and clinical endpoints. However, recent major meta-analyses revealed benefits of probiotics in patients with IBS. Inhibition of binding of pathogenic bacteria to intestinal epithelial cells, enhancing barrier function of intestinal epithelial, acidification of the colon, suppression of the growth of pathogens, modulation of immunity, inhibition of visceral hypersensitivity, alteration in mucosal response to stress, and improvement of bowel dysmotility are among mechanisms that probiotics may act. Most commonly used probiotics come from the genera Bifidobacterium and Lactobacillus but other species are in trial.

EXPERT OPINION

Although further studies are still needed, current evidences are almost enough to convince experts that probiotics are efficient in the treatment of IBS.

Role of food in onset of symptoms and treatment of irritable bowel syndrome

Epidemiological studies have suggested that the onset of some symptoms in patients with irritable bowel syndrome (IBS) is related with food. Although the potential mechanisms are not fully elucidated, there is some evidence that the inherent prokinetic and crinogenic effects of food components, food intolerance and allergies, as well as poor eating habits could plausibly contribute to symptom onset. Food elimination, supplemental dietary fiber, and special additives such as probiotics and prebiotics could relieve IBS symptoms. In this article we will review current advances in understanding the relationship between food and onset of IBS symptoms, the possible mechanisms, and emerging therapeutics involving dietary administration.

Gut-central nervous system axis is a target for nutritional therapies

Historically, in the 1950s, the chemist Linus Pauling established a relationship between decreased longevity and obesity. At this time, with the advent of studies involving the mechanisms that modulate appetite control, some researchers observed that the hypothalamus is the "appetite centre" and that peripheral tissues have important roles in the modulation of gut inflammatory processes and levels of hormones that control food intake. Likewise, the advances of physiological and molecular mechanisms for patients with obesity, type 2 diabetes mellitus, inflammatory bowel diseases, bariatric surgery and anorexia-associated diseases has been greatly appreciated by nutritionists. Therefore, this review highlights the relationship between the gut-central nervous system axis and targets for nutritional therapies.

Review article: probiotics for the treatment of irritable bowel syndrome--focus on lactic acid bacteria

BACKGROUND

Irritable bowel syndrome (IBS) is a poorly understood, yet highly prevalent functional gastrointestinal disorder (FGID). The withdrawal, due to adverse events, of a number of pharmacological agents that were approved for the treatment of IBS has left a therapeutic vacuum for patients suffering from the disorder.

AIM

To review, summarise and critically evaluate current knowledge of lactic acid bacteria (LAB) used to treat IBS.

METHODS

We assessed a comprehensive range of relevant literature from Pubmed, Medline and online sources based on our definition of LAB which included both typical and atypical species, covering Lactobacilli, Bifidobacteria, Enterococci, Streptococci and Bacilli.

RESULTS

Of the 42 trials evaluated examining the efficacy of LAB in IBS, 34 reported beneficial effects in at least one of the endpoints or symptoms examined, albeit with tremendous variation in both the magnitude of effect and the choice of outcome under consideration. However, numerous concerns have been expressed over deficits of trial design and execution relating to strain selection, optimum dosage, mode of action, safety and long-term tolerability in a disorder that can persist throughout the lifetime of affected individuals.

CONCLUSIONS

Progress in the field will require an improved understanding of how the microbiota impacts on health and disease, adequately powered long-term multicentre trials and the embracing of bench to bedside approaches. Recent incremental advances suggest these areas are being addressed and that the future holds much promise for the use of lactic acid bacteria in the treatment of irritable bowel syndrome.

Abdominal bloating and distension: what is the role of the microbiota

Most patients with irritable bowel syndrome complain of a sensation of an increase in pressure within their abdomen during the course of the day which is called bloating and, in approximately half of these individuals, this symptom is accompanied by an actual increase in abdominal girth, which is referred to as distension. The pathophysiology of these two phenomena is somewhat different and it is now recognised that a whole variety of overlapping mechanisms are involved. Some of these are potentially amenable to treatment by modification of the bacterial flora of the gut and this article reviews the evidence for this.

Brain-gut-microbe communication in health and disease

Bidirectional signalling between the gastrointestinal tract and the brain is regulated at neural, hormonal, and immunological levels. This construct is known as the brain–gut axis and is vital for maintaining homeostasis. Bacterial colonization of the intestine plays a major role in the post-natal development and maturation of the immune and endocrine systems. These processes are key factors underpinning central nervous system (CNS) signaling. Recent research advances have seen a tremendous improvement in our understanding of the scale, diversity, and importance of the gut microbiome. This has been reflected in the form of a revised nomenclature to the more inclusive brain–gut–enteric microbiota axis and a sustained research effort to establish how communication along this axis contributes to both normal and pathological conditions. In this review, we will briefly discuss the critical components of this axis and the methodological challenges that have been presented in attempts to define what constitutes a normal microbiota and chart its temporal development. Emphasis is placed on the new research narrative that confirms the critical influence of the microbiota on mood and behavior. Mechanistic insights are provided with examples of both neural and humoral routes through which these effects can be mediated. The evidence supporting a role for the enteric flora in brain–gut axis disorders is explored with the spotlight on the clinical relevance for irritable bowel syndrome, a stress-related functional gastrointestinal disorder. We also critically evaluate the therapeutic opportunities arising from this research and consider in particular whether targeting the microbiome might represent a valid strategy for the management of CNS disorders and ponder the pitfalls inherent in such an approach. Despite the considerable challenges that lie ahead, this is an exciting area of research and one that is destined to remain the center of focus for some time to come.

Do Patients with Functional Gastrointestinal Disorders have an Altered Gut Flora?

The description of the de novo development of irritable bowel syndrome (IBS) following an episode of bacterial gastroenteritis (postinfectious IBS) illustrated the potential for a luminal factor (a bacterial pathogen) to cause this common gastrointestinal ailment. As a consequence of these and other observations as well as results of experiments involving animal models, the enteric flora and the immune response that it generates in the host have, somewhat surprisingly, come centre-stage in IBS research with their potential to induce the pathophysiological changes that are associated with IBS. While evidence for immune dysfunction both in the mucosa and systemically continues to accumulate, methodological limitations have hampered a full delineation of the nature of the microbiota in IBS. The latter is eagerly awaited and may yet provide a firm rationale for the use of certain probiotics and antibiotics in IBS, whose benefits have now been described with some consistency.