Irritable Bowel Syndrome (IBS) is a common functional disorder of the intestines estimated to affect five million Americans. The cause of IBS is not yet known. Doctors refer to IBS as a functional disorder because there is no sign of disease when the colon is examined. But functional, in this case, means "dysfunctional," as one doctor notes.
Doctors believe that people with IBS experience abnormal patterns of colonic movement and absorption capabilities. The IBS colon is highly sensitive, overreacting to any stimuli such as gas, stress, or eating high-fat or fiber-rich foods.
Patients with IBS often experience alternating bouts of constipation and diarrhea. Although abdominal pain and cramps are among the most common IBS symptoms, pain or discomfort alone is not sufficient to make the diagnosis. However, when a bowel movement or the passage of gas temporarily relieves pain and cramps, a doctor may suspect IBS and begin therapy.
IBS is frequently diagnosed after doctors exclude more serious intestinal diseases through a detailed medical history and complete physical examination. There is no standard way of treating IBS, but multiple drugs are often used. In addition, antidepressants and psychotherapy are frequently part of the program.
Of critical importance is restoration of friendly bacteria to the gut and appropriate lifestyle and dietary changes.
Probiotics have been used with apparent success for several gut disorders, so it is not surprising that they have been tried in the treatment of irritable bowel syndrome. However, the pathogenesis of this disease is unknown, and opinions about how probiotics might work are speculative.
“Nevertheless, two small trials suggest they might benefit patients with IBS, particularly those suffering from pain and bloating, ”notes Dr. G. W. Thompson of the University of Ottawa, Canada .“This possibility deserves further study.”
“Promising results” are being reported in patients not only with inflammatory bowel disease but also irritable bowel syndrome, says researcher S.L. Gorbach, of Tufts University School of Medicine, Boston.
At the Department of Gastroenterology, M. Curie Regional Hospital, Szczecin, Poland, researchers assessed the efficacy of Lactobacillus plantarum 299V (LP299V) in patients with IBS. Forty patients were randomized to receive either LP299V in liquid suspension (20 patients) or placebo (20 patients) over a period of four weeks. Additionally, patients assessed their symptoms by applying a scoring system. All patients treated with LP299V reported resolution of their abdominal pain as compared to 11 patients from a placebo group. There was also a trend towards normalization of stool frequency in constipated patients in six out of 10 patients treated with LP299V compared with two out of 11 treated with placebo. With regards to all IBS symptoms, an improvement was noted in 95 percent of patients in the LP299V group versus 15 percent in the placebo group.
Meanwhile, researchers from the Department of Internal Medicine and Gastroenterology, Bellana Hospital, University of Bologna, Italy, report in the September 2002 issue of Digestive & Liver Diseases, that their open noncontrolled trial was the first showing a clinical improvement related to changes in the composition of the fecal bacterial flora and in fecal biochemistry and, remarkably, in elimination, to be induced by administration of probiotics, in patients with functional diarrhea, often a symptom of IBS.
The idea that unbalanced bacterial populations can play a role in causing IBS is a new idea but one that seems solid. “This is really exciting because it points to the cause of the disease,” says Mark Pimentel, M.D., assistant director of the gastrointestinal motility program at Cedars-Sinai Medical Center, Beverly Hills, California and co-author of a study in The American Journal of Gastroenterology that linked pathogenic bacterial strains to IBS. “Treatments for irritable bowel syndrome to this point have been directed at symptoms, not any cause.” Many other studies now support the bacterial-IBS link.
Thus, we see that probiotics seem to have a beneficial effect in patients with IBS. Of course, further studies on larger numbers of patients and with longer duration of therapy are required in order to establish the place of probiotics in the treatment of IBS.
How to Use Probiotics for Irritable Bowel Syndrome
This is really a case where I believe a number of different lactobacillus strains will help. Certainly, Lactobacillus plantarum 299V (LP299V) appears to be one of the more promising strains, and products containing this bacterium should be available at health food and drug stores. Other lactobacillus supplements may also benefit. Do not discontinue medications unless advised to do so by your physician.