1. Probiotics and IBS Gail A. Cresci, PhD, RD, LD, CNSC Associate Staff
Gastroenterology/Nutrition
Cleveland Clinic
Cleveland, OH

2. Disclosures Scientific Advisory Board – Advocare
Scientific Advisory Board - Covidien
Research Funding, Speaker’s Bureau - Metagenics

3. Probiotic
“Live microorganisms which when administered in adequate amounts confer a health benefit on the host”.
Food and Agricultural Org., WHO, 2001
“Good Little Bugs”

4. Prebiotics Three Necessary Criteria of Ingredient
Must be non-digestible by host enzymes
Must be fermented in the GI tract by anaerobic endogenous bacteria in colon
Must be selective in the stimulation of intestinal microbiota and of metabolic activity
Demonstration of criterion is difficult
A prebiotic is not available to all bacterial species that inhabit GI ecosystem
Lactobacillus and Bifidobacterium considered indicator organisms
Simple, naturally occurring or synthetic sugars
Used as a carbon source by certain colonic bacteria for growth and metabolism
Examples: Inulin, fructooligosaccharides (FOS), galactooligosaccharides (GOS), lactulose

5. Synbiotic Combination of probiotic and prebiotic General Aim:
Meets criteria of probiotic and prebiotic
The prebiotic selectively supports the growth of the probiotic component
General Aim:
Support the probiotic and other indigenous beneficial organisms by providing a preferred carbon and energy source to promote its growth
Provide substrate for optimal or desired fermentation byproducts of probiotic

6. Probiotics, Prebiotics, Synbiotics Biologic Effects and Mechanisms of Action

7. Patel Clin Infect Dis 2015

8. Sept 2007-December 2013
24 Clinical Trials [15 meta-analysis; 9 systematic review]
RCT, evaluating probiotic vs placebo in IBS improvement
Study quality evaluated

10. Systematic review was performed to summarize non-eligible clinical trials for the meta-analysis that were excluded because of heterogeneity or different measurement scales for IBS symptoms
All the nine studies were classified as randomized placebo-controlled trials. Four, six, and eight weeks of treatment with probiotics were reported.

11. 1793 patients in meta-analysis RR of responders to therapies:
Results
1793 patients in meta-analysis
RR of responders to therapies:
Abdominal pain score: two trials was 1.96 (95%CI: ; P = 0.01)
Global symptom score: two trials was 2.43 (95%CI: ; P = 0.02)
Adequate improvement of general symptoms: 7 trials (six studies)
was 2.14 (95%CI: ; P = 0.03)
Distension, bloating, and flatulence were evaluated using an IBS severity scoring system in 3 trials (two studies)
the standardized effect size of mean differences for probiotics therapy was (95%CI: )
Use of different scales to analyze mean differences of symptoms makes analysis difficult
Further studies needed

12. Summary
Probiotics reduce pain and symptom severity scores compared to placebo in IBS patients
Studies inconsistent with design and outcome measurement
Future studies needed with standardization
Longer treatment needed (8-12 week)
Ideal probiotic yet to be discovered

13. References
Patel Clin Infect Dis 2015