1. 肠胃道易激综合症 (IBS) 对食物的过敏 及 饮食控制 黄光明医生 副顾问 国大医院 黄光明医生 副顾问 国大医院

2. Gut Bacteria and the Irritable Bowel Syndrome

3. What is Irritable Bowel Syndrome? Abdominal pain Bloating Constipation Diarrhoea Eructation Flatulence ‘Gastric’

4. The Role of Microbes in IBS Post-infectious IBS Small intestinal bacterial overgrowth Effect of antibiotics on IBS symptoms Probiotic treatment for IBS

5. IBS can develop after Infection Salmonella Campylobacter Shigella The risk is as high as 12x more than people without infection

6. Small Intestinal Bacterial Overgrowth

7. Colonic Fermentation

8. Antibiotics, good or bad? Antibiotic treatment may improve IBS symptoms if bacterial overgrowth is present But, IBS may also develop in some patients after receiving antibiotics for other infections

9. Protective effect of gut bacteria

10. How to achieve a balance between good and bad bacteria?

11. What are probiotics? Greek: ‘for life’ Live organisms that, when ingested in adequate amounts, exert a health benefit on the host Eg Lactobacilli, Bifidobacteria, Saccharomyces boulardii

12. Effect of probiotics on the intestine Reduce amount of harmful bacteria Control inflammation Alter the intestinal movements Reduce gas production

13. Which probiotics to use?

14. Probiotics (Lactobacillus) in IBS OrganismStudynOutcome L plantarumNoback 200060 ↓ flatus, pain L plantarumNiedzielin 200120 ↓ pain L plantarumSen 200212 ↓ bloating L GGO’Sullivan 200025Negative L GGBausserman 200550 ↓ distension L reuteriiNiv 200554Negative

15. Probiotics (others) in IBS OrganismStudynOutcome VSL#3Kim 200325 ↓ bloating VSL#3Kim 200548 ↓ flatus B infantisO’Mahony 200577 ↓ all symptoms B infantisWhorwell 2006362 ↓ all symptoms VSL#3 = Streptococcus thermophilus, Lactobacillus spp, Bifidobacteria spp Bifidobacterium infantis

16. Conclusions IBS is a common condition that can severely affect a person’s quality of life. Probiotic organisms may be useful in the treatment of IBS. However, the benefits in IBS are brought about by some but not all probiotic organisms. Different probiotic organisms have different effects; Some may have opposite effects on the intestines.