Probióticos para el tratamiento específico del dolor en el síndrome del intestino irritable: Una revisión / Probiotics for Specific Treatment of Pain in Irritable Bowel Syndrome: A Review

El dolor abdominal es uno de los síntomas peor tolerados por los pacientes con síndrome del intestino irritable (SII). Estudios realizados los últimos años sugieren que existe una disbiosis intestinal en estos pacientes, que podría ser responsable, al menos en parte, de los síntomas. La revisión de la literatura apunta hacia que los probióticos podrían ser una terapia efectiva en el alivio del dolor en el SII, y se acepta que sus efectos son específicos de cuerdo a la cepa empleada. En este artículo se revisa el efecto que cada cepa, o mezcla de probióticos, tiene en el alivio del dolor abdominal, según los ensayos clínicos publicados, y se discuten los posibles mecanismos de acción. Se proponen nuevas perspectivas de investigación para poder dilucidar el mecanismo de acción de los probióticos en el alivio del dolor abdominal en estos pacientes.

Abdominal pain is one of the least well tolerated symptoms in patients with irritable bowel syndrome (IBS). Studies conducted in recent years suggest that dysbiosis in these patients may be responsible, at least in part, for these symptoms. This literature review indicates that probiotics may be an effective therapy for the relief of pain in patients with IBS and recognizes that the effects of probiotics are specific to the strain used. In this article we review the effect that each strain or mixture of probiotics has for relieving abdominal pain according to published clinical trials and we also discuss possible mechanisms of action. New perspectives are proposed for research to elucidate the mechanisms of probiotic action for relief of abdominal pain in these patients.

Effect of probiotic species on irritable bowel syndrome symptoms: A bring up to date meta-analysis.

BACKGROUND AND OBJECTIVES: immune system alteration in irritable bowel syndrome (IBS) patients may be modulated by probiotics. We assessed the efficacy of some probiotic species in alleviating characteristic IBS symptoms. MATERIAL AND METHODS: a meta-analysis of all identified randomized controlled trials comparing probiotics with placebo in treating IBS symptoms was performed with continuous data summarized using standardized mean differences (SMDs) with 95% confidence intervals (95% CIs), where appropriate. The random-effects model was employed in cases of heterogeneity; otherwise, fixed-effects models were used. RESULTS: meta-analysis was performed with 10 of 24 studies identified as suitable for inclusion. Probiotics improved pain scores if they contained Bifidobacterium breve (SMD, - 0.34; 95% CI, - 0.66; -0.02), Bifidobacterium longum (SMD, -0.48; 95% CI, - 0.91; -0.06), or Lactobacillus acidophilus (SMD, -0.31; 95% CI, -0.61; -0.01) species. Distension scores were improved by probiotics containing B. breve (SMD, -0.45; 95% CI, -0.77; -0.13), Bifidobacterium infantis, Lactobacillus casei, or Lactobacillus plantarum (SMD, -0.53; 95% CI, -1.00; -0.06) species. All probiotic species tested improved flatulence: B. breve (SMD, -0.42; 95% CI, -0.75;- 0.10), B. infantis, L. casei, L. plantarum (SMD, -0.60; 95% CI, -1.07; -0.13), B. longum, L. acidophilus, Lactobacillus bulgaricus, and Streptococcus salivarius ssp. thermophilus (SMD, -0.61; 95% CI, -1.01; -0.21). There was not a clear positive effect of probiotics concerning the quality of life. CONCLUSIONS: some probiotics are an effective therapeutic option for IBS patients, and the effects on each IBS symptom are likely species-specific. Future studies must focus on the role of probiotics in modulating intestinal microbiota and the immune system while considering individual patient symptom profiles.

Efecto de los probióticos en los síntomas del síndrome del intestino irritable: un meta-análisis actualizado / Effect of probiotic species on irritable bowel syndrome symptoms: a bring up to date meta-analysis

Antecedentes y objetivos: la alteración del sistema inmune en los pacientes con síndrome del intestino irritable (SII) podría modularse por el efecto de los probióticos. Se evaluó la eficacia de algunas especies de probióticos en el alivio de síntomas característicos del SII. Material y métodos: se realizó un meta-análisis de todos los ensayos clínicos aleatorios identificados donde se comparaba los probióticos con el placebo en el tratamiento de síntomas del SII. El meta-análisis se realizó empleando datos continuos empleando diferencias de medias estandarizadas (DME) con intervalos de confianza del 95% (IC 95%). Se empleó el modelo de efectos aleatorios en casos de heterogeneidad, si no, el modelo de efectos fijos. Resultados: el meta-análisis se realizó con 10 de los 24 estudios que cumplían los criterios de inclusión. Los probióticos mejoraron el dolor si contenían las especies Bifidobacterium breve (DME, 0,34; IC 95%, -0,66; -0,02), Bifidobacterium longum(DME, -0,48; IC 95%, -0,91; -0,06), o Lactobacillus acidophilus (DME, -0,31; IC 95%, -0,61; -0,01). La distensión mejoró si los probióticos contenían las especies B. breve (DME, -0,45; IC 95%, -0,77; -0,13), Bifidobacterium infantis, Lactobacillus casei, o Lactobacillus plantarum(DME, -0,53; IC 95%, -1,00; -0,06). Todas las especies de probióticos evaluadas mejoraron la flatulencia: B. breve (DME, -0,42; IC 95%, -0,75; -0,10), B. infantis, L. casei, L. plantarum(DME, -0,60; IC 95%, -1,07; -0,13), B. longum, L. acidophilus, Lactobacillus bulgaricus, y Streptococcus salivarius ssp. thermophilus (DME, -0,61; IC 95%, -1,01; -0,21). No hubo un efecto positivo claro de los probióticos en relación a la calidad de vida. Conclusiones: algunos probióticos son una opción terapéutica eficaz para los pacientes con SII, y sus efectos en cada síntoma del SII parecen ser específicos de la especie. Los futuros estudios deberían focalizarse en el papel de los probióticos en la modulación de la microbiota intestinal y del sistema inmune considerando el perfil de síntomas individual para cada paciente(AU)

Background and objectives: immune system alteration in irritable bowel syndrome (IBS) patients may be modulated by probiotics. We assessed the efficacy of some probiotic species in alleviating characteristic IBS symptoms. Material and methods: a meta-analysis of all identified randomized controlled trials comparing probiotics with placebo in treating IBS symptoms was performed with continuous data summarized using standardized mean differences (SMDs) with 95% confidence intervals (95% CIs), where appropriate. The randomeffects model was employed in cases of heterogeneity; otherwise, fixed-effects models were used. Results: meta-analysis was performed with 10 of 24 studies identified as suitable for inclusion. Probiotics improved pain scores if they contained Bifidobacterium breve (SMD, -0.34; 95% CI, -0.66; -0.02), Bifidobacterium longum (SMD, -0.48; 95% CI, -0.91; -0.06), or Lactobacillus acidophilus (SMD, -0.31; 95% CI, -0.61; -0.01) species. Distension scores were improved by probiotics containing B. breve (SMD, -0.45; 95% CI, -0.77; -0.13), Bifidobacterium infantis, Lactobacillus casei, or Lactobacillus plantarum(SMD, -0.53; 95% CI, -1.00; -0.06) species. All probiotic species tested improved flatulence: B. breve (SMD, -0.42; 95% CI, -0.75; -0.10), B. infantis, L. casei, L. plantarum(SMD, -0.60; 95% CI, -1.07; -0.13), B. longum, L. acidophilus, Lactobacillus bulgaricus, and Streptococcus salivarius ssp. thermophilus (SMD, -0.61; 95% CI, -1.01; -0.21). There was not a clear positive effect of probiotics concerning the quality of life. Conclusions: some probiotics are an effective therapeutic option for IBS patients, and the effects on each IBS symptom are likely species-specific. Future studies must focus on the role of probiotics in modulating intestinal microbiota and the immune system while considering individual patient symptom profiles(AU)

Levosulpiride and cisapride in the treatment of dysmotility-like functional dyspepsia: a randomized, double-masked trial.

BACKGROUND & AIMS: Levosulpiride is a benzamide derivate D(2) dopamine antagonist with prokinetic activity that can accelerate gastric emptying and reduce discomfort in response to gastric distention. The aim of the study is to compare the clinical efficacy of levosulpiride and cisapride in patients with dysmotility-like functional dyspepsia. METHODS: In a exploratory pilot study performed as a multicenter, randomized, double-masked trial, the effects of 8 weeks of treatment with either levosulpiride, 25 mg, 3 times daily (n = 69) or cisapride, 10 mg, 3 times daily (n = 71) were compared. Individual symptoms (pain/discomfort, fullness, bloating, early satiety, and nausea/vomiting), global symptom score, effect on health-related quality of life (HRQoL), and anxiety-state and anxiety-trait were evaluated. Adverse events also were recorded. RESULTS: Both levosulpiride and cisapride improved dyspeptic symptoms and decreased total symptom score (79.9% and 71.3%, respectively); no significant statistical difference between treatments was found (P = 0.07 for total symptom score). HRQoL improved similarly after both treatments, whereas no change was observed in anxiety. Medication-related adverse effects were present in 13 of 69 patients (18.8%) in the levosulpiride group and 8 of 71 patients (11.3%) in the cisapride group. Significantly more (P = 0.03) patients treated with cisapride had to abandon the trial because of side effects. CONCLUSIONS: Levosulpiride is at least as effective as cisapride in the treatment of dysmotility-like functional dyspepsia.