Impact of Saccharomyces boulardii CNCM I-745 on Bacterial Overgrowth and Composition of Intestinal Microbiota in Diarrhea-Predominant Irritable Bowel Syndrome Patients: Results of a Randomized Pilot Study.

BACKGROUND: Small intestinal bacterial overgrowth (SIBO) is associated with diarrhea-predominant irritable bowel syndrome (IBS-D). Probiotics like Saccharomyces boulardii CNCM I-745 (Sb) may be efficacious in balancing the microbiota. This randomized open label study assessed the effect of Sb in patients with bacterial overgrowth associated with IBS-D and its impact on the intestinal microbiota. METHODS: Patients were randomized to receive Sb + dietary advice (Sb + DA) or dietary advice (DA) only for 15 days. SIBO was assessed by the lactulose hydrogen breath test (LHBT). Symptoms were assessed with the IBS Symptom Severity Scale (IBS-SSS) and stool consistency with the Bristol Stool Form Scale. Microbiota and mycobiota were analyzed by 16S rDNA and ITS2. RESULTS: 54 patients were included, among whom 48 (27 Sb + DA, 21 DA) were evaluated. Decrease of hydrogen excretion was slightly higher in Sb + DA group, 41% versus 29% in DA group, and IBS-SSS total score were reduced by -134 and -93, respectively. The proportion of patients with diarrhea was lower in the Sb + DA group than in the DA group (25.9% compared to 47.6%). Bacterial and fungal microbiota showed that Sb treatment was associated with several modifications. Interestingly, F. prausnitzii was more abundant in Sb-treated patients with marked clinical improvement. The safety of S. boulardii CNCM I-745 was excellent. CONCLUSIONS: In patients with SIBO, S. boulardii CNCM I-745 associated with dietary advice reduced bacterial overgrowth and improved digestive symptoms while restoring the intestinal microbiota. The increased abundance of F. prausnitzii coupled with symptom improvement merits further research.

[Brain gut microbiota axis. Importance in clinical practice]. / Eje cerebro intestino microbiota. Importancia en la práctica clínica.

The brain-gut-microbiota axis is a bidirectional complex that connects the central nervous system with the digestive system. Alterations in the composition of the intestinal microbiota have been linked to the presence of digestive and extradigestive diseases such as neuropsychiatric diseases. Dysbiosis predisposes to the appearance of alterations in intestinal permeability, which facilitates the release of neurotransmitters and cytokines that generate favorable conditions for the appearance of a state known as neuroinflammation, which seems to be key in the physiopathogenesis of neuropsychiatric diseases. Based on these data, the modulation of the microbiota through changes in diet, antibiotics and probiotics could be a useful alternative, not only for the treatment of digestive diseases but also extra-digestive disorders such as neuropsychiatric diseases.

Prevalence of extra-intestinal symptoms according to irritable bowel syndrome subtype.

BACKGROUND: Irritable bowel syndrome (IBS) is a functional disorder commonly associated with extra-intestinal symptoms. However, the prevalence of these symptoms according to IBS subtype is not well established. AIM: To compare the prevalence of extra-intestinal symptoms among patients with different subtypes of IBS. METHODS: A descriptive cross-sectional study including patients with IBS according to Rome IV criteria was performed between July 2022 and April 2023. Patients were classified according their subtype of IBS: IBS-D (diarrhea-predominant), IBS-C (constipation-predominant), and IBS-M (mixed bowel habits). Patients completed the IBS severity scoring system questionnaire (IBS-SSS) to determine severity of IBS symptoms and patient health questionnaire- 9 (PHQ-9) to define presence and severity of depressive symptoms. The prevalence of reported extra-intestinal symptoms was also assessed and compared between groups. KEY RESULTS: A total of 4862 patients with IBS were included; 608 IBS-D (12.5%), 1978 IBS-C (40.7%), and 2276 IBS-M (46.8%). Patients with IBS-C had significantly lower IBS-symptoms severity (mean IBS-SSS 290 vs. 310 and 320 for IBS-D and IBS-M, respectively, p = 0.03). The prevalence of obesity was also significantly lower in these patients (17.1% vs. 30.9% IBS-D and 27.9% IBS-M, p = 0.0001). Patients with IBS-D showed a significantly higher prevalence of food intolerance perception (9.5%, p = 0.03), history of cholecystectomy (17.8%, p = 0.03), and fecal incontinence (36.2%, p = 0.0001) as compared to the other groups. Patients with IBS-M had significantly higher mean PHQ-9 score (12.7 vs. 11.1 IBS-D and 10.5 IBS-C, p = 0.001) and prevalence of depressive symptoms (80.0%, p = 0.01). Patients with IBS-M also had higher prevalence of extra-intestinal symptoms such as arthralgia (62.4%, p = 0.0001), extremity numbness (64.5%, p = 0.0001), atopic dermatitis (28.2%, p = 0.02), and chronic cervicalgia (81.0%, p = 0.01). CONCLUSIONS & INFERENCES: The prevalence of most extra-intestinal symptoms is higher among patients with IBS-M. Further research is needed to better characterize IBS subtypes, which could potentially help refining tailored therapeutic strategies.

[Irritable bowel syndrome: a functional disorder?]. / Sindrome de intestino irritable: ¿Un trastorno funcional?

Irritable bowel syndrome is a highly prevalent condition responsible for almost one third of visits to the gastroenterologist and huge expenses for diagnosis, treatment and loss of working days. A unique pathophysiologic mechanism has not been elucidated yet and several possibilities have been proposed such as senso-perception and motor disturbances, the effect of stress and anxiety, serotonin receptor failures, activation of abnormal brain areas and pain modulation differences, among others. The absence of a biological marker has led the investigators to consider this syndrome as an exclusion diagnostic condition, once the organic diseases have been discarded The changes in gut microbiota have recently raised great interest among gastroenterologists. The study of the small intestinal bowel overgrowth syndrome, the effect of antibiotics upon the flora, the recognition of post-infectious irritable bowel syndrome and the action of probiotics, together with the effect of malabsortion of diet carbohydrates have brought some new light in our knowledge. The present update will focus on the published evidence about the subject, bearing in mind that the mechanisms elicited here are only suitable for a subgroup of patients.

A controlled pilot study on the efficacy of a low dose antibiotic for the treatment of chronic constipation in patients receiving a high fiber diet.

BACKGROUND AND AIMS: In a previous uncontrolled experiment, oral vancomycin improved the symptoms (S) of chronic constipation (CC). The aim of this 21 day controlled pilot study was to determine if a low lincomycin dose improved the S of CC patients unresponsive to a high fiber diet. METHODS: On days 0-to-10, patients were randomized to 500 mg oral lincomycin + high fiber (L + F) or to placebo + high fiber (P + F). Participants and patients were blinded. From days 10-to-21, patients were continued solely on the high fiber diet. The primary efficacy endpoint was the difference in S between L + F and P + F from days 0-to-21 using a visual analog scale (VAS) calibrated from 0 = severe S to 10 = asymptomatic. RESULTS: The means of all S were significantly improved by L + F but not by P + F. A significant higher proportion of L + F patients increased the VAS > or = 3 points. CONCLUSIONS: The initial course of L facilitated the effect of F probably by its effect on the colon flora. This sequence of flora-altering biologics + F may serve as model to replace chronic use of drugs.

[Breath hydrogen levels do not predict fiber intolerance in irritable bowel syndrome with constipation]. / El incremento del hidrógeno en el aire espirado no predice la intolerancia a la fibra en la dieta en el síndrome del intestino irritable con constipación. Estudio piloto.

BACKGROUND: Irritable Bowel Syndrome (IBS) is characterized by the worsening of symptoms with a high fiber diet. This intolerance could be related to an increase in colonic bacterial fermentation. The hydrogen breath test (HBT) is a marker of the intestinal micro flora fermentative capacity. AIM: To assess if there is an association between hydrogen (H2) levels and clinical changes between diets with and without bran. PATIENTS AND METHODS: 10 women with predominantly constipated irritable bowel syndrome (Rome II criteria) received a lowfiber diet during one week. This phase was followed by a second 7 day period with the same diet but supplemented with 12 g of crude dietary fiber. At the end of both periods, patients completed a symptom scale (Lickert type) and performed a HBT. RESULTS: Comparing both periods with a different diet the median difference in the clinical scale score (-2.5) shows a tendency favorable to the diet without bran, p = 0.048. In the fiber period the median increase of 2 ppm in H2 values was not significant deferent. Neither was possible to establish an association between breath H2 and the clinical response to a fiber diet. CONCLUSIONS: In this pilot study we could not detect ary association between breath H2 levels and the clinical response to dietary fiber.

Eje cerebro intestino microbiota. Importancia en la práctica clínica

El eje cerebro-intestino-microbiota es un complejo bidireccional que comunica al sistema nervioso central con el aparato digestivo. Las alteraciones en la composición de la microbiota intestinal se han relacionado con la presencia de enfermedades digestivas y extradigestivas tales como las enfermedades neuropsiquiátricas. La disbiosis predispone a la aparición de alteraciones en la permeabilidad intestinal, lo cual facilita la liberación de neurotransmisores y citoquinas que generan las condiciones propicias para que aparezca un estado conocido como neuroinflamación, que parece ser clave en la fisiopatogenia de las enfermedades neuropsiquiátricas. En virtud de estos datos, la modulación de la microbiota a través de cambios en la dieta, antibióticos y probióticos, podría ser una alternativa útil, no sólo para el tratamiento de enfermedades digestivas sino también de trastornos extra digestivos como las enfermedades neuropsiquiátricas.

The brain-gut-microbiota axis is a bidirectional complex that connects the central nervous system with the digestive system. Alterations in the composition of the intestinal microbiota have been linked to the presence of digestive and extradigestive diseases such as neuropsychiatric diseases. Dysbiosis predisposes to the appearance of alterations in intestinal permeability, which facilitates the release of neurotransmitters and cytokines that generate favorable conditions for the appearance of a state known as neuroinflammation, which seems to be key in the physiopathogenesis of neuropsychiatric diseases. Based on these data, the modulation of the microbiota through changes in diet, antibiotics and probiotics could be a useful alternative, not only for the treatment of digestive diseases but also extra-digestive disorders such as neuropsychiatric diseases.

Sindrome de intestino irritable: ¿Un trastorno funcional? / [Irritable bowel syndrome: a functional disorder?].

Irritable bowel syndrome is a highly prevalent condition responsible for almost one third of visits to the gastroenterologist and huge expenses for diagnosis, treatment and loss of working days. A unique pathophysiologic mechanism has not been elucidated yet and several possibilities have been proposed such as senso-perception and motor disturbances, the effect of stress and anxiety, serotonin receptor failures, activation of abnormal brain areas and pain modulation differences, among others. The absence of a biological marker has led the investigators to consider this syndrome as an exclusion diagnostic condition, once the organic diseases have been discarded The changes in gut microbiota have recently raised great interest among gastroenterologists. The study of the small intestinal bowel overgrowth syndrome, the effect of antibiotics upon the flora, the recognition of post-infectious irritable bowel syndrome and the action of probiotics, together with the effect of malabsortion of diet carbohydrates have brought some new light in our knowledge. The present update will focus on the published evidence about the subject, bearing in mind that the mechanisms elicited here are only suitable for a subgroup of patients.

A controlled pilot study on the efficacy of a low dose antibiotic for the treatment of chronic constipation in patients receiving a high fiber diet / A controlled pilot study on the efficacy of a low dose antibiotic for the treatment of chronic constipation in patients receiving a high fiber diet.

BACKGROUND AND AIMS: In a previous uncontrolled experiment, oral vancomycin improved the symptoms (S) of chronic constipation (CC). The aim of this 21 day controlled pilot study was to determine if a low lincomycin dose improved the S of CC patients unresponsive to a high fiber diet. METHODS: On days 0-to-10, patients were randomized to 500 mg oral lincomycin + high fiber (L + F) or to placebo + high fiber (P + F). Participants and patients were blinded. From days 10-to-21, patients were continued solely on the high fiber diet. The primary efficacy endpoint was the difference in S between L + F and P + F from days 0-to-21 using a visual analog scale (VAS) calibrated from 0 = severe S to 10 = asymptomatic. RESULTS: The means of all S were significantly improved by L + F but not by P + F. A significant higher proportion of L + F patients increased the VAS > or = 3 points. CONCLUSIONS: The initial course of L facilitated the effect of F probably by its effect on the colon flora. This sequence of flora-altering biologics + F may serve as model to replace chronic use of drugs.

Encuesta piloto virtual a médicos argentinos (usuarios de la red intramed) sobre conocimientos, conductas diagnósticas y terapéuticas referidas a la dispepsia funcional / Virtual Pilot survey to Argentinian physicians (users from IntraMed), knowledge, diagnostic approach and therapeutic related to functional dyspepsia

La dispepsia funcional es una entidad muy frecuente en la práctica diaria tanto del gastroenterólogo como de médicos clínicos y aún de los que practican otras especialidades, pero continúa siendo muy polémica desde el punto de vista de su definición, clasificación, diagnóstico y su enfoque terapéutico. Para conocer el punto de vista y los conocimientos que los médicos argentinos tienen del tema hemos realizado una encuesta virtual. Objetivos: 1) Determinar creencias, criterios y conductas édicas diagnósticas y terapéuticas más frecuentes asociadas al cuadro clínico de dispepsia funcional. 2) Determinar (estimativamente) por los médicos que respondieron, la prevalencia de dispépticos en la consulta diaria y mensual. 3) Determinar (estimativamente) por los médicos que respondieron, la prevalencia de enfermedad orgánica dentro de los pacientes que consultaron por dispepsia funcional. Población y muestra: Médicos residentes en Argentina, usuarios de red virtual IntraMed (expuestos: n=12.849). Respondieron voluntariamente 622 médicos de las siguientes especialidades: generalistas, de familia, gastroenterólogos, erontólogos, cirujanos generales y “otras” (muestreo no probabilístico). Fueron excluidos 43 especialistas que respondieron por no constituir una especialidad que reciba este tipo de consultas con mayor frecuencia. Fueron eliminadas las respuestas de pediatras por ser de bajísima frecuencia (3 pediatras). Lugar y período de exposición a la encuesta: Buenos Aires, Red virtual IntraMed, desde enero de 2005 a enero de 2006, encuesta colgada on-line desde el 2 al 31 de mayo de 2005. Metodología: Invitación electrónica a participar luego de una breve difusión previa. Exhibición de la encuesta on-line durante mayo de 2005. Diseño: exploratorio, prospectivo, observacional, transversal, de cuantificación. Instrumento: Cuestionario que exploróentre médicos de diferentes especialidades de la Argentina: a) Dificultades y preferencias acerca de la definición...

Algoritmo diagnóstico y terapéutico para la dispepsia funcional / Diagnostic and therapeutic algorithm in functional dyspepsia

Introducción. “Dispepsia” deriva del griego y significa “mala digestión”. Dado que se trata de una entidad que abarca distintas disciplinas, se realizó una reunión de consenso para discutir y acordar un algoritmo diagnóstico y terapéutico nacional. Objetivo: Consensuar un algoritmo nacional aplicable a la dispepsia funcional. Material y métodos: En junio de 2005 un grupo multidisciplinario se reunió para diseñar y proponer un algoritmo diagnóstico y terapéutico para dispepsia funcional. Resultados: Darle prioridad a la relación médico-paciente, a las medidas higiénicos dietéticas y al reaseguro. Luego dividimos a los pacientes de acuerdo a si tienen o no signos de alarma. Si están presentes, se los estudia, si no, se los divide de acuerdo a los síntomas principales en dolor o malestar epigástrico. Si tienen dolor, se realiza VEDA y ecografía abdominal. Si son positivos, tratamiento de la enfermedad. Si los estudios son negativos o tiene malestar epigástrico: prueba terapéutica. La pruebas serían: Dolor: Antagonistas H2, esperar 4 a 6 semanas, respuesta negativa: IBP, esperar 4 a 6 semanas, sin no hay mejoría: consulta Psiquiátrica o Psicológica. Malestar: Proquinéticos y esperar 4 a 6 semanas. Si no hay respuestas: Antidepresivos a bajas dosis, esperar 4 a 6 semanas y si no responde: Bloqueantes Cálcicos, Sumatriptan o Trimebutina. En todos los casos se pueden sumar ansiolíticos en personalidad ansiosa. Conclusiones: Se logró un consenso diagnóstico y terapéutico multidisciplinario de orden nacional para los pacientes con dispepsia funcional.

Introduction. Dyspepsia is a word that means bad digestion. In the conviction of which it is a question of an entity that it includes different disciplines, we realize a meeting consensus to discuss and to resolve a diagnostic and therapeutic algorithm of national order. Objetive: To agree on a national algorithm applicable to the functional dyspepsia. Material and methods: In June 2005 a multidisciplinary group met to design and to propose a diagnostic and therapeutic algorithm for the functional dyspepsia. Results: Priority gives to the medical-patient relationship and to the reinsurance. Then we divide the patients if they have signs of alarm. If they are present we studied them, if not we divide them, in accordance to the principal symptoms, in pain or epigastric discomfort. If they have pain we realized an endoscopy and a abdominal ultrasound scan. If they are positive, treatment of the disease. If the studies are negative or it has epigastric discomfort we propose a therapeutic test. Pain: H2 bloquers, wait 4 to 6 weeks, if it not response we propose a PPI, wait for 4 to 6 weeks, if there is no response psychiatric or psychological consultation. Discomfort: proquinetics, wait for 4 to 6 weeks if there are no answers, antidepressants in low doses, wait for 4 to 6 weeks if there are no answers, ca. bloquers, sumatriptan or trimebutina. In all cases we can add tranquillizers in anxious personality. Conclusions: A multidisciplinary dignostic and therapeutic consensus of national order for the patients with functional dyspepsia was obtained.