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Rifaximin and some probiotics lessen symptoms in patients with IBS
Clinical Question
Do treatments aimed at changing the gastrointestinal biome affect symptoms of irritable bowel syndrome?
Bottom line
When it comes to the bacterial community in the gastrointestinal (GI) tract, we can suppress the population with antibiotics, encourage new neighbors with probiotics, or selectively feed good citizens with prebiotics. In this systematic review of studies of colon urban planning, overall suppression of GI flora with the antibiotic rifaximin (Xifaxan) was effective for irritable bowel syndrome (IBS) with diarrhea. Some, but not all probiotics have proved effectiveness to decrease overall symptoms and abdominal pain. Prebiotics have not been shown to be effective in small studies. 1a-
Reference
Study design: Systematic review
Funding: Foundation
Setting: Various (meta-analysis)
Synopsis
These researchers combed 3 databases, including the Cochrane Controlled Trials Register, to identify randomized controlled trials of prebiotic treatment, probiotic treatment, and rifaximin in adults with IBS. They included studies in any language and also searched for reference lists of retrieved studies. Two reviewers independently abstracted study data and evaluated the studies for bias. Prebiotic treatment with fructooligosaccharides showed no benefit as compared with placebo in 2 of the 3 studies, though the studies were at risk of bias and were likely underpowered. Probiotic treatment using the combination of Bifidobacterium longum, B. bifidum, B. lactis, Lactobacillus acidophilus, L. rhamnosus, and Streptococcus thermophiles (LacClean Gold) was more effective than placebo in 2 studies of 130 patients, improving global symptoms and abdominal pain. Two small studies of 78 patients showed a 7-strain combination (3 Bifidobacterium, 3 Lactobacillus, and 1 Streptococcus) to be more effective than placebo. The combination of L. paracasei ssp paracasei F19, L. acidophilus La5, and B. lactis Bb12 (3 studies, 269 patients) found no benefit over placebo. Five studies of 1805 patients with IBS and diarrhea found benefit with the nonabsorbed antibiotic rifaximin.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Duel therapy for IBS
It is very interesting that with the antibiotics limiting the biome and the probiotics enhancing the biome are both effective. Have there been any studies to suggest that possibly using antibiotics first followed by probiotics might be a reasonable approach?