Probiotics in Intestinal Bacterial Overgrowth
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|ClinicalTrials.gov Identifier: NCT02204891|
Recruitment Status : Completed
First Posted : July 31, 2014
Last Update Posted : March 20, 2017
|Condition or disease||Intervention/treatment||Phase|
|Irritable Bowel Syndrome||Dietary Supplement: Probiotics in SIBO Dietary Supplement: Probiotics||Not Applicable|
Irritable bowel syndrome (IBS) is the most common gastrointestinal disorder. Pathogenesis remains multifactorial. Better understanding of the interaction of the host with intestinal microbiota the last decade led to the knowledge that many of the symptoms of IBS, mainly bloating and diarrhea, are related with the overgrowth of bacteria of colonic type in the small intestine. This overgrowth frames the syndrome of intestinal bacterial overgrowth (SIBO) where colonic type of bacteria predominate in the proximal parts of the small intestine. Fermentation of dietary carbohydrates by the bacteria colonizers of SIBO ends with the over-production of gas generating thus symptoms of IBS. The relationship between IBS and SIBO was found by a series of prospective observational studies using the lactulose and the glucose tolerance tests for the diagnosis of SIBO. Using this test, the prevalence of SIBO in patients with IBS ranged between 65 and 85%. The gold-standard technique for the diagnosis of SIBO is the quantitative culture of the content of the proximal intestine i.e. of the duodenum after upper GI tract endoscopy. Few studies are available with this design and they suggest a growth of colonic type of flora at counts equal to or greater than 10^5 cfu/ml as diagnostic of SIBO. Based on systematic review of the literature but also on data generated in a cohort of 320 consecutive patients undergoing upper GI tract endoscopy, normal subjects are never greater than 10^3 cfu/m in the duodenum. In the latter publication coming from Athens, using variable cut-offs greater than 10^3 or 10^4 or 10^5 cfu/ml for the diagnosis of SIBO, the frequency of SIBO was significantly greater among sufferers than among non-sufferers from IBS.
Oral supplementation with probiotics may be a rational approach for the eradication of SIBO and subsequently of the symptoms of IBS. The majority of probiotic bacteria belong to the Lactobacillus and Bifidobacterium genera. They are Gram-positive lactic acid-producing bacteria that constitute a major part of the normal intestinal microflora in animals and humans. The rationale behind their use as a therapeutic strategy in IBS is that orally administered probiotics may replace the overgrown enteric-type bacteria of SIBO. Four randomized clinical trials are available evaluating the efficacy of orally administered probiotics in IBS. The common findings of these trials are that a) efficacy refers to the improvement of symptoms of bloating and of diarrhea that are typical symptoms of the presence of SIBO; and b) efficacy is usually found when mixtures of different species of probiotics are used. However, no study has ever tested the efficacy of probiotics in patients with IBS and SIBO proven by small intestinal culture.
The aim of the present study is to demonstrate the effect of a mixture of four species of probiotics (Saccharomyces boulardii, Bifidobacterium lactis BB-12, Lactobacillus acidophilus LA-5 and Lactobacillus plantarum) in patients with symptomatic IBS who have culture verified SIBO and those who do not have. This will provide direct evidence for the role of probiotics in treating part of the pathogenesis of IBS.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||26 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||None (Open Label)|
|Official Title:||A Clinical Study of the Efficacy of a Formulation of Four Probiotics in Patients With Syndrome of Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome|
|Actual Study Start Date :||September 2014|
|Actual Primary Completion Date :||June 2016|
|Actual Study Completion Date :||September 2016|
Experimental: Probiotics in SIBO
Administration of probiotics in patients with IBS and SIBO
Dietary Supplement: Probiotics in SIBO
Mixture of the four probiotics in one capsule. One capsule twice daily for 30 days
Other Name: Saccharomyces Bifidobacterium Lactobacillus species
Active Comparator: Probiotics
Administration of probiotics in patients with IBS without SIBO
Dietary Supplement: Probiotics
One capsule twice daily for 30 days
- • The efficacy of probiotics in improvement of symptoms of IBS in patients with SIBO compared to their efficacy in patients with IBS without SIBO. [ Time Frame: 30 days ]This will be assessed after 30 days from start of therapy (visit 2) by comparisons of grading of symptoms and results of OLT between the two groups of treatment.
- • The efficacy of probiotics in symptoms of IBS in patients with SIBO compared to their efficacy in patients with IBS without SIBO. [ Time Frame: 60 days ]This will be assessed after 60 days from start of therapy (visit 3) by comparisons of grading of symptoms and results of OLT between the two groups of treatment.
- The efficacy of probiotics in specific symptoms of IBS both visits 2 and 3. [ Time Frame: Days 30 and 60 ]This will be done by comparing the grading for every symptom of IBS of patients in visits 2 and 3 compared with the baseline visit 1.
- • The importance of the inflammation cascade in the pathogenesis of SIBO-related IBS. [ Time Frame: 30 days ]This will be done by comparing the duodenal aspirate cytokines of the two groups of treatment.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02204891
|Department of Gastroenterology, ATTIKON University Hospital|
|Athens, Attiki, Greece, 12462|
|Principal Investigator:||Konstantinos Triantafyllou, MD, PhD||University of Athens, Medical School|
|Principal Investigator:||Evangelos Giamarellos-Bourboulis, MD, PhD||University of Athens, Medical School|