Efficiency of probiotics in children with irritable bowel syndrome: optimal duration of the treatment
DOI:
https://doi.org/10.15574/PP.2022.91.41Keywords:
irritable bowel syndrome, children, biopsychosocial model of medicine, fecal calprotectin, LactobacillusAbstract
Following the biopsychosocial model of medicine, irritable bowel syndrome (IBS) is a heterogeneous disorder, which is caused by multiple factors in different combinations. However, in most clinical cases probiotics are included in the treatment of IBS due to their influence on intestinal bacterial colonization, and immune, metabolic and motoric activity of the gut.
The purpose - to evaluate the efficiency of probiotics (Lactobacillus reuteri DSM 17938) in children with IBS and to determine the optimal duration of the treatment.
Materials and methods. We examined 108 children aged 6-12 years with a verified diagnosis of IBS, according to Rome criteria IV. Assessment of the main clinical symptoms was obtained by 4-point Likert scale. Enzyme immunoassay RIDASCREEN Calprotectin (R-Biopharm AG, Germany) was used for the quantitative determination of calprotectin in stool samples. Data were processed using Microsoft Excel 2016 and analysed with GraphPad (Prism 5.0).
Results. Our study revealed the heterogenety of IBS in children not only according to clinical subtype, but also due to the trigger factor of the disorder. Patients with stress-related IBS were characterized by the higher level of asthenic syndrome and autonomic dysfunction (р=0.0003). In contrast, children with post-infectious IBS had higher concentration of fecal calprotectin, which is a result of low-grade intestinal inflammation (р=0.0003). After 10 days and 1 month since the beginning of treatment, we have observed a significant decrease in the severity of clinical syndromes, but the level of fecal calprotectin remained elevated.
Conclusions. The efficiency of probiotics was confirmed by positive dynamics of clinical signs and the level of fecal calprotectin in children with various clinical subtypes of IBS. Even in the absence of any symptoms, the optimal duration of the use of Lactobacillus reuteri DSM 17938 in children with IBS should be 1-3 months.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
References
Ayling RM, Kok K. (2018). Fecal Calprotectin. Advances in clinical chemistry. 87: 161-190. https://doi.org/10.1016/bs.acc.2018.07.005; PMid:30342711
Barbara G, Cremon C, Pallotti F, De Giorgio R, Stanghellini V, Corinaldesi R. (2009). Postinfectious irritable bowel syndrome. Journal of pediatric gastroenterology and nutrition. 48 (2): S95-S97. https://doi.org/10.1097/MPG.0b013e3181a15e2e; PMid:19300138
Black CJ, Drossman DA, Talley NJ, Ruddy J, Ford AC. (2020). Functional gastrointestinal disorders: advances in understanding and management. The Lancet. 396 (10263): 1664-1674. https://doi.org/10.1016/S0140-6736(20)32115-2
Carlson AL, Xia K, Azcarate-Peril MA, Goldman BD, Ahn M, Styner MA et al. (2018). Infant Gut Microbiome Associated With Cognitive Development. Biological psychiatry. 83 (2): 148-159. https://doi.org/10.1016/j.biopsych.2017.06.021; PMid:28793975 PMCid:PMC5724966
Choi YJ, Jeong SJ. (2019). Is fecal calprotectin always normal in children with irritable bowel syndrome? Intestinal research. 17 (4): 546-553. https://doi.org/10.5217/ir.2019.00009; PMid:31467259 PMCid:PMC6821949
David LE, Surdea-Blaga T, Dumitrascu DL. (2015). Semiquantitative fecal calprotectin test in postinfectious and non-postinfectious irritable bowel syndrome: cross-sectional study. Sao Paulo medical journal. 133 (4): 343-349. https://doi.org/10.1590/1516-3180.2014.8000815; PMid:26039537
De Silva AP, Nandasiri SD, Hewavisenthi J, Manamperi A, Ariyasinghe MP, Dassanayake AS et al. (2012). Subclinical mucosal inflammation in diarrhea-predominant irritable bowel syndrome (IBS) in a tropical setting. Scandinavian journal of gastroenterology. 47 (6): 619-624. https://doi.org/10.3109/00365521.2012.666672; PMid:22486731
Devanarayana NM, Rajindrajith S. (2018). Irritable bowel syndrome in children: Current knowledge, challenges and opportunities. World Journal Gastroenterology. 24 (21): 2211-2235. https://doi.org/10.3748/wjg.v24.i21.2211; PMid:29881232 PMCid:PMC5989237
Ding F, Karkhaneh M, Zorzela L, Jou H, Vohra S. (2019). Probiotics for paediatric functional abdominal pain disorders: A rapid review. Paediatrics & child health. 24 (6): 383-394. https://doi.org/10.1093/pch/pxz036; PMid:31528110 PMCid:PMC6735714
Ford A, Sperber A, Corsetti M, Camilleri M. (2020). Irritable bowel syndrome. The Lancet. 396 (10263): 1675-1688. https://doi.org/10.1016/S0140-6736(20)31548-8
Giannetti E, Maglione M, Alessandrella A, Strisciuglio C, De Giovanni D, Campanozzi A et al. (2017). A mixture of 3 Bifidobacteria decreases abdominal pain and improves the quality of life in children with irritable bowel syndrome: a multicenter, randomized, double-blind, placebo-controlled, crossover trial. Journal of clinical gastroenterology. 51 (1): 5-10. https://doi.org/10.1097/MCG.0000000000000528; PMid:27306945
Jadrešin O, Hojsak I, Mišak Z, Kekez AJ, Trbojević T, Ivković L, Kolaček S. (2017). Lactobacillus reuteri DSM 17938 in the Treatment of Functional Abdominal Pain in Children: RCT Study. Journal of pediatric gastroenterology and nutrition. 64 (6): 925-929. https://doi.org/10.1097/MPG.0000000000001478; PMid:27906800
Kianifar H, Jafari SA, Kiani M, Ahanchian H, Ghasemi SV, Grover Z et al. (2015). Probiotic for irritable bowel syndrome in pediatric patients: a randomized controlled clinical trial. Electronic physician. 7 (5): 1255-1260. doi: 10.14661/1255.
Lacy B, Patel N. (2017). Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome. Journal of Clinical Medicine. 6 (11): 99. https://doi.org/10.3390/jcm6110099; PMid:29072609 PMCid:PMC5704116
Lee YY, Annamalai C, Rao S. (2017). Post-Infectious Irritable Bowel Syndrome. Current gastroenterology reports. 19 (11): 56. https://doi.org/10.1007/s11894-017-0595-4; PMid:28948467
Likert R. (1932). A technique for measurement of attitudes. Archives of Psychology. 140: 5-55.
Lychkovska OL, Hnateyko OZ, Yavorskiy OH, Semen KO, Kozerema KB, Semen VD, Yelisyeyeva OP. (2015). Efficacy of probiotics in treatment of paediatric patients with irritable bowel syndrome. Modern Gastroenterology. 5 (85): 26-32.
Pathirana W, Chubb SP, Gillett MJ, Vasikaran SD. (2018). Faecal Calprotectin. The Clinical biochemist. Reviews. 39 (3): 77-90.
Ricciuto A, Griffiths AM. (2019). Clinical value of fecal calprotectin. Critical reviews in clinical laboratory sciences. 56 (5): 307-320. https://doi.org/10.1080/10408363.2019.1619159; PMid:31088326
Schmulson MJ, Drossman DA. (2017). What Is New in Rome IV. Journal of neurogastroenterology and motility. 23 (2): 151-163. https://doi.org/10.5056/jnm16214; PMid:28274109 PMCid:PMC5383110
Shulman RJ, Eakin MN, Czyzewski DI, Jarrett M, Ou CN. (2008). Increased gastrointestinal permeability and gut inflammation in children with functional abdominal pain and irritable bowel syndrome. The Journal of pediatrics. 153 (5): 646-650. https://doi.org/10.1016/j.jpeds.2008.04.062; PMid:18538790 PMCid:PMC2614282
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