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IBS and role of probiotics, prebiotics, and antibiotics
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IBS and role of probiotics, prebiotics, and antibiotics

Prebiotics and synbiotics in IBS: Currently there is insufficient evidence to recommend prebiotics or synbiotics in IBS.   Recommendation: weak. Quality of evidence: very low. 3

Definitions:

  • Prebiotics are food ingredients that induce the growth or activity of beneficial microorganisms
  • Synbiotics refer to food ingredients or dietary supplements combining probiotics and prebiotics in a form of synergism

Probiotics in IBS: 3

Findings:

  • Probiotics improve global symptoms such as  bloating, and flatulence
  • Recommendations regarding individual species, preparations, or strains cannot be made at this time.
  • Recommendation: weak. Quality of evidence: low.

Definition:

  • Probiotics are defined as live microorganisms that are believed to provide health benefits when consumed.

Antibiotic therapy in IBS patients:

Findings from the American College of Gastroenterology:

  • Overall, antibiotic therapy improved IBS symptoms compared with placebo.
  •  Rifaximin was found to be effective at reducing total IBS symptoms and bloating in diarrhea predominant IBS.
    Recommendation: weak. Quality of evidence: Moderate.

Findings from the American Gastroenterological Association regarding Rifaximin:7

  • Pooled data from 2 RCTs showed a small but beneficial effect based on the combination of improvement in abdominal pain plus improvement in stool consistency.
  • Three RCTs demonstrated an improvement in IBS-related global symptoms.
  • Side effects were minimal.
  • The AGA suggests using rifaximin (over no drug treatment) in patients with IBS–D.
  • Conditional recommendation; Moderate-quality evidence

 
Rifaximin drug information:

  • FDA approval:  Treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults.
  • Dosage for Irritable Bowel Syndrome with Diarrhea:
    The recommended dose of XIFAXAN is one 550 mg tablet taken orally three times a day for 14 days. Patients who experience a recurrence of symptoms can be retreated up to two times with the same dosage regimen.
  • Mechanism of Action: Rifaximin is a semi-synthetic derivative of rifampin and acts by binding to the beta-subunit of bacterial DNA-dependent RNA polymerase blocking one of the steps in transcription. This results in inhibition of bacterial protein synthesis and consequently inhibits the growth of bacteria.

Source:  Xifaxan® (rifaxamin) package insert. Salix Pharmaceuticals, Bridgewater, NJ 08807 USA. Rev. 11/2015. Acccessed: July 2017

>>> Antispasmotics

References
  1. Lovell RM , Ford AC . Global prevalence of, and risk factors for, irritable bowel syndrome: a meta-analysis . Clin Gastroenterol Hepatol 2012; 10 : 712 - 21 .
  2. Quigley EM , Abdel-Hamid H , Barbara G et al. A global perspective on irritable bowel syndrome: a consensus statement of the World Gastroenterology Organisation Summit Task Force on Irritable Bowel Syndrome . J Clin Gastroenterol 2012 ; 46 : 356 - 66 .
  3. Ford AC, et al.   American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation Am J Gastroenterol 2014 109 Suppl 1 S2-S26. PubMed.
  4. Chang, L., Lembo, A., and Sultan, S. American Gastroenterological Association technical review on the pharmacological management of irritable bowel syndrome. Gastroenterology. 2014; 147: 1149-1172.
  5. Simren M,  Palsson OS,  Whitehead WE. Update on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice.  Curr Gastroenterol Rep. 2017; 19(4): 15.  Published online 2017 Apr 3. doi: 10.1007/s11894-017-0554-0 PMCID: PMC5378729
  6. Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology. 2016;150:1262-1279.
  7. American Gastroenterological Association Institute Guideline on the Pharmacological Management of Irritable Bowel Syndrome. Accessed: July 2017. Available at:
    http://www.gastro.org/guidelines/pharmacological-management-of-ibs
  8. Zuckerman MJ. The role of fiber in the treatment of irritable bowel syndrome: therapeutic recommendations. J Clin Gastroenterol. 2006 Feb;40(2):104-8.
  9. LINZESS(R) package insert.  Allergan USA, Inc. Ironwood Pharmaceuticals, Inc. Irvine, CA 92612 Cambridge, MA, 02142.  Revised: 1/2017. Accessed: July 2017.
  10. Amitiza® (lubiprostone) package insert.  Takeda Pharmaceuticals America, Inc. Deerfield, IL 60015.  Revised: 9/2016.  Accessed: July 2017.  

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Please review the latest applicable package insert for additional information and possible updates.  A local search option of this data can be found here.

IBS and role of probiotics, prebiotics, and antibiotics