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Irritable bowel syndrome (IBS) is a chronic
disorder characterized by recurring symptoms
treatment is aimed at controlling symptoms.
of abdominal pain or discomfort and associated
Unfortunately, even symptomatic treatment is
with disturbed defecation. It affects as many as
hindered by a dearth of truly effective therapies.
one in ﬁve American adults and is among the most
The serotonergic medications tegaserod (Zelnorm®)
common syndromes seen by gastroenterologists
and alosetron (Lotronex®)—both of which had
and primary care providers. IBS occurs more
been shown to improve patients’ overall quality
frequently in women than in men; it is diagnosed
of life and moderate many of the motor and
before the age of 35 years in about half of patients.
sensory abnormalities associated with IBS—were withdrawn from the U.S. market following reports of serious adverse effects. (Alosetron currently
is available through a restricted prescribing
program only for the treatment of women with severe IBS with diarrhea; tegaserod is available for
recurrent abdominal pain or discomfort (an uncomfortable
use in emergency situations only.) Lubiprostone
sensation not described as pain) at least 3 days per month
(Amitiza®), a locally acting chloride channel
in the past 3 months, associated with two or more of the
activator, was approved in April 2008 for the
treatment of IBS with constipation in women aged
18 years and older. It is not approved for use in men
n onset associated with a change in frequency of
or for the treatment of other IBS subtypes.
n onset associated with a change in form (appearance)
probiotics as a promising therapeutic strategy
for IBS. Researchers have reported signiﬁcant alterations in the intestinal microbiota of patients
the criteria must be fulﬁlled for the last 3 months with
with IBS, including a relative decrease in the
symptom onset at least 6 months before diagnosis.
number of biﬁdobacteria. Probiotics have the potential to inﬂuence many of the mechanisms
Source: Reprinted from Longstreth et al. (see
references) with permission from Elsevier.
that may underlie the symptoms of IBS, including immune function, intestinal motility, and the
IBS is referred to as a “functional disorder,”
intraluminal milieu. A growing number of studies
meaning that it has no known or detectable
show probiotics to be a safe, convenient option for
organic causes. The diagnosis is made on the basis
improving a wide variety of IBS symptoms.
of symptom-based criteria known as the “Rome criteria” (Table). IBS may be further categorized into one of three subtypes, according to the
n IBS with diarrhea (more common in men).
n IBS with alternating symptoms of constipation
Pharmacists can ask the following questions
Each group accounts for approximately one third of
Do you have recurrent abdominal pain
emotional distress. In addition to constipation,
diarrhea, and abdominal pain, IBS symptoms
may include cramping, bloating, fecal urgency,
ﬂatulence, a sense of incomplete evacuation, and
straining. The symptoms can be unpredictable
and disabling; some patients are unable to work,
consult with a health care provider.
attend social events, or even travel short distances. Patients report a diminished quality of life similar to that reported by patients with diabetes or chronic
Source: Adapted with permission from the American College
renal failure. As many as 70% of patients with IBS
do not seek or do not receive medical care for their symptoms (see Is IT IrrITable bowel syndrome?).
Species of Biﬁdobacterium
account for tion about their symptoms and stool char- to those observed in healthy volunteers)
acteristics each day. Blood samples were
only in patients who received B. infantis
trointestinal tract of breastfed infants.
obtained at the beginning and end of the
The high proportion of biﬁdobacteria may
study for measurement of cytokine levels.
be responsible for, or at least contribute
to, the health beneﬁts associated with
tients who received B. infantis
colleagues investigated the efﬁcacy of an
breastfeeding. Although the percentage of
signiﬁcantly lower scores most weeks for
encapsulated formulation of B. infantis
biﬁdobacteria declines with age, they still
account for up to 25% of the bacteria in
of three daily doses of B. infantis
35624 is a probiotic strain
(1 x 106, 1 x 108, or 1 x 1010 CFU/mL) or
tients who received L. salivarius
their symptoms daily using an interactive
reconstructive surgery. (Until that time,
parison between the groups receiving B.
—was associated with a signiﬁcant im-
primarily from feces, rather than from the
35624 and L. salivarius
patients receiving B. infantis
ated with signiﬁcant improvements in the
conﬁrmed the ability of B. infantis
tion, passage of gas, straining, and bowel
the beneﬁts of B. infantis
could not be attributed to either a laxa-
tive effect or an antidiarrheal effect.
was signiﬁcant among patients with the
leagues administered B. infantis
UCC4331 in a malted
(IL)-10 and high levels of IL-12, compared
alone as a placebo—to 75 adults with IBS.
with those of a group of age-matched and
to a global assessment of relief from both
Both bacteria were administered at a dose
of 1 x 1010 live cells. The study subjects
inﬂammatory state. Cytokine levels were
more than 20% greater for B. infantis
normalized (i.e., returned to levels similar
American College of Gastroenterology. Understanding Irritable Bowel Syndrome:
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A Consumer Education Brochure.
Available at: http://www.gi.org/patients/
of irritable bowel syndrome patients differs signiﬁcantly from that of
ibsrelief/IBS.pdf. Accessed September 9, 2008.
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Camilleri M. Probiotics and irritable bowel syndrome: rationale, puta-
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tive mechanisms, and evidence of clinical efﬁcacy. J Clin Gastroenterol
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in irritable bowel syndrome and the effects of probiotics. Br J Nutr
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National Digestive Diseases Information Clearinghouse. Irritable bowel
release]. Rockville, MD: Food and Drug Administration; April 29, 2008.
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Available at: http://www.fda.gov/bbs/topics/NEWS/2008/NEW01828.
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irritable bowel syndrome: symptom responses and relationship to cytokine
chloride) information. Available at: http://www.fda.gov/cder/drug/
infopage/lotronex/lotronex.htm. Accessed September 12, 2008.
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Am J Gastroenterol
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35624 in women with irritable bowel syndrome.
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