Effect of Probiotics on Constipation and Weight in CP (cerebral palsy)

Probiotic and Synbiotic Supplementation for Constipation-related Outcomes in Children With Cerebral Palsy: a Randomized, Double-blind, Placebo-controlled Trial

The goal of this clinical trial is to learn whether using Lactobacillus reuteri or a prebiotic-containing Lactobacillus rhamnosus supplement helps to improve constipation and weight gain in children with cerebral palsy (CP). It will also examine the safety and tolerability of these probiotic products.

The main questions it aims to answer are:

Do these probiotic supplements improve bowel movement frequency and stool consistency?

Do they support better weight gain and nutritional status in children with CP?

Are there any side effects or tolerability issues during treatment?

Researchers will compare Lactobacillus reuteri with prebiotic-enriched Lactobacillus rhamnosus in a randomized, double-blind, controlled design.

Participants will:

Take one of the probiotic products daily for 28 days

Visit the clinic at the beginning and end of the study for measurements and stool testing

Have their caregivers keep a stool diary using the Bristol stool scale

Study Overview

• Status: Completed
• Conditions: Constipation; Cerebral Palsy (CP); Probiotic
• Intervention / Treatment: Dietary supplement: Lactobacillus Reuteri Oral Solution [BioGaia]; Dietary supplement: Lactobacillus Rhamnosus; Dietary supplement: Prebiotic (inulin)

Detailed Description

ClinicalTrials.gov Study Record Example Title The Effect of Using Lactobacillus reuteri and Prebiotic-Containing Lactobacillus rhamnosus Strains on Constipation and Weight Gain in Children with Cerebral Palsy: A Prospective Randomized Controlled Study ________________________________________ Brief Summary This clinical trial aims to determine whether daily supplementation with Lactobacillus reuteri or a prebiotic-enriched Lactobacillus rhamnosus formula can improve constipation and weight gain in children with cerebral palsy (CP). Constipation is a common problem in children with CP due to impaired intestinal motility and disruption of the gut microbiota. The study will compare the effects and safety of two probiotic products over a 28-day period.

________________________________________ Detailed Description Cerebral palsy (CP) is a non-progressive neurodevelopmental disorder characterized by impairments in movement and posture. Gastrointestinal complications, particularly chronic constipation and inadequate weight gain, are frequently observed in this population and may significantly affect quality of life. Altered intestinal motility, limited physical activity, and gut microbiota dysbiosis are considered key contributors to bowel dysfunction in children with CP.

Probiotics have been proposed as a supportive therapeutic approach for gastrointestinal symptoms through modulation of intestinal microbiota, enhancement of barrier function, and regulation of bowel motility. Lactobacillus reuteri and Lactobacillus rhamnosus are among the most commonly studied probiotic strains with documented benefits in pediatric gastrointestinal disorders. The addition of prebiotics such as inulin may further enhance probiotic efficacy by promoting the growth of beneficial bacteria.

This prospective, randomized, double-blind, controlled study is designed to evaluate the effects of daily probiotic supplementation on bowel habits and growth parameters in children with cerebral palsy. Eligible participants are allocated to one of three parallel intervention arms and followed for a 28-day treatment period.

Clinical assessments are conducted at baseline and at the end of the intervention period. Anthropometric measurements are obtained using standardized techniques. Stool samples are collected for laboratory analysis, and stool consistency is evaluated using a validated scoring system. Caregivers maintain a daily stool diary to document bowel movement frequency and gastrointestinal symptoms throughout the study period.

The study evaluates changes in bowel function and growth-related parameters over time, as well as the safety and tolerability of the probiotic formulations. Adverse events and treatment adherence are monitored throughout follow-up. This study aims to provide evidence on whether probiotic supplementation represents a safe and effective supportive strategy for managing constipation and improving nutritional outcomes in children with cerebral palsy.

________________________________________ Study Type Interventional (Clinical Trial) Study Design

• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Double-blind (Participant, Investigator)
• Primary Purpose: Treatment ________________________________________ Estimated Enrollment (Insert total number, e.g., n = 90 participants)

Official Title The Effect of Using Lactobacillus reuteri and Prebiotic-Containing Lactobacillus rhamnosus Strains on Constipation and Weight Gain in Children with Cerebral Palsy: A Prospective Randomized Controlled Study ________________________________________ Arms and Interventions Arm 1: Lactobacillus reuteri Participants receive Lactobacillus reuteri daily for 28 days. Arm 2: Lactobacillus rhamnosus + Prebiotic (Inulin) Participants receive a probiotic containing Lactobacillus rhamnosus with prebiotic inulin daily for 28 days.

Arm 3: Control Group Participants receive standard dietary management for constipation.

________________________________________ Primary Outcome Measures

1. Change in defecation frequency [Time Frame: Baseline and Day 28]
2. Change in stool consistency (Bristol Stool Scale) [Time Frame: Baseline and Day 28] ________________________________________ Secondary Outcome Measures

1. Change in body weight and BMI [Time Frame: Baseline and Day 28]
2. Stool pH level [Time Frame: Baseline and Day 28]
3. Caregiver-reported gastrointestinal symptoms [Time Frame: Throughout 28-day follow-up]

4. Incidence of adverse events [Time Frame: Throughout 28-day follow-up]

   ________________________________________ Eligibility Criteria

   Inclusion Criteria:

   • Children aged 2-18 years
   • Diagnosed with cerebral palsy (GMFCS levels III-V)
   • Chronic constipation meeting Rome IV criteria
   • Stable medical condition and able to take oral or enteral feeding

   Exclusion Criteria:

   • Degenerative neurological diseases

   • Congenital gastrointestinal malformations
   • Inflammatory bowel disease or metabolic disorders
   • Kidney failure
   • Antibiotic, probiotic, or prebiotic use within one month before enrollment
   • Poor adherence (<95%) or hospitalization during study period ________________________________________ Study Start Date January 2023 Estimated Study Completion Date February 2025 ________________________________________ Location Ordu University Faculty of Medicine, Departments of Pediatric Surgery, Pediatrics, and Pediatric Neurology, Ordu University Training and Research Hospital, Ordu, Turkey

   Sponsors and Collaborators

   • Sponsor: Ordu University Faculty of Medicine, Department of Pediatric Surgery

   • Collaborators: Department of Pediatrics and Division of Pediatric Neurology

   • Product Support: Nestlé (Inulin-Enriched Lactobacillus rhamnosus formulation)

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Outside of the US
    • Ordu, Outside of the US, Turkey (Türkiye), 52200
      • Ordu University Faculty of Medicine, Department Of Pediatric Surgery

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age between 6 months and 18 years
• Clinical diagnosis of cerebral palsy
• Gross Motor Function Classification System (GMFCS) levels III, IV, or V
• Chronic constipation diagnosed according to Rome IV criteria
• Stable medical condition
• Ability to receive oral or enteral nutrition

Exclusion Criteria:

• Cerebral palsy due to degenerative neurological disorders
• Constipation due to a known organic cause
• Congenital gastrointestinal tract malformations
• Inflammatory bowel disease
• Metabolic diseases
• History of kidney failure
• Use of antibiotics, probiotics, or prebiotics within one month prior to enrollment
• Anticipated poor adherence to the study protocol
• Requirement for hospitalization during the study period

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Lactobacillus reuteri group; Participants receive Lactobacillus reuteri supplement daily for 28 days.	Dietary supplement: Lactobacillus Reuteri Oral Solution [BioGaia]; Participants receive *Lactobacillus reuteri* supplement once daily for 28 days.
Experimental: Lactobacillus rhamnosus + Prebiotic (Inulin) group; Participants receive Lactobacillus rhamnosus with prebiotic inulin daily for 28 days.	Dietary supplement: Lactobacillus Rhamnosus; Lactobacillus rhamnosus is administered as part of a single synbiotic product that also contains the prebiotic inulin. The synbiotic formulation is provided as one commercially available product and is administered once daily for 28 days.; Dietary supplement: Prebiotic (inulin); Inulin is administered as part of the same single synbiotic product that contains Lactobacillus rhamnosus. The synbiotic formulation is provided as one commercially available product and is administered once daily for 28 days.
No Intervention: Control group; Participants receive standard dietary management (no probiotic supplementation).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in stool consistency (Bristol Stool Scale)	Stool form assessed using the Bristol Stool Scale (types 1-7). Higher scores reflect softer stool consistency.	Baseline and Day 28
Change in defecation frequency	Number of bowel movements per week, recorded in caregiver stool diaries. Increase in defecation frequency indicates improvement in constipation.	Baseline and Day 28
Change in Stool Consistency (Bristol Stool Scale)	Change in stool consistency assessed using the Bristol Stool Scale (types 1-7). Improvement is defined as an increase in Bristol Stool Scale score from baseline to Day 28.	Baseline and Day 28

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in stool pH	Stool samples analyzed for pH using a standard test kit to evaluate intestinal microbiota activity.	Baseline and Day 28
Change in body weight	Change in body weight measured in kilograms. An increase indicates improved nutritional status.	Baseline and Day 28
Change in body mass index (BMI)	Change in body mass index calculated as weight in kilograms divided by height in meters squared (kg/m²).	Baseline and Day 28
Change in mid-arm circumference	Change in mid-arm circumference measured in centimeters as an indicator of muscle mass and nutritional status.	Baseline and Day 28
Change in heel-to-knee length	Change in heel-to-knee length measured in centimeters as an indicator of linear growth.	Baseline and Day 28
Caregiver-reported gastrointestinal symptoms	Caregiver-reported presence and frequency of gastrointestinal symptoms, including gagging, vomiting, retching, bloating, and feeding intolerance, recorded using a daily symptom diary. No composite symptom score is calculated.	Throughout 28-day follow-up
Incidence of adverse events	Number and type of any adverse or unexpected reactions observed during the study period.	Throughout 28-day follow-up

Collaborators and Investigators

• Sponsor: Ordu University
• Investigators: Study Director: Aybegum Kalyoncu Aycenk, Assistant Professor, ORDU UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF PEDIATRIC SURGERY

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2022
• Primary Completion (Actual): March 29, 2025
• Study Completion (Actual): April 29, 2025

Study Registration Dates

• First Submitted: January 20, 2026
• First Submitted That Met QC Criteria: January 30, 2026
• First Posted (Actual): February 6, 2026

Study Record Updates

• Last Update Posted (Actual): February 6, 2026
• Last Update Submitted That Met QC Criteria: January 30, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: children; probiotics; cerebral palsy; constipation; Lactobacillus reuteri; Lactobacillus rhamnosus; inulin
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Signs and Symptoms, Digestive; Brain Damage, Chronic; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Cerebral Palsy; Constipation; Dietary Supplements; Food; Diet, Food, and Nutrition; Physiological Phenomena; Food and Beverages; Dietary Carbohydrates; Carbohydrates; Polymers; Macromolecular Substances; Polysaccharides; Starch; Glucans; Biopolymers; Fructans; Dietary Fiber; Polysaccharides, Bacterial; Inulin; Prebiotics
• Other Study ID Numbers: 2023/82

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: At this time, there are no plans to share individual participant data outside of the research team due to ethical considerations and patient confidentiality.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No