A candidate probiotic with unfavourable effects in subjects with irritable bowel syndrome: a randomised controlled trial

Solveig C Ligaarden, Lars Axelsson, Kristine Naterstad, Stian Lydersen, Per G Farup, Solveig C Ligaarden, Lars Axelsson, Kristine Naterstad, Stian Lydersen, Per G Farup

Abstract

Background: Some probiotics have shown efficacy for patients with irritable bowel syndrome (IBS). Lactobacillus (L.) plantarum MF1298 was found to have the best in vitro probiotic properties of 22 strains of lactobacilli. The aim of this study was to investigate the symptomatic effect of L. plantarum MF1298 in subjects with IBS. Primary outcome was treatment preference and secondary outcomes were number of weeks with satisfactory relief of symptoms and IBS sum score.

Methods: The design was a randomised double blind placebo-controlled crossover trial. 16 subjects with IBS underwent two three-week periods of daily intake of one capsule of 10(10) CFU L. plantarum MF 1298 or placebo separated by a four-week washout period.

Results: Thirteen participants (81%; 95% CI 57% to 93%; P = 0.012) preferred placebo to L. plantarum MF1298 treatment. The mean (SD) number of weeks with satisfactory relief of symptoms in the periods with L. plantarum MF1298 and placebo were 0.50 (0.89) and 1.44 (1.26), respectively (P = 0.006). IBS sum score was 6.44 (1.81) in the period with L. plantarum MF1298 treatment compared with 5.35 (1.77) in the period with placebo (P = 0.010). With a clinically significant difference in the IBS sum score of 2 in disfavour of active treatment, the number needed to harm was 3.7, 95% CI 2.3 to 10.9.

Conclusions: This trial shows for the first time an unfavourable effect on symptoms in subjects with IBS after intake of a potential probiotic.

Trial registration: ClinicalTrials.gov NCT00355810.

Figures

Figure 1
Figure 1
Flow chart of the participants through the trial.
Figure 2
Figure 2
IBS sum score during the trial by allocation group. The results are given as mean with SEM.

References

    1. Spiller R, Aziz Q, Creed F, Emmanuel A, Houghton L, Hungin P, Jones R, Kumar D, Rubin G, Trudgill N, Whorwell P. Guidelines on the irritable bowel syndrome: mechanisms and practical management. Gut. 2007;56:1770–1798. doi: 10.1136/gut.2007.119446.
    1. Chang L. Review article: epidemiology and quality of life in functional gastrointestinal disorders. Aliment Pharmacol Ther. 2004;20(Suppl 7):31–39. doi: 10.1111/j.1365-2036.2004.02183.x.
    1. Drossman DA. Review article: an integrated approach to the irritable bowel syndrome. Aliment Pharmacol Ther. 1999;13(Suppl 2):3–14. doi: 10.1046/j.1365-2036.1999.0130s2003.x.
    1. Zoetendal EG, Vaughan EE, de Vos WM. A microbial world within us. Mol Microbiol. 2006;59:1639–1650. doi: 10.1111/j.1365-2958.2006.05056.x.
    1. FAO/WHO Expert Consultation Group. Health and nutritional properties of probiotics in food including powder milk with live lactic acid bacteria. Argentina: FAO/WHO; 2001.
    1. Spiller R. Review article: probiotics and prebiotics in irritable bowel syndrome. Aliment Pharmacol Ther. 2008;28:385–396. doi: 10.1111/j.1365-2036.2008.03750.x.
    1. Nobaek S, Johansson ML, Molin G, Ahrne S, Jeppsson B. Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Am J Gastroenterol. 2000;95:1231–1238. doi: 10.1111/j.1572-0241.2000.02015.x.
    1. Klingberg TD, Pedersen MH, Cencic A, Budde BB. Application of measurements of transepithelial electrical resistance of intestinal epithelial cell monolayers to evaluate probiotic activity. Appl Environ Microbiol. 2005;71:7528–7530. doi: 10.1128/AEM.71.11.7528-7530.2005.
    1. Klingberg TD, Axelsson L, Naterstad K, Elsser D, Budde BB. Identification of potential probiotic starter cultures for Scandinavian-type fermented sausages. Int J Food Microbiol. 2005;105:419–431. doi: 10.1016/j.ijfoodmicro.2005.03.020.
    1. Klingberg TD, Budde BB. The survival and persistence in the human gastrointestinal tract of five potential probiotic lactobacilli consumed as freeze-dried cultures or as probiotic sausage. Int J Food Microbiol. 2006;109:157–159. doi: 10.1016/j.ijfoodmicro.2006.01.014.
    1. Heaton KW. Dietary fibre. BMJ. 1990;300:1479–1480. doi: 10.1136/bmj.300.6738.1479.
    1. Walter SD. Number needed to treat (NNT): estimation of a measure of clinical benefit. Stat Med. 2001;20:3947–3962. doi: 10.1002/sim.1173.
    1. Quigley EM. The efficacy of probiotics in IBS. J Clin Gastroenterol. 2008;42(Suppl 2):S85–S90. doi: 10.1097/MCG.0b013e31816244ca.
    1. Guyonnet D, Chassany O, Ducrotte P, Picard C, Mouret M, Mercier CH, Matuchansky C. Effect of a fermented milk containing Bifidobacterium animalis DN-173 010 on the health-related quality of life and symptoms in irritable bowel syndrome in adults in primary care: a multicentre, randomized, double-blind, controlled trial. Aliment Pharmacol Ther. 2007;26:475–486.
    1. O'Mahony L, McCarthy J, Kelly P, Hurley G, Luo F, Chen K, O'Sullivan GC, Kiely B, Collins JK, Shanahan F, Quigley EM. Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. Gastroenterology. 2005;128:541–551. doi: 10.1053/j.gastro.2004.11.050.
    1. Whorwell PJ, Altringer L, Morel J, Bond Y, Charbonneau D, O'Mahony L, Kiely B, Shanahan F, Quigley EMM. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol. 2006;101:1581–1590. doi: 10.1111/j.1572-0241.2006.00734.x.
    1. O'Sullivan MA, O'Morain CA. Bacterial supplementation in the irritable bowel syndrome. A randomised double-blind placebo-controlled crossover study. Dig Liver Dis. 2000;32:294–301. doi: 10.1016/S1590-8658(00)80021-3.
    1. Kajander K, Myllyluoma E, Rajilic-Stojanovic M, Kyronpalo S, Rasmussen M, Jarvenpaa S, Zoetendal EG, de Vos WM, Vapaatalo H, Korpela R. Clinical trial: multispecies probiotic supplementation alleviates the symptoms of irritable bowel syndrome and stabilizes intestinal microbiota. Aliment Pharmacol Ther. 2008;27:48–57.
    1. Sen S, Mullan MM, Parker TJ, Woolner JT, Tarry SA, Hunter JO. Effect of Lactobacillus plantarum 299v on colonic fermentation and symptoms of irritable bowel syndrome. Dig Dis Sci. 2002;47:2615–2260. doi: 10.1023/A:1020597001460.
    1. Montrose DC, Floch MH. Probiotics used in human studies. J Clin Gastroenterol. 2005;39:469–484. doi: 10.1097/01.mcg.0000165649.32371.71.
    1. Boyle RJ, Robins-Browne RM, Tang MLK. Probiotic use in clinical practice: what are the risks? Am J Clin Nutr. 2006;83:1256–1264.
    1. Besselink MG, van Santvoort HC, Buskens E, Boermeester MA, van Goor H, Timmerman HM, Nieuwenhuijs VB, Bollen TL, van Ramshorst B, Witteman BJ, Rosman C, Ploeg RJ, Boermeester MA, Schaapherder AF, Dejong CH, Wahab PJ, van Laarhoven CJ, Harst E van der, van Eijck CH, Cuesta MA, Akkermans LM, Gooszen HG. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. Lancet. 2008;371:651–659. doi: 10.1016/S0140-6736(08)60207-X.
    1. Niedzielin K, Kordecki H, Birkenfeld B. A controlled, double-blind, randomized study on the efficacy of Lactobacillus plantarum 299V in patients with irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2001;13:1143–1147. doi: 10.1097/00042737-200110000-00004.
    1. Niv E, Naftali T, Hallak R, Vaisman N. The efficacy of Lactobacillus reuteri ATCC 55730 in the treatment of patients with irritable bowel syndrome-a double blind, placebo-controlled, randomized study. Clin Nutr. 2005;24:925–931. doi: 10.1016/j.clnu.2005.06.001.
    1. Ersryd A, Posserud I, Abrahamsson H, Simren M. Subtyping the irritable bowel syndrome by predominant bowel habit: Rome II versus Rome III. Aliment Pharmacol Ther. 2007;26:953–961.
    1. Woods JR, Williams JG, Tavel M. The two-period crossover design in medical research. Ann Intern Med. 1989;110:560–566.

Source: PubMed

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