Background
Small intestinal bacterial overgrowth (SIBO) is associated with diarrhea-predominant irritable bowel syndrome (IBS-D). Probiotics like S. boulardii CNCM I-745 (Sb) may be efficacious in balancing the microbiota.
This randomized open label study assessed the effect of Sb in patients with bacterial overgrowth associated with IBS-D and its impact on the intestinal microbiota.
Methods
Patients were randomized to receive for 15 days; S. boulardii + dietary advice (Sb+DA) or dietary advice (DA) only. SIBO was assessed by the lactulose hydrogen breath test (LHBT). Symptoms were assessed with the IBS Symptom Severity Scale (IBS-SSS) and stool consistency with the Bristol Stool Form Scale. Microbiota and mycobiota were analyzed by 16S rDNA and ITS2.
Results
54 patients were included, among them 48 (27 Sb+DA, 21 DA) were evaluated. Decrease of hydrogen excretion was slightly higher in Sb+DA group, 41% vs 29% in DA group, and IBS-SSS total score were reduced by -134 and -93, respectively
The proportion of patients with diarrhea was lower in the Sb+DA group than in the DA group (25.9% compared to 47.6%)
Bacterial and fungal microbiota showed that S. boulardii CNCM I-745 treatment was associated with several modifications. Interestingly, F. prausnitzii was more abundant in Sb-treated patients with marked clinical improvement. The safety of Sb was excellent.
Conclusions
In patients with SIBO, S. boulardii CNCM I-745 associated with dietary advice reduced bacterial overgrowth and improved digestive symptoms while restoring the intestinal microbiota. The increased abundance of F. prausnitzii coupled with symptom improvement merits further research.
In 9 out of 14 patients with chronic eosinophilic pneumonia (CEP), followed-up in our department, circulating immune complexes (CIC) and other immunologic indices were investigated. The diagnosis of CEP was based on the typical clinical and radiographic findings and on the demonstration of eosinophilia in serum, bronchoalveolar lavage (BAL), fiberoptic transbronchial biopsies and surgical lung biopsies. CIC measured by solid-phase monoclonal RF binding were always strongly positive during a flare-up of CEP, and CIC measured by solid-phase C1q binding were also positive in most cases. Remissions of CEP were accompanied by lowering or disappearance of CIC. CIC were significantly correlated with eosinophilia (p less than 0.001 for RF and p less than 0.02 for C1q). Other immunologic indices were normal except for increased IgE in two thirds of the patients, and a slightly positive rheumafactor without rheumatic disease in half of the patients. The CIC are thus related to disease activity, and can be used as one of the markers of it, in addition to the classical markers such as eosinophilia and chest X-ray. However, this does not imply that the CIC have a pathogenetic role in CEP; these CIC can, indeed, be an epiphenomenon only.
It is now well known that intestinal microbiota exerts not only several physiological functions, but has also been implied in the mechanisms of many conditions, both intestinal and extraintestinal. These advances, to the best of our knowledge, have been made possible by the development of new ways of studying gut flora. Metagenomics, the study of genetic material taken directly from environmental samples, avoiding individual culture, has become an excellent tool to study the human microbiota. Therefore, it has demonstrated an association between an altered intestinal microbiota and inflammatory bowel disease or irritable bowel syndrome, perhaps the most extensively studied conditions associated with this particular subject. However, microbiota has a potential role in the development of other diseases; their manifestations are not confined to the intestine only. In this article, an extensive updated review is conducted on the role intestinal microbiota has in health and in different diseases. Focus is made on the following conditions: inflammatory bowel disease, irritable bowel syndrome, celiac disease, hepatic encephalopathy, and obesity.
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