Fasting breath H2 and gut microbiota metabolic potential are associated with the response to a fermented milk product in irritable bowel syndrome

Abstract

Objectives Aim of this study was to assess the effect of a fermented milk product containing Bifidobacterium lactis CNCM I-2494 (FMP) on gastrointestinal (GI) symptoms and exhaled H 2 and CH 4 during a nutrient and lactulose challenge in patients with irritable bowel syndrome (IBS). Methods We included 125 patients with IBS (Rome III). Fasted subjects were served a 400ml liquid test meal containing 25g lactulose. The intensity of eight GI symptoms and the amount of exhaled H 2 and CH 4 were assessed before and during 4h after meal intake. The challenge was repeated after 14 days consumption of FMP or a control product in a double-blind, randomized, parallel design. The metabolic potential of fecal microbiota was profiled using 16S MiSeq analysis of samples obtained before and after the intervention. Results 106 patients with IBS were randomized. No difference between FMP or control groups was found on GI symptoms or breath H 2 and CH 4 in the whole cohort. A post-hoc analysis in patients stratified according to their fasting H 2 levels showed that in high H 2 producers (fasting H 2 level≥10ppm, n = 35), FMP consumption reduced fasting H 2 levels (p = 0.003) and H 2 production during the challenge (p = 0.002) and tended to decrease GI discomfort (p = 0.05) vs. control product. The Prevotella / Bacteroides metabolic potential at baseline was higher in high H 2 producers (p<0.05) vs. low H 2 producers and FMP consumption reduced this ratio (p<0.05) vs. control product. Conclusions The response to a fermented milk product containing Bifidobacterium lactis CNCM I-2494 (FMP) in patients with IBS seems to be associated with the metabolic potential of the gut microbiota. Trial registration ClinicalTrial.gov NCT01252550 . These results were presented as congress posters at Digestive Disease Week 2016 in San Diego, USA and United European Gastroenterology Week 2016 in Vienna, Austria.

Gut microbiome, diet and symptom interactions in irritable bowel syndrome

“…Interestingly, we found that patients with severe IBS symptoms had a higher abundance of hydrogenases involved in the metabolism of H 2 . This is in agreement with our previous finding that IBS patients with high exhaled H 2 levels had a distinctive ratio of active members of the gut microbiota regardless of gastrointestinal symptoms 37 . We confirm the important role of hydrogen metabolism and provide novel insight into the identification of specific hydrogenases for symptom generation in IBS.…”

A Fermented Milk Product with B. lactis CNCM I-2494 and Lactic Acid Bacteria Improves Gastrointestinal Comfort in Response to a Challenge Diet Rich in Fermentable Residues in Healthy Subjects

“…A 15-day period in the run-in phase was allowed before the flatulogenic diet to avoid potential carry-over effects of probiotic consumption in the habitual diet of the participants prior to their inclusion in the study. During the study, participants consumed their habitual diet except during the last 3 days of the run-in phase (days [16][17][18] and the administration phase (days 44-46) when a flatulogenic diet (see below) was administered. The day after the run-in phase (day 19) subjects were re-evaluated, and only subjects who fulfilled the 2 following continuation criteria entered the administration phase: (a) ≥50% daily compliance to the flatulogenic diet (calculated as the percent intake per day of the total fiber content in the diet); and (b) an increase in flatulence score ≥2 on a 0-10 scale during the flatulogenic diet as compared to the habitual diet.…”

“…The challenge diet [22] consisted of: (a) breakfast of wholemeal cookies (39 g) plus coffee, tea, and/or milk; (b) lunch of white beans (200 g), mixed vegetables (250 g) or chickpeas (200 g) and wholemeal bread (50 g), plus meat, fowl or fish, and fruit (banana, figs, peaches or prunes); and (c) dinner of vegetable soup (200 mL), wholemeal bread (50 g) and fruit (banana, figs, peaches, or During the study, participants consumed their habitual diet except during the last 3 days of the run-in phase (days [16][17][18] and the administration phase (days 44-46) when a flatulogenic diet (see below) was administered. The day after the run-in phase (day 19) subjects were re-evaluated, and only subjects who fulfilled the 2 following continuation criteria entered the administration phase: (a) ≥50% daily compliance to the flatulogenic diet (calculated as the percent intake per day of the total fiber content in the diet); and (b) an increase in flatulence score ≥2 on a 0-10 scale during the flatulogenic diet as compared to the habitual diet.…”

“…Digestive sensations and the number of anal gas evacuations were measured during 3-day periods at 3 time points throughout the study: (a) at the beginning of the run-in phase on the habitual diet (days 1-3); (b) at the end of the run-in phase on the challenge diet (days [16][17][18]; and (c) at the end of the administration phase on the challenge diet (days 44-46) ( Figure 1). The volume of gas evacuated after a probe meal was measured after the 3 days challenge diet on 2 occasions: (a) the day after the run-in phase (day 19); and (b) the day after the administration phase (day 47).…”

“…lactis CNCM I-2494 and lactic acid bacteria has been shown to improve symptoms and well-being in women with mild digestive complaints [12][13][14][15], and to improve bloating, digestive discomfort, and reduce abdominal distension in IBS-C patients [16,17]. The response to this product seems to be related to the metabolic activity of the gut microbiota [18].…”