Prebiotic Galacto-Oligosaccharides Impact Stool Frequency and Fecal Microbiota in Self-Reported Constipated Adults: A Randomized Clinical Trial

Abstract

Constipation is a major issue for 10–20% of the global population. In a double-blind randomized placebo-controlled clinical trial, we aimed to determine a dose-response effect of galacto-oligosaccharides (GOS) on stool characteristics and fecal microbiota in 132 adults with self-reported constipation according to Rome IV criteria (including less than three bowel movements per week). Subjects (94% females, aged: 18–59 years) received either 11 g or 5.5 g of BiotisTM GOS, or a control product, once daily for three weeks. Validated questionnaires were conducted weekly to study primarily stool frequency and secondary stool consistency. At base- and endline, stool samples were taken to study fecal microbiota. A trend towards an increased stool frequency was observed after the intervention with 11 g of GOS compared to control. While during screening everybody was considered constipated, not all subjects (n = 78) had less than three bowel movements per week at baseline. In total, 11 g of GOS increased stool frequency compared to control in subjects with a low stool frequency at baseline (≤3 bowel movements per week) and in self-reported constipated adults 35 years of age or older. A clear dose-response of GOS was seen on fecal Bifidobacterium, and 11 g of GOS significantly increased Anaerostipes hadrus. In conclusion, GOS seems to be a solution to benefit adults with a low stool frequency and middle-aged adults with self-reported constipation.

Functional constipation and the effect of prebiotics on the gut microbiota: a review

“…The comparison of studies and the evaluation of prebiotic efficacy is seriously hampered by a number of issues plaguing the field. Only some studies have used people with symptoms of constipation (44)(45)(46)(47)(48)(49)(50)(51) (Table 2), with differing criteria of functional constipation ranging from undefined or vague (23,44,46,47,50) , Rome I, III or IV (25,45,51) , or combinations with IBS-C criteria (49) , while others tested healthy people (52)(53)(54)(55)(56)(57)(58)(59) . The number of participants varies greatly and very small studies lack the power for generalisable results (60,61) .…”

Probiotics, prebiotics, and synbiotics in chronic constipation: Outstanding aspects to be considered for the current evidence

“…However, these effects of prebiotics on SCFAs concentrations are still under discussion, because of the selective effect of different prebiotic materials and the rapid absorption of SCFAs by the epithelium and other gut bacteria, which can limit the assessment of SCFAs level from fecal samples. The supplementation of different prebiotics (e.g., insulin, lactitol, and aloe vera gel or GOS) did not change the fecal SCFA concentrations in healthy or constipated adults after the treatment ( 96 , 97 ). However, an increase in butyrate producer bacterium was found, such as Roseburia hominis , a major butyrate producer ( 33 ).…”

Functional response to a microbial synbiotic in the gastrointestinal system of children: a randomized clinical trial

“…Our results were additionally similar to trials testing laxatives and other dietary interventions. 50,51 Our cohort had two major drawbacks: (i) like other recent efforts in this field, 52 a number of non-constipated individuals not meeting our definition of constipation enrolled at baseline due to discrepancies between parental reporting of constipation and our clinical trial's definition of constipation (being <4 WBMs), and (ii) a high placebo response rate. Looking at the full cohort, we found a significant increase in the number of WBMs for both placebo and active.…”