The intestinal ecosystem in chronic functional constipation

148

Background/Aims We investigated gut flora characteristics in patients with functional constipation (FC) and influences of short-term treatment with VSL#3 probiotic on flora and symptom improvement. Methods Thirty patients fulfilling Rome III criteria for FC and 30 controls were enrolled. Fecal samples were obtained before and after VSL#3 intake (one sachet twice daily for 2 weeks) and flora were examined by quantitative real-time polymerase chain reaction (qRT-PCR). Symptom changes were also investigated. Results The fold differences in Bifidobacterium and Bacteroides species were significantly lower in feces from FC, compared to in controls ( P = 0.030 and P = 0.021). After taking VSL#3, the fold differences in Lactobacillus , Bifidobacterium and Bacteroides species increased in controls ( P = 0.022, P = 0.018, and P = 0.076), but not in FC. Mean Bristol scores and complete spontaneous bowel movements (CSBMs)/week increased significantly in FC after ingesting VSL#3 (both P < 0.001). Relief of subjective CSBM frequency, stool consistency and abdominal bloating were reported in 70%, 60%, and 47% of patients. After VSL#3 cessation, 44.4% of patients with symptom improvement experienced constipation recurrence mostly within one month. Conclusions Bifidobacterium and Bacteroides species might be quantitatively altered in FC. A short-term VSL#3 treatment can improve clinical symptoms of FC. Further studies are needed to investigate VSL#3’s additional effects beyond altering gut flora to allevate constipation.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Change of Fecal Flora and Effectiveness of the Short-term VSL#3 Probiotic Treatment in Patients With Functional Constipation

Kim

Choi

Park

et al. 2015

148

“…149 Previous studies have found that the intestinal microbiota in chronic constipation patients differed from that in healthy controls. 150,151 A systematic review of RCTs to evaluate the efficacy and safety of probiotic supplementation for the treatment of constipation suggested a favorable effect of treatment with Bifidobacterium lactis DN-173 010, Lactobacillus casei Shirota, and Escherichia coli Nissle 1917 on defecation frequency and stool consistency. 152 How-ever, to achieve the same health benefits seen in clinical trials, probiotics should be administered with specific strains, at a specific doses, in specific populations of people.…”

Section: 148mentioning

confidence: 99%

Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

Shin

Jung

Lee

et al. 2016

The Korean Society of Neurogastroenterology and Motility first published guidelines for chronic constipation in 2005 and was updated in 2011. Although the guidelines were updated using evidence-based process, they lacked multidisciplinary participation and did not include a diagnostic approach for chronic constipation. This article includes guidelines for diagnosis and treatment of chronic constipation to realistically fit the situation in Korea and to be applicable to clinical practice. The guideline development was based upon the adaptation method because research evidence was limited in Korea, and an organized multidisciplinary group carried out systematical literature review and series of evidence-based evaluations. Six guidelines were selected using the Appraisal of Guidelines for Research & Evaluation (AGREE) II process. A total 37 recommendations were adopted, including 4 concerning the definition and risk factors of chronic constipation, 8 regarding diagnoses, and 25 regarding treatments. The guidelines are intended to help primary physicians and general health professionals in clinical practice in Korea, to provide the principles of medical treatment to medical students, residents, and other healthcare professionals, and to help patients for choosing medical services based on the information. These guidelines will be updated and revised periodically to reflect new diagnostic and therapeutic methods.

“…7 In contrast, a study of children with constipation found that the levels of bifidobacteria and clostridia were increased in their feces compared with healthy subjects. 9 A cross-sectional pilot study using 16S rRNA gene pyrosequencing found that patients with constipation did not exhibit decreased levels of Lactobacillus and Bifidobacterium species, but did exhibit significantly decreased levels of Prevotella. 10 Regarding methane, the presence of methanogenic bacteria has been shown to be higher in patients with slow transit constipation compared withnon-constipated controls.…”

Section: 8mentioning

confidence: 99%

Alteration of Gut Microbiota and Efficacy of Probiotics in Functional Constipation

Choi

Chang

2015

Article: Change of fecal flora and effectiveness of the short-term VSL#3 probiotic treatment in patients with functional constipation Kim SE, Choi CS, Park KS, et al Functional constipation (FC) is a common symptom-based gastrointestinal (GI) disorder without organic abnormality, the prevalence of which is between 5% and 20% of the general population.1,2 The symptoms of constipation can be severe; thus, this disorder has a significant impact on patient's quality of life. 3The cause of FC remains unclear, especially for slow transit constipation. Alterations of the gut microbiota have been suggested as one possible pathophysiologic mechanism of FC. 4,5 However, the quantitative and/or qualitative changes of the gut microbiota in FC are poorly understood, and many discrepancies exist in the literature.In the current issue of the Journal of Neurogastroenterology and Motility, Kim et al 6 have published a prospective study in which they investigated the characteristics of gut microbiota in patients with FC using quantitative real-time polymerase chain reaction. The authors found that Bifidobacterium and Bacteroides species were significantly less abundant in feces from patients with FC compared with healthy controls. However, no significant differences were observed regarding the proportion of Lactobacillus, Escherichia coli and Clostridium species. These results are partially consistent with previous studies that have analyzed the fecal microbiota in patients with FC. 7,8Bifidobacterium and Lactobacillus have been shown to be significantly less abundant in adult patients with constipation. 8 One study found that patients with constipation predominant-irritable bowel syndrome exhibited significantly less lactate-producing (bifidobacteria and lactobacilli) and lactate-utilizing bacteria in their feces compared with controls; moreover, the abundances of H 2 -consuming populations, methanogens and reductive acetogens were also significantly lower in these patients compared with controls. 7 In contrast, a study of children with constipation found that the levels of bifidobacteria and clostridia were increased in