Small intestinal bacterial overgrowth (SIBO) is a common feature in irritable bowel syndrome (IBS) and in fact may be directly related to the genesis of IBS symptoms. An ERBHAL on a lactulose breath test may indicate SIBO. Antibiotics and elemental diets have been shown to be effective in treating SIBO, but the efficacy of probiotics is untested.
A pilot study was undertaken to determine the effect of L. strain Shirota (Yakult®) on intestinal fermentation patterns of IBS patients. After 6 week of treatment with 1 x 65 mL dose of Yakult(R) daily, 9 of 14 patients (64%) completing the study had reversal of ERBHAL, with the median time of first rise increasing from 45 to 75 min (P = 0.03). Furthermore, symptoms improved in those in whom ERBHAL was corrected.
The results indicate that Yakult(R) alters fermentation patterns suggesting a reduction in SIBO. ERBHAL can also indicate rapid small intestinal transit and therefore, in order to confirm the effect of Yakult(R) on SIBO, future studies will include monitoring of transit time in addition to placebo control.
A research article to be published on August 28, 2008 in the World Journal of Gastroenterology addresses this question. The research team was led by Peter Gibson and his colleagues at Monash University, Box Hill Hospital. The pilot trial was undertaken to determine whether a probiotic could have an effect on SIBO.
Currently, SIBO is managed by antibiotics and/or elemental diets, the side effects and practicalities of which make them undesirable options. Probiotics may provide a safe alternative. The results of the pilot trial warrant a well powered, double blind, placebo-controlled trial.
The effect of probiotics on SIBO had not previously been investigated, but after taking Yakult(R) daily for 6 wk, there was a significant shift in the time of first rise on the lactulose breath test indicating a reduction in SIBO. If these findings are confirmed by further research, Yakult(R) may be a safe and effective alternative for the management of this patient group.
- Jacqueline S Barrett, Kim EK Canale, Richard B Gearry, Peter M Irving, Peter R Gibson. Probiotic effects on intestinal fermentation patterns in patients with irritable bowel syndrome. World J Gastroenterol, 2008 August 28; 14 (32): 5020-5024 [link]
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