For years, IBS has been known as a “psychological disease”, an intestinal spastic disease, and a segmental hypersensitivity syndrome (nerves hyperirritable). Now there is increased gut permeability, particluarly in the diarrhea predominant form. This “leaky gut” creates an immune reaction with “increased numbers of T lymphocytes, mast cells and enterochromaffin cells.” This offers new avenues to treatment like probiotics.
Gut. 2008 Sep 29. [Epub ahead of print]
Impaired intestinal barrier integrity in the colon of irritable bowel syndrome patients: involvement of soluble mediators.
Piche T, Barbara G, Aubert P, Bruley des Varannes S, Dainese R, Nano JL, Cremon C, Stanghellini V, De Giorgio R, Galmiche JP, Neunlist M. abstract
Colonic biopsies show increased permeability offering a new biomarker of IBS disease.
Aliment Pharmacol Ther. 2008 Oct 15;28(8):994-1002.
Clinical trial: effect of active lactic acid bacteria on mucosal barrier function in patients with diarrhoea-predominant irritable bowel syndrome.
Zeng J, Li YQ, Zuo XL, Zhen YB, Yang J, Liu CH.
Lactic acid bacteria probiotics help small intestine but not colon
“After probiotics treatment, small bowel permeability decreased significantly from 0.038 (0.024) at baseline to 0.023 (0.020) (P = 0.004), the proportion of patients with increased small bowel permeability was lower than baseline (28.6% vs. 64.3%, P = 0.023). However, colonic permeability improved neither in the probiotics group nor in the placebo group at week 4.”
Probiotics made a difference
“Treatment with probiotics significantly decreased the mean global IBS scores compared with the baseline scores (9.62 +/- 1.05 vs. 7.64 +/- 1.24, P < 0.001).”
Comment – I remember many years ago there was a study demonstrating increased prostaglandins in the stools of people with irritable bowel. At the time it was considered a psychological disease and a gastroenterologist who was giving a talk on the subject was not wanting to take any questions asking why these inflammatory mediators (they cause fever and arthritis) were present in stools of IBS. Now it looks like low grade inflammation is part of the disease as is permeability incompetence. Probiotics make some difference but not the answer. Once the answer is available, IBS will no longer be considered a predominantly psychological disease. (heck, 1/5 people have it and it is one the 1/10 severely affected that attract all the attention of psychologists).
I use Tu Zen – a lactobacillis based probiotic on patients. My feeling is that pretreatment with an antibiotic would give better results. I have discussed this in another blog writeup.
any comments?
Looking good!