Irritable Bowel Syndrome (IBS) is among the most common gastrointestinal conditions in the world, yet patients still find it difficult to find relief from its symptoms, which include intermittent abdominal discomfort or pain (cramping), bloating, constipation and/or diarrhoea.
In 2002, the International Foundation for Functional Gastrointestinal Disorders (IFFGD) sponsored a study to find out more about the burden of IBS symptoms in U.S. adults and found that diarrhoea, either alone or in combination with constipation, was the predominant IBS condition.
Furthermore, respondents who had symptoms of constipation and/or diarrhoea reported episodes of gas, bloating and abdominal pain with an average frequency of over 200 times a year! This significantly interfered with their daily comfort, work or social activities with friends or families.
Prevalence of IBS
The data on the prevalence of IBS in Malaysia is limited. However, it is estimated that between 15-19% of Malaysians suffer from IBS which is comparable to that seen in parts of the West, South America and Russia.
We are constantly reminded of reports citing Malaysia as the most obese state in Asia, Malaysians generally not meeting the recommended amount of daily nutrients, fibre consumption and Malaysians having decreased physical activity; these have contributed to the rise of noncommunicable diseases, particularly those involving the digestive system.
A Local Solution Found!
Each person, based on the subtype of IBS they have, will have different symptoms. It is not surprising, then, that treatment which works for one person may not be beneficial for another. This makes IBS harder for doctors to treat and even more frustrating for patients.
Many studies have been conducted to find a single common approach to alleviate the symptoms of IBS and one alternative has become increasingly popular: the application of bacteria – more specifically, probiotics. Probiotics rose to popularity as an answer because it is safe, easily available, and relatively cheap.
Probiotics can be defined simply as live microorganisms that if administered in adequate amounts can confer health benefits on the host. One study conducted at Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), found that these probiotics – from the species Lactobacillus acidophilus and Lactobacillus casei – were able to improve intestinal transit time (ITT). Intestinal transit time is the amount of time needed for food to travel from your mouth through your digestive tract to your anus.
Assoc Prof Dr Raja Affendi Raja Ali, a Physician and Consultant Gastroenterologist at Hospital Canselor Tuanku Muhriz, PPUKM said, "In some patients, ITT can be very fast, which leads to diarrhoea. While in others, the transit time is sluggish which leads to hard stool and constipation. IBS patients with constipation symptoms have longer ITTs". He further explained that the longer the transit time, the more constipated a patient gets. The results of the study proved that probiotics were able to reduce the ITT and hence assist food movement through the intestine. This in turn, relieved constipation symptoms. This is a significant finding since many IBS patients with constipation reported having to pass hard, lumpy stool with tummy pain every time they strain or use force to empty their bowels.
The landmark local study was conducted by a team of experts from the Gastroenterology Unit at PPUKM and involved 180 subjects evenly distributed between those who are healthy and those who had been diagnosed with IBS with constipation as the predominant symptom (IBS-C).
All subjects were required to complete a dietary regiment of three bottles of cultured milk drink containing the probiotics L.acidophilus and L.casei every day for 30 days straight. So far, the test has shown very promising results in terms of reducing the ITT and also improving the symptoms of constipation in both IBS-C and healthy subjects.
Additionally, those who reported always having to pass hard stool prior to the regiment decreased dramatically; stool consistency became softer, thus, reducing pain and discomfort that they suffered so frequently before.
"The preliminary results of this ongoing research are promising and it echoes the same conclusions from other studies of different strains of probiotics around the world; probiotics can improve bowel health," states Assoc Prof Dr Raja Affendi.
How Probiotic Helps IBS Patients
It is known that a person suffering from IBS-C also has an imbalance of good vs bad bacteria in their gut. This imbalance, termed dysbiosis, aggravates constipation symptoms and disrupts digestion in general. Bacteria in our gut help out a lot in terms of digesting our food, and the lack of bacteria would slow digestion and increase ITT in IBS patients, which can then lead to constipation.
Some gut bacteria species (the bad bacteria) are linked to IBS and could influence some of the symptoms suffered by patients. Hence, by replenishing the gut with good bacteria, balance would be restored and this would help alleviate constipation symptoms in IBS and in healthy people as well.
Added Value of Probiotics
The benefits of probiotics are also not limited to the gut. "There are emerging evidences from the current research indicating that probiotics also plays a pivotal role in mental health and clarity as well as improve immune function." The research Principle Investigator adds, "The L.acidophillus and L.casei used in the study also showed the ability to influence the immune response among the subjects." Other studies have also demonstrated the ability of probiotics to exert anti-inflammatory, antibacterial and antiviral properties that help protect the host.
The multi-benefits of probiotics across various functionalities of the body make it a valuable option for treating an array of different problems.
Over the past few years, there has been an emergence of new concepts related to the mechanism and disease state of IBS. This changing paradigm may allow for probiotic therapeutic opportunities in IBS and even in healthy persons. Further studies are warranted but in the meantime, what we do know is that probiotics have potential to be a viable option to treat constipation in IBS and healthy patients and also have potential to alleviate other symptoms as well.