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Effect of Lactobacillus plantarum 299v on Colonic Fermentation and Symptoms of Irritable Bowel Syndrome
Abstract
A number of recent clinical trials have promoted the use of probiotic bacteria as a treatment for irritable bowel syndrome (IBS). The recent demonstration of abnormal colonic fermentation in some patients with this condition provides an opportunity for the objective assessment of the therapeutic value of these bacteria. This study was designed to investigate the effects of Lactobacillus plantarum 299V on colonic fermentation. We conducted a double-blind, placebo-controlled, cross-over, four-week trial of Lactobacillus plantarum 299V in 12 previously untreated patients with IBS. Symptoms were assessed daily by a validated composite score and fermentation by 24-hr indirect calorimetry in a 1.4-m3 canopy followed by breath hydrogen determination for 3 hr after 20 ml of lactulose. On placebo, the median symptom score was 8.5 [6.25-11.25 interquartile range (IQR)], the median maximum rate of gas production was 0.55 ml/min (0.4-1.1 IQR), and the median hydrogen production was 189.7 ml/24 hr (118.3-291.1 IQR). On Lactobacillus plantarum 299V the median symptom score was 8 (6.75-13.5 IQR), the median maximum rate of gas production 0.92 ml/min (0.45-1.5 IQR), and the median hydrogen production 208.2 ml/24 hr (146-350.9 IQR). There was no significant difference. Breath hydrogen excretion after lactulose was reduced by the probiotic (median at 120 min, 6 ppm; placebo, 17 ppm; P = 0.019). In conclusion, Lactobacillus plantarum 299V in this study did not appear to alter colonic fermentati…
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Two studies reported no difference between specific probiotic treatments and placebo, and one study reported a significant worsening of diarrhoea with the specific probiotic treatment compared with placebo.
“Two studies reported no difference between specific probiotic treatments and placebo,28–37 and one study reported a significant worsening of diarrhoea with the specific probiotic treatment compared with placebo.59”
From Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice - an evidence-based international guide (2013) · cites this paper as [30]
Twelve studies evaluated abdominal pain as a secondary end point only, with mixed results: one reported a negative effect, eight reported no significant effect, and three reported a significant beneficial effect.
“Twelve studies evaluated abdominal pain as a secondary end point only. Results from these studies were mixed: one reported a negative effect of the specific probiotic treatment,59 eight (examining six different probiotics) reported no significant effect28–38 and three reported a significant beneficial effect of three different probiotics35,39”
From Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice - an evidence-based international guide (2013) · cites this paper as [30]
All three studies that examined flatus as a primary end point, and four of seven studies in which flatus was a secondary end point only, showed no significant difference between seven specific probiotic treatments and control.
“all three studies that examined flatus as a primary end point,30,57 and four of seven studies in which flatus was a secondary end point only,28–38 showed no significant difference between seven specific probiotic treatments and control.”
From Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice - an evidence-based international guide (2013) · cites this paper as [30]
Probiotics tested to date do not help reduce flatus in patients with IBS, with low grade of evidence.
“Probiotics tested to date do not help reduce flatus in patients with IBS Low [147,149-150,156,168,174-175, 178-179,184]”
From Gut microbiota role in irritable bowel syndrome: New therapeutic strategies (2016) · cites this paper as [178]
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Quigley, E. M. M. (2011) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2010.12.009 · Cited by 67
Bacterial flora in irritable bowel syndrome: role in pathophysiology, implications for management
Quigley, E. M. M. (2007) · Journal of Digestive Diseases · doi:10.1111/j.1443-9573.2007.00277.x · Cited by 67
Bonfrate, L., Tack, J. F., Grattagliano, I., Cuomo, R., & Portincasa, P. (2013) · Scandinavian Journal of Gastroenterology · doi:10.3109/00365521.2013.799220 · Cited by 69
Probiotics as Therapy in Gastroenterology
Williams, M. D., Ha, C. Y., & Ciorba, M. A. (2010) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0b013e3181d47f5b · Cited by 69
Treatment of irritable bowel syndrome with probiotics: An etiopathogenic approach at last?
Jiménez, M. B. (2009) · Revista Española de Enfermedades Digestivas · doi:10.4321/s1130-01082009000800006 · Cited by 69
Tansel, A., & Levinthal, D. J. (2023) · Clinical and Translational Gastroenterology · doi:10.14309/ctg.0000000000000567 · Cited by 65
Huertas‐Ceballos, A., Logan, S., Bennett, C., & Macarthur, C. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003019.pub3 · Cited by 66
RetractedSerotonergic and non‐serotonergic targets in the pharmacotherapy of visceral hypersensitivity
Bueno, L., De Ponti, F., Fried, M., Kullak‐ublick, G. A., Kwiatek, M. A., Pohl, D., Quigley, E. M. M., Tack, J., & Talley, N. J. (2007) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2006.00876.x · Cited by 64
The Role of Food Intolerance in Irritable Bowel Syndrome
Lea, R., & Whorwell, P. J. (2005) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2005.02.005 · Cited by 63
(2018) · Advances in Environmental Biology · doi:10.22587/aeb.2018.12.1.4 · Cited by 65
Probiotics Used in Human Studies
Montrose, D. C., & Floch, M. H. (2005) · Journal of Clinical Gastroenterology · doi:10.1097/01.mcg.0000165649.32371.71 · Cited by 60
Qvirist, L., Filippo, C. D., Strati, F., Stefanini, I., Sordo, M., Andlid, T. A., Felis, G. E., Mattarelli, P., & Cavalieri, D. (2016) · Frontiers in Microbiology · doi:10.3389/fmicb.2016.01690 · Cited by 59
Walker, W. A., Goulet, O., Morelli, L., & Antoine, J. (2006) · European Journal of Nutrition · doi:10.1007/s00394-006-1101-1 · Cited by 59
Actual concept of "probiotics": Is it more functional to science or business?
Caselli, M. (2013) · World Journal of Gastroenterology · doi:10.3748/wjg.v19.i10.1527 · Cited by 59
Treating irritable bowel syndrome with probiotics: the evidence
Parkes, G. C., Sanderson, J. D., & Whelan, K. (2010) · Proceedings of The Nutrition Society · doi:10.1017/s002966511000011x · Cited by 57
Gut Microbiota, Probiotics, and Human Health
Suvorov, A. N. (2013) · Bioscience of Microbiota Food and Health · doi:10.12938/bmfh.32.81 · Cited by 55
Update on Irritable Bowel Syndrome and Gender Differences
Heitkemper, M. M., & Jarrett, M. E. (2008) · Nutrition in Clinical Practice · doi:10.1177/0884533608318672 · Cited by 56
The Effect of Oral α-Galactosidase on Intestinal Gas Production and Gas-Related Symptoms
Stefano, M. D., Miceli, E., Gotti, S., Missanelli, A., Mazzocchi, S., & Corazza, G. R. (2006) · Digestive Diseases and Sciences · doi:10.1007/s10620-006-9296-9 · Cited by 55
Arebi, N., Gurmany, S., Bullas, D. C., Hobson, A. R., Stagg, A. J., & Kamm, M. A. (2008) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2008.03801.x · Cited by 53
Use of Diet and Probiotic Therapy in the Irritable Bowel Syndrome: Analysis of the Literature
Floch, M. H. (2005) · Journal of Clinical Gastroenterology · doi:10.1097/01.mcg.0000156104.67505.5b · Cited by 52
Verdu, E. F., & Collins, S. M. (2004) · Best Practice & Research Clinical Gastroenterology · doi:10.1016/j.bpg.2003.11.003 · Cited by 52
Gastrointestinal Microflora: Probiotics
Kolida, S., Saulnier, D. M. A., & Gibson, G. R. (2006) · Advances in applied microbiology · doi:10.1016/s0065-2164(06)59007-0 · Cited by 51
Ludidi, S., Jonkers, D. M. A. E., Koning, C. J., Kruimel, J. W., Mulder, L. H. C., der Vaart, I. B.-V., Conchillo, J. M., & Masclee, A. (2014) · Neurogastroenterology & Motility · doi:10.1111/nmo.12320 · Cited by 51
Aljohani, A., Rashwan, N., Vasani, S., AlKhawashki, A. M., Wu, T. T., Lu, X., Castillo, D. A., & Xiao, J. (2024) · Probiotics and Antimicrobial Proteins · doi:10.1007/s12602-024-10287-3 · Cited by 52
Probiotics, Prebiotics, and Synbiotics in the Irritable Bowel Syndrome Treatment: A Review
Chlebicz-Wójcik, A., & Śliżewska, K. (2021) · Biomolecules · doi:10.3390/biom11081154 · Cited by 52
Clinical practice guidelines for irritable bowel syndrome in Korea, 2017 revised edition
Song, K. H., Jung, H.-K., Kim, H. J., Koo, H. S., Kwon, Y. H., Shin, H. D., Lim, H. C., Shin, J. E., Kim, S. E., Cho, D. H., et al. (2018) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm17145 · Cited by 47
Huertas‐Ceballos, A., Logan, S., Bennett, C., & Macarthur, C. (2008) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003019.pub2 · Cited by 49
RetractedShin, S. P., Choi, Y. M., Kim, W. H., Hong, S. P., Park, J.-M., Kim, J., Kwon, O., Lee, E. H., & Hahm, K. B. (2018) · Journal of Clinical Biochemistry and Nutrition · doi:10.3164/jcbn.17-73 · Cited by 46
Metadata
- Authors
- Sen, S., Mullan, M. M., Parker, T. J., Woolner, J. T., Tarry, S. A., & Hunter, J. O.
- Affiliations
- Addenbrooke's Hospital (GB)
- ORCID
- Parker, T.J.
- Venue
- Digestive Diseases and Sciences
- Published
- 2002-11
- Volume
- 47
- Issue
- 11
- Pages
- 2615-2620
- ISSN
- 0163-2116 (ISSN-L)
- 1573-2568
- OpenAlex
- W2059455849
- Cited by
- 245
- References
- 25
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 4 · 2020: 2 · 2019: 3 · 2018: 5 · 2017: 8 · 2016: 7 · 2015: 2 · 2014: 16 · 2013: 12 · 2012: 17
- FWCI
- 10.86
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Digestive Diseases and Sciences (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Lunds Universitet
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Keywords
- Lactobacillus plantarum 299v, irritable bowel syndrome, probiotics, colonic fermentation, breath hydrogen, lactulose breath test, gas production, IBS symptoms, indirect calorimetry
- MeSH terms
- Adult, Breath Tests, Calorimetry, Indirect, Colon, Colonic Diseases, Functional, Double-Blind Method, Female, Fermentation, Humans, Hydrogen, Lactobacillus, Male, Middle Aged, Avena, Cross-Over Studies, Probiotics
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