TREATMENT OF ABNORMAL GUT FLORA IMPROVES SYMPTOMS IN IBS PATIENTS USING IBS-QOL

Steven M Faber, MDFACG

PURPOSE: IBS is a common GI disorder without effective medical therapy. Little is known about the role of indigenous bacteria in the etiology of IBS. Studies suggest a subset of IBS pts. have imbalances in the types and colonization of indigenous gut flora and show improvement in symptoms of abdominal pain, gas, bloating, and bowel habits after supplementation with exogenous probiotic flora. The purpose of this study was to determine if changes in bowel ecology with probiotics and antimicrobials would improve symptoms in IBS patients.
METHODS: In an open labeled retrospective study in an outpatient clinic, 13 consecutive IBS pts diagnosed by ROME criteria were evaluated using the Irritable Bowel Syndrome Quality of Life questionnaire (IBS-QOL) validated instrument and the Symptom Frequency Index (SFI) before and 4-6 weeks after treatment. Ages ranged from (17-71) in 10F, 3M pts. All patients submitted stool for culture and received Lactobacillus acidophilus (NCFM strain), Bifidobacteria infantis and fructooligosaccharides (FOS) for one month. Cultures revealed a deficiency of Lactobacillus in (10/13) and bifidobacterium in (6/13) pts. Organisms identified included Citrobacter Freundi (3/13), Proteus Mirabilis (2/13), Klebsiella Pneumonia (2/13), Pseudomonas Aeuroginosa (1/13) and Candida species (6/13). Based on stool results (3) pts. received Dilucan (10 days) and (4) pts Cipro for (1 week).
RESULTS: The IBS-QOL total score averaged 60.2 at baseline, a range similar to the average scores for IBS patients reported in published studies. After treatment, average scores increased to 83.8 (significant at p<0.001.) signifying significant improved quality of life. The SFI at baseline averaged 41.8, similar to the 42.2 in the validation study. After treatment, all pts. experienced a decrease SFI with an average decrease of 21.5 (significant at p<0.001.)
CONCLUSIONS: A subset of IBS pts. appear to have an imbalanced gut flora including a deficiency of probiotics. This imbalance may also predispose to an overgrowth of pathogenic bacteria and yeast. Supplementation with Probiotics and treating culture positive growth of bacteria and yeast improved some of the most common IBS symptoms as measured by IBS-QOL validated instrument.