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FYIwith Permission from the UNC"ASK THE EXPERT � PROBIOTIC BACTERIA IN PATIENTS WITH IBSDR. Y. RINGELQUESTION:Is there a clinical use for Probiotic Bacteria in Patients with IBS?ANSWER:probiotics are live micro-organisms (bacteria) which, upon ingestion, benefit the hostbeyond their inherent general nutrition. The most studied organisms in the treatment ofhuman intestinal diseases are the lcatobacilli (L. GG, L. plantarum, and L. acidophilus), andbifidobactreia (B. infantis). The apparent success of probiotics in several intestinal disorders-- including chronic inflammatory bowel diseases (IBD), childhood diarrhea (rotavirusinfection), and travelers diarrhea -- has led to increased interest in their use in patients withIBS. Data on the use of probiotics in IBS is still very limited and the results are not consistent.However, some of the studies show encouraging results and suggest clinical symptomaticresponse and parallel improvement in quality of life. For example, Nobaek et al reported adecrease in abdominal pain and bloating in patients with IBS that were treated withlactobacillus plantarum, and a more recent study by Kim et al reported decrease in bloating,but no effect on pain or gut transit, in IBS patients with diarrhea that were treated with VSL#3(a probiotic composite containing multiple bacterial strains).Probiotics are regarded as �diet supplements�. They are provided in the format of capsules,tablets, gel caps, and liquids. They fall under the US Food and Drug Administration (FDA)special categories of dietary supplements (1995) and, therefore, are under FDA jurisdictionregarding their safety, labeling, and health statements.The growing interest in the potential health benefits of cretin diets and nutritional foodsupplements has lead to a significant increase in the availability and marketing of theseproducts. However, despite some preliminary encouraging results, current data do notallow a definitive conclusion or recommendation regarding the use of probiotics in IBS. Onlya few clinical studies have been preformed, most of them have involved only a smallnumber of treated subjects, and they differ in terms of bacterial strains and doses. Muchlarger double-blind, placebo-controlled studies are required. Until such studies areperformed, the use of probiotics in the treatment of IBS should be considered speculativeand experimental.Dr. Y. Ringel, is an Assistant Professor of Medicine in the Department of Medicine, Division ofGastroenterology and Hepatology, UNC School of Medicine. He is also a member of the UNCCenter for Functional GI & Motility�s clinical services staff and coordinates the Functional GIConference."
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