Excerpt:

A possible cause of irritable bowel syndrome has been traced to a small piece of RNA that blocks a substance protecting the colon membrane, leading to hostile conditions that can produce diarrhea, bloating and chronic abdominal pain.

New research shows that this RNA segment sends signals that stop the activity of the gene that produces glutamine, an amino acid. Previous research has linked a shortage of glutamine in the gut with the seepage of toxins and bacteria through the intestinal wall, irritating nerves and creating disease symptoms.

Scientists say that trying to generate glutamine in the disordered bowel by silencing this RNA segment could open up a whole new way of thinking about treating the diarrhea-predominant type of irritable bowel syndrome (IBS). In the meantime, they are making plans to conduct a clinical trial to see if glutamine supplements could also reduce common IBS symptoms

This form of the disorder is characterized by diarrhea and bloating as well as chronic abdominal pain that is difficult to treat. About a third of IBS patients have the diarrhea-predominant type, another third experience consistent constipation, and the rest experience alternating bouts of diarrhea and constipation.

Regards, Linda

http://www.nutraingredients.com/Research/Probiotic-research-needed-to-fulfill-gut-health-potential

By Guy Montague-Jones, 02-Dec-2009

Related topics: Probiotics, Research, Probiotics and prebiotics, Gut health

Probiotics should be considered as living drugs rather than “simple good bacteria” in order to become effective treatment options for IBS, according to Joseph Haddad, medical director of Institut Rosell-Lallemand.

Following a recent seminar on probiotics and Irritable Bowel Syndrome (IBS), hosted by Institut Rosell in London ahead of Gastro 2009, Haddad gave NutraIngredients.com a progress report.

Delegates at the seminar, which focused on the potential of the Lactobacillus plantarum 299v strain, were agreed on the potential of probiotics to treat IBS, but acknowledged that more work is needed to develop effective treatment strategies.

Probiotic potential

Haddad said a lot of scientific work has been done on the therapeutic potential of some specific strains. This work, Haddad, said: “Is now starting to draw a lot of interest from the medical community, which is very promising.”

The medical attraction of adapted probiotics is that unlike traditional drugs, they may not only treat the symptoms of IBS, but also the cause.

However, the development of a consensus on treatment strategies is still some way off.

Haddad said consensus building is a very long process, beginning with initial clinical evidence that is then reviewed and discussed by the specialist community, who ask for more clinical evidence. And finally, after many years, a consensus can emerge and some common guideline scan be defined.

“Many probiotics are not even at the first stage of this process,” said Haddad. When it comes to IBS, he identified three areas where more work is needed.

1. All IBS mechanisms are not completely elucidated yet.

2. Not all probiotics have the same therapeutic potential so it is very difficult to determine the perfect bacteria for IBS.

3. Even though probiotics have been known and used for a very long time, a therapeutic approach with probiotics is still considered innovative in the medical community.

Recommendations

To help build a treatment consensus, Haddad said more in vivo clinical trials are needed in order to validate in vitro data. This will allow those promising strains that are most effective in alleviating abdominal pain and discomfort to be recognised as truly efficient.

As for the probiotics industry, Haddad said it needs to invest more in R&D and state-of-the-art clinical trials to find out and support the most efficient strains. He said: “Some companies are already well positioned, but overall a lot of investment is still required.

“The challenge is really to demonstrate that the industry is not dealing with ‘simple good bacteria’ but that probiotics should be considered as living drugs, backed up by strong clinical evidence.”

Posted: 02/12/2009

Case 1

Mr. X is a healthy, active 33-year-old man who travels frequently for his job as a sales representative. He has a history of 1 depressive episode, which occurred at age 24 when he was attending graduate school. He was treated over a 6-month period with a selective serotonin reuptake inhibitor (SSRI), and he has not had a recurrence since. In his late 20s, he was diagnosed with constipation-predominant irritable bowel syndrome (IBS). Until recently, he was able to control his symptoms by carefully managing his diet, which he did by maintaining a high fiber intake and by avoiding foods that trigger his symptoms. His workup at the time of diagnosis by a gastroenterologist included colonoscopy and other laboratory tests to exclude other bowel pathology.

Over the past year, the IBS has increased in severity, resulting in cyclical constipation and associated abdominal spasms every 3 to 6 weeks. The IBS has begun to interfere with his work productivity, because he must take time off every few months. He has tried lactulose as a laxative, and he has increased his bran fiber intake, but there has been no improvement.

He is seeking control of his symptoms, but he prefers to try dietary measures before resorting to medications. He has no symptoms of depression and no recent major life stressors, other than a heavy workload. There are no bowel symptoms suggestive of peptic ulcer disease. Similarly, there are no “red flags” or systemic symptoms, such as weight loss, that would suggest the presence of other chronic diseases.

The physical examination reveals a healthy, young man with a body mass index of 26. The cardiovascular and respiratory examinations are normal. The abdominal examination, on deep palpation, reveals slight tenderness over the large bowel, mild distension, and an absence of masses. The rectal examination is normal, and test results for occult fecal blood are negative. The mental status examination is normal, and the constipation and associated abdominal spasms within normal limits.

What are some options for improving his symptoms?

Case 2
Mrs. Y is a 44-year-old woman with diarrhea-predominant IBS that was diagnosed a year ago after she underwent a complete gastroenterologic workup to exclude other pathologies. Her symptoms are persistent, and this causes her inconvenience at work, limits her social activities, and affects her ability to perform daily functions. Because of her IBS, she leads a sedentary lifestyle.

She has tried an anxiolytic for the abdominal pain and loperamide for the diarrhea, but the abdominal distension, bloating, and painful spasms continue. She takes fiber in various forms, including Metamucil® and wheat bran, but the fiber supplements do not seem to control the diarrhea. She admits that life is stressful and has been in counseling for a few months.

What else can she try to better control her IBS symptoms?