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Functional bowel disorders / Present in the treatment of IBS
Present in the treatment of IBS
These studies demonstrate that specific probiotics may target the neuromuscular apparatus and improve muscle function in postinfective-IBS. They may also affect neurotransmission and modulate visceral perception.]
O’Mahoney et al.((13)) suggested that the mechanism by which probiotics may produce their beneficial effects is immune modulated by normalizing the ratio of antiinflammatory to proinflammatory cytokines.
Probiotics may also be useful in patients with abnormal fermentation due to altered flora((14)).
Pain is a cardinal symptom in IBS, and visceral hypersensitivity is believed to underlie this symptom.
There is some evidence that specific probiotics may modulate neurotransmission in the gut. The administration of Saccaromyces boulardii to pigs has been shown to modulate the expression of neuronal markers in the submucous plexus((15)). The administration of L. paracasei NCC2461 attenuates the visceral hypersensitivity and sensory neurotransmitter expression associated with antibiotic administration((16)).
The majority of conventional IBS treatments currently used are empiric. Therapies may include dietary modification, fibre consumption for constipation, antidiarrhoeals, smooth muscle relaxants for pain, and psychotropical agents.Psychological treatments (e.g., relaxation techniques) have also been used for IBS.
From a theoretical point of view, treatment for IBS should address the three main pathophysiologically relevant factors: psychosocial disturbances, visceral hypersensitivity and dysmotility.
There are a growing number of studies evaluating the efficacy of probiotics in IBS. The beneficial effect of probiotics appears to be dependent on the particular strain. Probiotics may target one or more pathophysiological pathways in IBS, and specific probiotics with more than one mechanism of action may prove to be an attractive ‘natural’ approach compared with conventional drug therapy for patients with IBS.
Until recently, the neuromuscular apparatus was not considered as a possible target for probiotic therapy, presumably because of its distance from the lumen.
Of five different probiotic species tested, only L. paracasei was able to significantly attenuate muscle dysfunction in the model of Trichinella spiralis-induced IBS. The beneficial effect was observed even when the probiotic was administered long after resolution of the initial infection((11)).
This was the first study to demonstrate the differential effects of probiotic strains on neuromuscular function in a model of postinfective-IBS. L. paracasei significantly improved postinfective dysmotility in vivo, as assessed by video fluoroscopy and image analysis. Oral administration of spent culture medium from L. paracasei, devoid of live bacteria, also improved postinfective dysmotility ((12)).
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