Probiotische Behandlung des Reizdarmsyndroms

Zusammenfassung

Das Reizdarmsyndrom (RDS) zählt zu den häufigsten gastroenterologischen Krankheitsbildern mit einer Prävalenz in Deutschland von ca. 12 %, charakterisiert durch abdominelle Schmerzen oder Beschwerden, veränderte Stuhlfrequenz und -konsistenz, Meteorismus und Blähungen. Zwischen den verschiedenen Fachdisziplinen, die Patienten mit RDS sehen und behandeln (Hausärzte, Gastroenterologen, Psychosomatiker) besteht bislang keine Einigkeit über die klinische Definition. Metaanalysen von Therapiestudien beim RDS belegen den hohen Stellenwert der Probiotika bei diesem Krankheitsbild, insbesondere nachdem neuere Medikamentenentwicklungen den Markt nicht erreicht haben oder wieder vom Markt genommen worden sind. Neben der weltweiten aktuellen Studienlage zur Wirksamkeit von Probiotika auf Symptome des Reizdarmsyndroms werden hier drei klinische Studien aus Deutschland mit E.coli-Präparaten vorgestellt, die deren Wirksamkeit beim RDS im Kindes- und im Erwachsenenalter belegen.

Abstract

The irritable bowel syndrome (IBS) is among the most common disorders in gastroenterological practice with a prevalence of approx. 12 % in Germany, and it is characterized by abdominal pain or discomfort, altered stool frequency and consistency, and meteorism and bloating. There is currently no agreement between those seeing patients with IBS (general practitioner, gastroenterologist, psychosomatics) on the criteria for clinical diagnosis. Metaanalyses of treatment studies in IBS have shown that probiotics have a high clinical efficacy in IBS, especially since development of novel pharmaceutical compounds have not reached the market or have been withdrawn. In addition to the actual status of probiotic efficacy in IBS studies conducted worldwide, we present 3 German clinical studies with probiotic E.coli preparations that have proven their efficacy in IBS in adults and in children.

Schlüsselwörter

Probiotika - Reizdarmsyndrom - Review - Metaanalyse

Keywords

probiotics - irritable bowel syndrome - review - metaanalysis

Literatur

• 1 Bausserman M, Michail S. The use of Lactobacillus GG in irritable bowel syndrome in children: a double-blind randomized control trial.  J Pediatr. 2005;  147 197-201
• 2 Brenner D M, Moeller M J, Chey W D, Schoenfeld P S. The utility of probiotics in the treatment of irritable bowel syndrome: a systematic review.  Am J Gastroenterol. 2009;  104 1033-1049
• 3 Drouault-Holowacz S, Bieuvelet S, Burckel A. et al . A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome.  Gastroenterol Clin Biol. 2008;  32 147-152
• 4 Enck P, Martens U. Der nächste Konsensus zum Reizdarmsyndrom muss interdisziplinär sein.  Z Gastroenterol. 2008;  46 211-215
• 5 Enck P, Zimmermann K, Menke G, Klosterhalfen, S. Randomized controlled treatment trial of irritable bowel syndrome with a probiotic E.-coli preparation (DSM17252) compared to placebo.  Z Gastroenterol. 2009;  47 209-214
• 6 Enck P, Zimmermann K, Menke G. et al . A mixture of Escherichia coli (DSM 17252) and Enterococcus faecalis (DSM 16440) for treatment of the irritable bowel syndrome – a randomized controlled trial with primary care physicians.  Neurogastroenterol Motil. 2008;  20 1103-1109
• 7 Enck P, Junne F, Klosterhalfen S, Zipfel S, Martens U. Therapy options in irritable bowel syndrome.  Eur J Gastroenterol Hepatol. (in press); 
• 8 Food and Agriculture Organisation, World Health Organisation .Evaluation of health and nutritional properties of probiotics in food, including powder milk with live lactic acid bacteria.. FAO & WHO Expert Consultation Report; 2001
• 9 Ford A C, Talley N J, Spiegel B M. et al . Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis.  BMJ. 2008;  337 a2313
• 10 Ford A C, Talley N J, Schoenfeld P S, Quigley E M, Moayyedi P. Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis.  Gut. 2009;  58 367-378
• 11 Ford A C, Brandt L J, Young C, Chey W D, Foxx-Orenstein A E, Moayyedi P. Efficacy of 5-HT3 antagonists and 5-HT4 agonists in irritable bowel syndrome: systematic review and meta-analysis.  Am J Gastroenterol. 2009;  104 1831-1843
• 12 Fuller R. Probiotics in man and animals.  J Appl Bacteriol. 1989;  66 365-378
• 13 Gade J, Thorn P. Paraghurt for patients with Irritable Bowel Syndrome.  Scand J Prim Health Care. 1989;  7 23-26
• 14 Gawronska A, Dziechciarz P, Horvath A, Szajewska H. A randomized double-blind placebo-controlled trial of Lactobacillus GG for abdominal pain disorders in children.  Aliment Pharmacol Ther. 2007;  25 177-184
• 15 Guyonnet D, Chassany P, Ducrotte P. et al . Effect of a fermented milk containing Bifidobacterium animalis DN-173 010 on the health-related quality of life and symptoms in irritable bowel syndrome in adults in primary care: a multicentre, randomized, double-blind, controlled trial.  Aliment Pharmacol Ther. 2007;  26 475-486
• 16 Haller D, Antoine J M, Bengmark S. et al . Guidance for substantiating the evidence for beneficial effects of probiotics: probiotics in chronic inflammatory bowel disease and the functional disorder irritable bowel syndrome.  J Nutr. 2010;  140 690S-697S
• 17 Hoveyda N, Heneghan C, Mahtani K R. et al . A systematic review and meta-analysis: probiotics in the treatment of irritable bowel syndrome.  BMC Gastroenterol. 2009;  9 15
• 18 Isolauri E, Juntunen M, Rautanen T, Sillanaukee P, Koivula T. A human Lactobacillus strain (Lactobacillus casei sp strain GG) promotes recovery from acute diarrhea in children.  Pediatrics. 1991;  88 90-97
• 19 Isolauri E, Kaila M, Mykkänen H, Ling W H, Salminen S. Oral bacteriotherapy for viral gastroenteritis.  Dig Dis Sci. 1994;  39 2595-2600
• 20 Jadad A R, Moore R A, Carroll D. et al . Assessing the quality of reports of randomized clinical trials: Is blinding necessary?.  Controlled Clinical Trials. 1996;  17 1-12
• 21 Kajander K, Krogius-Kurikka L, Rinttila T. et al . Effects of multispecies probiotic supplementation on intestinal microbiota in irritable bowel syndrome.  Aliment Pharmacol Ther. 2007;  26 463-473
• 22 Kim H J, Camilleri M, McKinzie S. et al . A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome.  Aliment Pharmacol Ther. 2003;  17 895-904
• 23 Krammer H J, Kämper H, v Bünau R. et al . Probiotische Arzneimitteltherapie mit E.coli Stamm Nissle 1917 (EcN): Ergebnisse einer prospektiven Datenerhebung mit 3807 Patienten.  Z Gastroenterol. 2006;  44 651-656
• 24 Kruis W, Schütz E, Fric P, Fixa B, Judmaier G, Stolte M. Double-blind comparison of an oral Escherichia coli preparation and mesalazine in maintaining remission of ulcerative colitis.  Aliment Pharmacol Ther. 1997;  11 853-858
• 25 Longstreth G F, Thompson W G, Chey W D. et al . Functional bowel disorders.  Gastroenterology. 2006;  130 1480-1491
• 26 Manning A P, Thompson W G, Heaton K W, Morris A F. Towards positive diagnosis of the irritable bowel syndrome.  Brit Med J. 1978;  2 653-654
• 27 Martens U, Enck P, Zieseniss E. Probiotic treatment of irritable bowel syndrome in children.  Ger Med Sci. 2010;  8 Doc07
• 28 McFarland L V, Surawicz C M, Greenberg R N. et al . A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease.  JAMA. 1994;  271 1913-1918
• 29 McFarland L V, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome.  World J Gastroenterol. 2008;  14 2650-2661
• 30 McKernan D P, Fitzgerald P, Dinan T G, Cryan J F. The probiotic Bifidobacterium infantis 35624 displays visceral antinociceptive effects in the rat.  Neurogastroenterol Motil. 2010;  22 1029-1035
• 31 Metschnikoff I I. The prolongation of life – Optimistic studies.. Heidelberg: Springer; 2004 Erstauflage: G.P.Putham’s Sons, New York 1908
• 32 Moayyedi P, Ford A C, Talley N J. et al . The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review.  Gut. 2010;  59 325-332
• 33 Niedzielin K, Kordecki H, Birkenfeld B. A controlled, double-blind, randomized study on the efficacy of Lactobacillus plantarum 299V in patients with irritable bowel syndrome.  Eur J Gastroenterol Hepatol. 2001;  13 1143-1147
• 34 Nissle A. Über die Grundlagen einer neuen ursächlichen Bekämpfung der pathologischen Darmflora.  Dtsch Med Wochenschr. 1916;  42 1181-1184
• 35 Nobaek S, Johansson M L, Molin G, Ahrné S, Jeppsson B. Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome.  Am J Gastroenterol. 2000;  95 1231-1238
• 36 Oksanen P J, Salminen S, Saxelin M. et al . Prevention of travellers’ diarrhoea by Lactobacillus GG.  Ann Med. 1990;  22 53-56
• 37 O’Mahony L, McCarthy J, Kelly P. et al . Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles.  Gastroenterology. 2005;  128 541-551
• 38 Parker R B. Probiotics, the other half of the antibiotic story.  Anim Nutr Health. 1974;  29 4-8
• 39 Quartero A O, Meineche-Schmidt V, Muris J, Rubin G, de Wit N. Bulking agents, antispasmodic and antidepressant medication for the treatment of irritable bowel syndrome.  Cochrane Database Syst Rev. 2005 ;  (2) CD003460)
• 40 Rahimi R, Nikfar S, Rezaie A, Abdollahi M. Efficacy of tricyclic antidepressants in irritable bowel syndrome: a meta-analysis.  World J Gastroenterol. 2009;  15 1548-1553
• 41 Rolfe R D. The role of probiotic cultures in the control of gastrointestinal health.  J Nutr. 2000;  130 (Suppl) 396S-402S
• 42 Schulze J, Sonnenborn U, Ölschläger T, Kruis W. Probiotika. Mikroökologie, Mikrobiologie, Qualität, Sicherheit und gesundheitliche Effekte. Kap. 2.2: Die Entwicklung des probiotischen Konzeptes.. Stuttgart: Thieme; 2009
• 43 Simrén M, Ohman L, Olsson J. et al . Clinical trial: the effects of a fermented milk containing three probiotic bacteria in patients with irritable bowel syndrome – a randomized, double-blind, controlled study.  Aliment Pharmacol Ther. 2010;  31 218-227
• 44 Sinn D H, Song J H, Kim H J. et al . Therapeutic effect of Lactobacillus acidophilus-SDC 2012, 2013 in patients with irritable bowel syndrome.  Dig Dis Sci. 2008;  53 2714-2718
• 45 Surawicz C M, Elmer G W, Speelman P. et al . Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: a prospective study.  Gastroenterology. 1989;  96 981-988
• 46 Tsuchiya J, Barreto R, Okura R. et al . Single-blind follow up study on the effectiveness of a symbiotic preparation in irritable bowel syndrome.  Chin J Dig Dis. 2004;  5 169-174
• 47 Vandenplas Y, Benninga M. Probiotics and functional gastrointestinal disorders in children.  J Pediatr Gastroenterol Nutr. 2009;  48 (Suppl 2) S107-109
• 48 Van der Waaij D. The digestive tract in immunocompromised patients: importance of maintaining its resistance to colonization, especially in hospital-in-patients and those taking antibiotics.  Antonie van Leeuwenhoek. 1984;  50 745-761
• 49 Whorwell P J, Altringer L, Morel J. et al . Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome.  Am J Gastroenterol. 2006;  101 1581-1590
• 50 Wunderlich P F, Braun L, Fumagalli I. et al . Double-blind report on the efficacy of lactic acid-producing Enterococcus SF68 in the prevention of antibiotic-associated diarrhoea and in the treatment of acute diarrhoea.  J Int Med Res. 1989;  17 333-338
• 51 Zijdenbos I L, de Wit N J, van der Heijden G J, Rubin G, Quartero A O. Psychological treatments for the management of irritable bowel syndrome.  Cochrane Database Syst Rev. 2009 ;  (1) CD006442)