A cocktail of antibiotics, probiotics and prebiotics shows results in irritable bowel syndrome

Personalized ‘cocktails’ of antibiotics, probiotics and prebiotics show great promise in treating a common form of irritable bowel syndrome (IBS), as will be presented at the ESCMID (formerly ECCMID) Global Congress in Barcelona, ​​Spain (27-30 of April). The main researcher, Professor Maurizio Sanguinetti, from the Università Cattolica del Sacro Cuore, Rome, Italy, says: ‘Estimates vary, but research indicates that approximately 10 to 30% of people who experience acute gastroenteritis develop PI-IBS. Symptoms such as diarrhea, constipation, bloating, and abdominal pain can persist for months or even years after the initial infection. It is worth remembering post-infection IBS (PI-IBS) It is a form of irritable bowel syndrome which occurs after gastroenteritis or food poisoning. ‘Treatment focuses on controlling symptoms and improving quality of life. It usually involves a combination of dietary modifications, lifestyle changes, antidiarrheal medications, probiotics and other medications, and psychological therapies, such as cognitive behavioral therapy. But symptoms can vary widely between individuals and may not always respond to conventional therapies, meaning they can be challenging to treat. Since gastroenteritis can alter the intestinal microbiota, Restoration of a healthy microbiota is a possible avenue of treatment‘, points out the specialist. To investigate its potential, Professor Sanguinetti and his colleagues conducted a pilot study in which 13 PI-IBS patients (8 men and 5 women; mean age, 31 years) were treated with a therapy targeting the gut microbiota. Nine of the patients (69.2%) had diarrhea-predominant IBS (IBS-D) and 4 (30.8%) constipation-predominant IBS (IBS-E). Bloating and abdominal pain were present in 69.2% (9/13) and 76.9% (10/13) of patients, respectively.

Analysis of the intestinal microbiota

First, the patient’s intestinal microbiota was analyzed. Genetic profiling was used to identify the bacteria present in the fecal samples and, therefore, in the intestine. Also The abundance of different types of bacteria was measured. 23% (3/13) of patients had a lower than expected bacterial diversity. Likewise, 23% (3/13) had high levels of Proteobacteria. These are pro-inflammatory bacteria and an increase in their number could make PI-IBS worse. 61.5% (8/13) had low levels of Akkermansia, a ‘protective’ bacteria, and 69% (9/13) had low levels of Bifidobacterium, another ‘protective’ microbe. 38.5% (5/13) of patients had low levels of Firmicutes and 54% (7/13) had low levels of short-chain fatty acid-producing bacteria, which are also protective. Then, A personalized therapy was designed for each patient, based on your results, with the aim of rebalancing your intestinal microbiota. These consisted of short courses of antibiotics rifaximin (9/13, 69% of patients) or paromomycin (4/13, 31%) to reduce levels of potentially harmful bacteria, followed by prebiotics and/or postbiotics to improve the number of protective agents. bacteria and compete with harmful bacteria for space and resources. Prebiotics were inulin and psyllium (9/13; 69%), probiotics were Bifidobacterium (5/13; 38.5%), Lactobacillus (7/13; 54%), Escherichia coli Nissle 1917 (2/13; 15). %) and based on multiple species (5/13; 38.5%). Symptoms such as abdominal pain, bloating, constipation, and diarrhea were assessed using the gastrointestinal symptoms rating scale (GSRS). Twelve weeks after the start of treatment, 93% (12/13) of patients experienced symptom improvement and 38.5% (5/13) achieved complete remission. Professor Sanguinetti says: ‘A precision medicine approach, in which testing and Careful analysis of the intestinal microbiota allows the development of personalized treatments, It is very promising in the treatment of post-infection IBS.