肠胃道易激综合症 肠胃道易激综合症 (IBS)(IBS)对食物的过敏对食物的过敏

及及饮食控制饮食控制黄光明医生副顾问国大医院

黄光明医生副顾问国大医院

Gut Bacteria and the Irritable Bowel Syndrome

What is Irritable Bowel Syndrome?• Abdominal pain• Bloating• Constipation • Diarrhoea

• Eructation • Flatulence • ‘Gastric’

The Role of Microbes in IBS

• Post-infectious IBS

• Small intestinal bacterial overgrowth

• Effect of antibiotics on IBS symptoms

• Probiotic treatment for IBS

IBS can develop after Infection

• Salmonella

• Campylobacter

• Shigella

The risk is as high as 12x more than people without infection

Small Intestinal Bacterial Small Intestinal Bacterial OvergrowthOvergrowth

Colonic Fermentation

Antibiotics, good or bad?

• Antibiotic treatment may improve IBS symptoms if bacterial overgrowth is present

• But, IBS may also develop in some patients after receiving antibiotics for other infections

Protective effect of gut bacteria

How to achieve a balance between good and bad bacteria?

What are probiotics?

• Greek: ‘for life’

• Live organisms that, when ingested in adequate amounts, exert a health benefit on the host

• Eg Lactobacilli, Bifidobacteria, Saccharomyces boulardii

Effect of probiotics on the intestine

• Reduce amount of harmful bacteria

• Control inflammation

• Alter the intestinal movements

• Reduce gas production

Which probiotics to use?

Probiotics (Lactobacillus) in IBS

Organism Study n Outcome

L plantarum Noback 2000 60 ↓flatus, pain

L plantarum Niedzielin 2001 20 ↓pain

L plantarum Sen 2002 12 ↓bloating

L GG O’Sullivan 2000 25 Negative

L GG Bausserman 2005 50 ↓distension

L reuterii Niv 2005 54 Negative

Probiotics (others) in IBS

Organism Study n Outcome

VSL#3 Kim 2003 25 ↓bloating

VSL#3 Kim 2005 48 ↓flatus

B infantis O’Mahony 2005 77 ↓all symptoms

B infantis Whorwell 2006 362 ↓all symptoms

VSL#3 = Streptococcus thermophilus, Lactobacillus spp, Bifidobacteria spp

Bifidobacterium infantis

Conclusions• IBS is a common condition that can severely affect a

person’s quality of life.

• Probiotic organisms may be useful in the treatment of IBS.

• However, the benefits in IBS are brought about by some but not all probiotic organisms.

• Different probiotic organisms have different effects; Some may have opposite effects on the intestines.