Personalized ‘cocktails’ of antibiotics, probiotics and prebiotics show promise in the treatment of IBS, according to a pilot study

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Personalized ‘cocktails’ of antibiotics, probiotics and prebiotics hold promise in treating a common form of irritable bowel syndrome (IBS), according to research presented at the ESCMID Global Congress (formerly ECCMID) in Barcelona, ​​Spain (April 27-30).

Post-infection IBS (PI-IBS) is a form of irritable bowel syndrome that occurs after gastroenteritis or food poisoning.

Lead researcher Professor Maurizio Sanguinetti, from the Università Cattolica del Sacro Cuore, Rome, Italy, said: “Estimates vary, but research suggests that around 10-30% 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.

“Treatment focuses on controlling symptoms and improving quality of life. It typically involves a combination of dietary changes, lifestyle changes, anti-diarrheal medications, probiotics and other medications, and psychological therapies, such as cognitive behavioral therapy .

“But symptoms can vary widely from person to person and may not always respond to conventional therapies, meaning it can be challenging to treat. Given that gastroenteritis can disrupt the gut microbiota, restoring a healthy microbiota a potential treatment option.”

To investigate its potential, Professor Sanguinetti and colleagues conducted a pilot study in which 13 PI-IBS patients (eight men and five women; mean age 31 years) were treated with targeted gut microbiota therapy.

Nine of the patients (69.2%) had diarrhea-dominant IBS (IBS-D) and four (30.8%) constipation-dominant IBS (IBS-C). Bloating and abdominal pain were present in 69.2% (9/13) and 76.9% (10/13) of patients, respectively.

First, the patient’s gut microbiota was analyzed. Genetic profiling was used to identify the bacteria present in fecal samples and therefore in the intestines. The density of the different types of bacteria was also measured.

Of the patients, 23% (3/13) had lower than expected bacterial diversity, while 23% (3/13) had high levels of Proteobacteria. These are pro-inflammatory bacteria and an increase in their numbers could worsen PI-IBS. A total of 61.5% (8/13) had low levels of Akkermansia, a “protective” bacterium, and 69% (9/13) had low levels of Bifidobacterium, another “protective” microbe.

About 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, both of which are also protective.

A personalized therapy was then designed for each patient, based on their results, with the aim of rebalancing the gut microbiota.

These consisted of short courses of the antibiotics rifaximin (9/13, 69% of patients) or paromomycin (4/13, 31%) to reduce the number of potentially harmful bacteria, followed by prebiotics and/or postbiotics to increase the number of protective increase bacteria. bacteria and compete with the harmful bacteria for space and resources.

The prebiotics were inulin and psyllium (9/13; 69%), the probiotics were Bifidobacterium (5/13; 38.5%), Lactobacillus (7/13; 54%), Escherichia coli Nissle 1917 (2/13; 15 %) and multi-species based (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 starting treatment, 93% (12/13) of patients experienced an improvement in symptoms and 38.5% (5/13) achieved a total remission.

Professor Sanguinetti says: “A precision medicine approach, where testing and careful analysis of the gut microbiota allows the development of personalized treatments, holds promise in the treatment of IBS after infection.

“Although rigorous larger-scale studies are needed to confirm these preliminary findings, this type of testing is likely to soon be widely used in the treatment of post-infection IBS and other similar conditions.”

Provided by the European Society of Clinical Microbiology and Infectious Diseases

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