A synbiotic mixture improves flatulence in irritable bowel syndrome

OP186 A SYNBIOTIC MIXTURE IMPROVES FLATULENCE IN IRRITABLE BOWEL SYNDROME C. Cappello1, F. Tremolaterra1, A. Pascariello1, T. Niglio2, C. Ciacci3, P. Iovino1. 1Endoscopia Digestiva, Dipartimento Chirurgia Gen, Federico II University, Naples, 2SIDBAE-Settore Informatico, Istituto Superiore di Sanit`a, 3Gastroenterologia- Dipartimento di Medicina Sperimentale, Federico II University, Naples, Naples, Italy INTRODUCTION/OBJECTIVES: Recent data suggest that the intestinal microbiota play a role in the pathogenesis of irritable bowel syndrome (IBS) Probiotic studies in IBS generated inconsistent results suggesting a strain and product specific effect. Better results can possibly be achieved by combining probiotics with prebiotics, i.e. synbiotics. AIMS & METHODS: The aim of this study was to investigate the clinical efficacy of a commercially available synbiotic mixture which contains high concentrations of a wide range of bacteria (5×109 Lactobacillus plantarum, 2×109 L. reuterii, 2×109 L. casei subsp.rhamnosus, 2×109 Bifidobacterium infantis and B. longum, 1×109 L. salivarius, 1×109 L. acidophilus, 5×109 Streptococcus termophilus, and 1×109 L. sporogenes (Lactobacillaceae) as well as inuline as a prebiotic in patients with Rome III IBS. Methods: A double-blind, randomized placebo-control clinical trial of the synbiotic mixture (5 g BID) vs. placebo over 4-weeks after a 2 weeks run-in. Primary endpoints: global satisfactory relief of abdominal flatulence and bloating. Patients who reported at least 50% of the weeks of treatment with satisfactory relief were designated as responders. Secondary endpoints: Change in GI symptoms (abdominal bloating, flatulence, pain and urgency) on 100mm of VAS scales, in stool frequency and bowel functions on validated adjectival scales (Bristol scale, ease of passage scale and sense of incomplete evacuation) and in quality of life (SF36). Pre- and post-treatment total and segmental colonic transit time was assessed according to Metcalf et al. A strict exclusion of concomitant medications that could interfere with the study was requested. RESULTS: Sixty-four IBS patients (synbiotic n = 32, 64% females, mean age 38.7±12.6 years) completed the treatment period. Treatment with the synbiotic was associated with reduced flatulence over the entire treatment period (ANCOVA, p<0.05). Proportions of responders for satisfactory relief of flatulence and bloating were not significantly different between synbiotic group and placebo group. No other significantly differences were disclosed in any endpoints. Moreover, there were no significant differences in total and segmental colonic transit measurements and in quality of life between groups. CONCLUSION: This synbiotic mixture of wide range of bacteria as well as inuline as a prebiotic improves flatulence score in patients with IBS. This data supports the role of intestinal bacteria in the pathophysiology of IBS and the role for this symbiotic mixture in the management of these disorders. Disclosure of Interest: None Declared Gut 2010; 59 (Suppl III) A42