Blackmores Institute

While research into the aetiology of IBS continues, several hypotheses connect symptoms with:<ul><li>Changes to the intestinal mucosal environment leading to an immune response to the hosts’ microbiota</li><li>Changes to the microbiota with an increase in gas production</li><li>Alterations to bile acid conjugation changing the water and electrolyte composition within the intestines caused by an imbalanced microbiota</li><li>Enteric neuromuscular changes and alterations to the brain-gut axis.1 <h3>Pharmacological approaches to IBS</h3> To date, the pharmacological approach to IBS has centred around the use of anti-diarrhoeal, laxatives, antispasmodics and antacid medications to alleviate symptoms.1 While this approach may provide temporary symptomatic relief, for most, symptoms return with the cessation of treatment, or at a point when they no longer respond to the interventions, leaving many to live with symptoms and a reduced quality of life. <h3>Hope for IBS patients</h3> <h3>An imbalanced microbiome is central to many hypotheses for the aetiology for IBS, for which the use of probiotics has garnered attention, with studies identifying reduced numbers of Lactobacillus and Bifidobacterium in the microbiota of IBS patients.1</h3> Research on one multi-strain probiotic – LAB4 - has been found to address the reduction in Lactobacillus and Bifidobacterium in IBS patients. LAB4 is a lactic acid bacteria, multi-strain probiotic comprising the following bacterial strains: </li><li>Lactobacillus acidophilus – CUL 60</li><li>Lactobacillus acidophilus – CUL 21</li><li>Bifidobacterium bifidum – CUL 20</li><li>Bifidobacterium animalis subsp. lactis – CUL342</li></ul> Research has shown that multistrain probiotics have an increased efficacy, with generally a higher total concentration of bacteria when compared to single-strain probiotics.3 The constellation of probiotics found in LAB4 can survive both the stomach, at a pH of 2.5 for up to 90 minutes, and bile acid based on the genomic profile of the bacteria, allowing the probiotic to transit through the stomach and into the intestines intact.4 Imperative to transient colonisation of the gastrointestinal microbiome, LAB4 has the genetic capacity to adhere the the epithelium and form a biofilm, essential features of a probiotic to allow for extended exposure and interaction with the human host.4 <h3>LAB4 and IBS</h3>A double-blind placebo-controlled 10-week study assessed the efficacy of LAB4 for the management of IBS symptoms, with outcomes based on participant IBS Symptom Severity Scores during the intervention.1 Those within the probiotic treatment arm demonstrated significant improvements to their IBS Symptom Severity Score, with improvement to quality of life associated with improvements to bowel habits and a reduction to the number of pain days recorded.1Other studies using LAB4 for the treatment for IBS demonstrated its potential for immunomodulatory benefits with an increase in the anti-inflammatory cytokines IL-10 and TGF-β and a reduction in pro-inflammatory cytokines IL-1β and IL-6.1Symptomatic improvement observed in clinical trials with patients living with irritable bowel syndrome demonstrate LAB4’s ability to reduce inflammation,4 improve bowel habits and reduce pain experienced associated with IBS.1While more research is needed on the use of probiotics for IBS symptoms, these studies provide IBS patients and practitioners with the confidence in the therapeutic benefit of LAB4 for IBS. <h3>References</h3>Williams, E. A., Stimpson, J., Wang, D., Plummer, S., Garaiova, I., Barker, M. E., &amp; Corfe, B. M. (2009). Clinical trial: A multistrain probiotic preparation significantly reduces symptoms of irritable bowel syndrome in a double-blind placebo-controlled study. Alimentary Pharmacology and Therapeutics, 29(1), 97–103. <a href="https://doi.org/10.1111/j.1365-2036.2008.03848.x" target="_blank">https://doi.org/10.1111/j.1365-2036.2008.03848.x</a>About lab4 by Cultech - #1 manufacturer and supplier (2023) Lab4 Probiotics. Available at: https://lab4probiotics.co.uk/about-lab4 (Accessed: March 6, 2023).Hepburn, N. J., Garaiova, I., Williams, E. A., Michael, D. R., &amp; Plummer, S. (2013). Probiotic supplement consumption alters cytokine production from peripheral blood mononuclear cells: A preliminary study using healthy individuals. Beneficial Microbes, 4(4), 313–318. <a href="https://doi.org/10.3920/BM2013.0012" target="_blank">https://doi.org/10.3920/BM2013.0012</a>Baker, L. M., Webberley, T. S., Masetti, G., Hughes, T. R., Marchesi, J. R., Jack, A. A., Joyce, T. S. C., Allen, M. D., Plummer, S. F., Michael, D. R., Ramanathan, G., del Sol, R., &amp; Facey, P. D. (2021). A genome guided evaluation of the Lab4 probiotic consortium. Genomics, 113(6), 4028–4038. <a href="https://doi.org/10.1016/j.ygeno.2021.08.007" target="_blank">https://doi.org/10.1016/j.ygeno.2021.08.007</a>

Irritable bowel syndrome (IBS) is a chronic relapsing gastrointestinal condition that plagues patients with symptoms of gastrointestinal bloating, cramping, abdominal pain and altered bowel motions.1 Symptoms of IBS can lead to a reduced quality of life and social challenges for the patient as a result of the unpredictability of the condition.1 In this article we look at the role of multi-strain probiotics in IBS.

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