Purpose of this study is to explore the effect of irritable bowel syndrome in relationship to body systems and evaluate the benefit of adding probiotic therapy to the treatment plan.
Methods:
One hundred thirty-three articles initially identified, of which 32 met the inclusion criteria. The selected articles included four Level I meta-analysis and systematic reviews of Randomized Control Trials (RCT) totaling 144 studies, seven Level II RCTs totaling 992 patients, and one Level IV, an observational study.
Results:
Irritable bowel syndrome (IBS) is one of the most common gastroenterological diseases affecting 15-20 % of the Western population, and disturbance in the gastrointestinal microbiota may be implicated, according to Urgesi, Casale, Pistelli, Rapaccini, & de Vitis (2014). Diagnostic criteria utilized by physicians and clinics effect the variance in prevalence, as the looser the criteria, the higher the prevalence. The criteria may be reported utilizing the Rome II, Rome III, Manning, or other criteria. Irritable bowel syndrome is a chronic gastrointestinal disorder that effects a large percent of the population, and is costly to the medical profession and the business world (Zhang et al., 2016).
Irritable bowel syndrome is a gastrointestinal condition characterized by abdominal pain or discomfort and other various types of symptoms, which vary in type and severity including bloating, and alterations of bowel function, singularly or in any combination (Park, Byung-Hee, & Hyangsook, 2013). According to Ford et al. (2014), evidence suggests visceral hypersensitivity, disturbances in gastrointestinal (GI) flora, and chronic activation leading to a low-grade mucosal inflammation have an effect on intestinal flora. Faghihi, Agah, Masoudi, Ghafoori, & Eshraghi (2015) reported changes in the microflora of the intestine, such as recent intestinal illnesses, have been a significant factor in the search for pathogenesis of the illness. Sisson, Ayis, Sherwood, & Bjarnason (2014) shared that extra-intestinal symptoms include genitourinary, musculoskeletal (fibromyalgia, arthralgia, backache), headaches and fatigue, menstrual and sexual dysfunction, and anxiety and mood disorders are frequently present.
Traditional treatments have not been effective for long-term benefit and use of alternative therapy is increasing as patients seek answers and relief from the symptoms. Choi et al. (2015) indicated irritable bowel syndrome affects a patient physically, and may have social, mental and emotional ramifications resulting in a disruption in the quality of life for many patients. Research by Begtrup, de Muckadell, Kjeldsen, Christensen, & Jarbol (2013) suggested improving IBS symptoms may positively affect a patient’s quality of life.
In 2001, the Food and Agriculture Organization of the United Nations (FAO) convened a multinational expert group of scientist who defined probiotics as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host” (Saez-Lara, Gomez-Llorente, Diaz, & Gill, 2015). Probiotics are bacteria and yeasts that are good for a person’s health, especially the digestive system. Urgesi et al. (2014) reported probiotics help maintain the natural balance of organisms (microflora) in the intestines and may be beneficial for patients suffering with IBS. Choi and associates (2015) stated the gut microbiota effects many systems including the auto-immune, musculoskeletal, genitourinary, sexual dysfunction, mood and anxiety disorders, thought processes, and may generate low-grade chronic inflammation. To assist patients improve their health status and quality of life is the goal of every nurse. To be proactive and address a solution to the problem, not treat the symptoms, should be the plan. Hung, Kang, Bollom, Wolf, & Lembo (2015) indicated research into alternative modalities for those solutions may be beneficial in the treatment of IBS.
Irritable bowel syndrome is a chronic, complex gastrointestinal disorder that is usually very hard to manage. The microbiota of the gastrointestinal is less stable in an adult with IBS in comparison to a health adult, and in recent years, a closer focus has been on the gut microbiota (Begtrup et al., 2013). According to Yoon et al. (2014), the pathophysiology of IBS is not clearly understood and may involve many factors, including gut motor dysfunction, post-infection bowel changes, psychological factors, and visceral hypersensitivity. There has been a renewed interest in recent years into understanding the pathophysiological mechanisms and etiology of IBS. Mezzasalma et al (2016) stated the role of intestinal microbiota is significant in human health and disease as the microbial community resides in the gut of the host. Research data reported by Begtrup et al. (2013) indicated probiotics can modify the gut microbiota, and may be beneficial for the treatment and prevention of IBS and other intestinal diseases. Individual strains and species of probiotics vary significantly in composition, and affect the gut microbiota differently (Ford et al., 2014); therefore, prescribing the correct strain of probiotic is important for the patient to achieve a therapeutic benefit.
Patients with IBS have a fecal flora difference from health clients, and may harbor bacterial overgrowth. Urgesi et al. (2014) suggested probiotics are noted to normalize the GI microflora, thus restoring gut epithelial function and the mucosal immunological barrier. As noted by Yoon et al. in 2013, it is known that the effect of probiotics is species-specific, but it remains unclear which probiotic organisms induce the change in intestinal microbiota. The possible mechanisms of action of different probiotic strains include effects on intestinal motility, visceral hypersensitivity, secretion of interleukins (e.g. IL-10) and increases in anti-inflammatory T-cell populations (Sisson et al., 2014). What does seem to be clear from the literature is that the efficacy of individual probiotics depends both on the strain(s) of bacteria and the formulation of the preparations and/or delivery methods used (Mezzasalama et al., 2016; Yoon et al., 2013; and Choi et al, 2015). This has resulted in new insights, which highlight the importance of interactions between the host and intestinal luminal microbial and nonmicrobial constituents.
Begtrup et al. (2013) signified the role of intestinal microbiota is significant in human health and disease as microbial community resides in the gut of the host, and Ford et al. (2014) believed that probiotics can modify the gut microbiota, and may be beneficial for the treatment and prevention of IBS and other intestinal diseases. Mezzasalma et al. (2016) indicated individual strains and species of probiotics vary significantly in composition, and affect the gut microbiota differently. Research conducted by Hung et al. (2015) suggested successful treatment involves understanding the benefits and effects of medications, including complementary and alternative medicine.
Conclusion:
Research indicates irritable bowel syndrome affects many people, and traditional treatment is for the symptoms, not the root of the disease. Patients suffering from IBS are assessing alternative treatment modality options and are willing to try non-traditional and non-pharmaceutical means of treatment. Research further indicates probiotics may be beneficial for the IBS patient, with the evidence of diminished symptoms and increased quality of life. Various studies have not given consistent findings for conclusively validating a reason to make a change in treatment to a universal algorithm (Yoon et al., 2014). As the data suggests, future studies to assess the benefits of probiotics in multi-species combinations and in combination with other medications to understand their effect on the gastrointestinal microbiota are needed.
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