Treatment of diarrhea-predominant irritable bowel syndrome with mesalazine and/or Saccharomyces boulardii.
BACKGROUND
Irritable bowel syndrome (IBS) is a functional bowel disease characterized by abdominal pain and altered intestinal habits. The pathophysiology of IBS remains unclear. Recent studies have demonstrated that some IBS patients, especially in diarrhea-predominant IBS (IBS-D), display persistent signs of minor mucosal inflammation and a modified intestinal microflora. The mesalazine has known intestinal anti-inflammatory properties. Saccharomyces boulardii is a probiotic used for a long time in treatment of diarrhea, including infectious diarrhea.


OBJECTIVE
Evaluate the effects of mesalazine alone, combined therapy of mesalazine with liophylised Saccharomyces boulardii or alone on symptoms of IBS-D patients.


METHODS
Based on Rome III criteria, 53 IBS-D patients (18 year or more) were included. To exclude organic diseases all patients underwent colonoscopy, stool culture, serum anti-endomisium antibody, lactose tolerance test and ova and parasite exam. Patients were divided in three groups: mesalazine group (MG) - 20 patients received mesalazine 800 mg t.i.d. for 30 days; mesalazine and Saccharomyces boulardii group (MSbG) - 21 patients received mesalazine 800 mg t.i.d. and Saccharomyces boulardii 200 mg t.i.d. for 30 days and; Saccharomyces boulardii group (SbG) - 12 patients received Sb 200 mg t.i.d. for 30 days. Drugs that might have any effect on intestinal motility or secretion were not allowed. Symptom evaluations at baseline and after treatment were performed by means of a 4-point likert scale including: stool frequency, stool form and consistency (Bristol scale), abdominal pain and distension. Paired t test and Kruskal-Wallis test were used for statistical analyses.


RESULTS
Compared to baseline, there were statistically significant reduction of symptom score after 30 th day therapy in all three groups: MG (P<0.0001); MSbG (P<0.0001) and in SbG (P = 0.003). There were statistically significant differences in the symptom score at 30 th day therapy of the MG, MSbG and SbG groups (P = 0.03). There were no statistical differences between MSbG and MG symptom score at 30th day therapy (P = 0.9).


CONCLUSIONS
The use of mesalazine alone, Saccharomyces boulardii alone or combined treatment with mesalasine and Saccaromyces boulardii improved IBS-D symptoms. The improvement of the symptom score was greater with mesalazine alone or combined with Sb as compared with Sb treatment alone. These preliminary results suggest that mezalazine may be useful in treatment of IBS-d patients, and warrant further larger studies.
Instituto Goiano de Gastroenterologia, GoiâniaGO, Brasil.
Mauro
M
Bafutto
Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal de Pernambuco (UFPE), RecifePE, Brasil.
José Roberto de
JR
Almeida
Instituto Goiano de Gastroenterologia, GoiâniaGO, Brasil.
Nayle Vilela
NV
Leite
Instituto Goiano de Gastroenterologia, GoiâniaGO, Brasil.
Michelle Bafutto Gomes
MB
Costa
Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal de Pernambuco (UFPE), RecifePE, Brasil.
Enio Chaves de
EC
Oliveira
Instituto Goiano de Gastroenterologia, GoiâniaGO, Brasil.
Joffre
J
Resende-Filho
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D003967:Diarrhea / Q000188:drug therapy; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000188:drug therapy*; D008297:Male; D019804:Mesalamine / Q000008:administration & dosage*; D008875:Middle Aged; D019936:Probiotics / Q000008:administration & dosage*; D012440:Saccharomyces; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D019804:Mesalamine