Authors: Diego Currò, Gianluca Ianiro, Silvia Pecere, Stefano Bibbò, Giovanni Cammarota
Summary:
Functional bowel disorders (FBDs), mainly irritable bowel syndrome (IBS) and functional constipation (FC, also called chronic idiopathic constipation), are highly diffused worldwide. Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease, although less common, has a strong impact on patients’ quality of life, as well as is highly expensive for our healthcare. A definite cure for those disorders is still yet to come. Over the years, several therapeutic approaches complementary or alternative to traditional pharmacological treatments, including probiotics, prebiotics, synbiotics, fiber and herbal medicinal products, have been investigated for the management of both groups of diseases. However, most available studies are biased by several drawbacks, including small samples and poor methodological quality. Probiotics, in particular Saccharomyces boulardii and Lactobacilli (among which Lactobacillus rhamnosus), synbiotics, psyllium, and some herbal medicinal products, primarily peppermint oil, seem to be effective in ameliorating IBS symptoms. Synbiotics and fiber seem to be beneficial in FC patients. The probiotic combination VSL#3 may be effective in inducing remission in patients with mild-to-moderate UC, in whom Escherichia coli Nissle 1917 seems to be as effective as mesalamine in maintaining remission. No definite conclusions can be drawn as to the efficacy of fiber and herbal medicinal products in IBD patients due to the low number of studies and the lack of RCTs that replicate the results obtained in the individual studies conducted so far. Thus, further, well-designed studies are needed to address the real role of these therapeutic options in the management of both FBDs and IBD.
Source:
British Journal of Pharmacology; 2016