Published online Aug 28, 2008. doi: 10.3748/wjg.14.5020
Revised: August 12, 2008
Accepted: August 19, 2008
Published online: August 28, 2008
AIM: To determine whether Lactobacillus casei strain Shirota (Yakult®) can alter small intestinal bacterial overgrowth (SIBO), as tested by the lactulose breath test, and whether this is associated with changes in symptoms in irritable bowel syndrome (IBS).
METHODS: 18 patients with IBS (Rome II criteria), who showed an early rise in breath hydrogen with lactulose (ERBHAL), consumed 65 mL of Yakult® daily for 6 wk. Lactulose breath test was repeated at the end of the treatment period. Symptoms were recorded daily using a 10 cm visual analogue scale.
RESULTS: 14 patients completed the study, 9 (64%) had reversal of ERBHAL, with the median time of first rise in breath hydrogen increasing from 45 to 75 min (P = 0.03). There was no significant improvement in the symptom score with probiotic therapy, except for wind (P = 0.04). Patients commencing with at least moderate symptoms and who no longer had ERBHAL at the end of treatment, showed improvement in the overall symptoms scores [median final score 5.3 (IQR 3.9-5.9), 55% reduction; n = 6] to a greater extent than those who had had persisting ERBHAL [final score 6.9 (5.0-7.0), 12% reduction; n = 5; P = 0.18].
CONCLUSION: Yakult® is effective in altering fermentation patterns in the small bowel, consistent with reducing SIBO. The loss of ERBHAL was associated with reduced symptoms. The true interpretation of these findings awaits a randomised, controlled trial.