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• W1962582213 abstract "Sirs, We thank Drs Agrawal and Whorwell for their interest and comments on our review article on the treatment of functional abdominal bloating and distension.1, 2 We acknowledge that our extensive literature search did not identify their published study on the effect of Bifidobacterium lactis DN-173 010 on bloating, abdominal inductance plethysmography (AIP) as a measure of distension, and gastrointestinal (GI) transit in patients with irritable bowel syndrome with constipation (IBS-C).3 However, we identified two other randomized-controlled trials with this probiotic.4, 5 One study assessed the efficacy of Bifidobacterium animalis DN-173 010,4 and the other evaluated B. lactis DN-173 010,4 although they are both considered to be B. animalis, but of the animalis and lactis subspecies.6 The first study included 274 IBS-C patients, and found that the fermented milk containing B. animalis DN-173 010 relieved bloating significantly more than a heat-treated yogurt containing non-living bacteria.4 In the second study, there was no significant difference in bloating frequency between B. lactis DN-173 010 and placebo in 202 women, who did not have a diagnosis of any functional bowel disorder, but had at least mildly frequent digestive symptoms.4 The study by Agrawal et al.,3 that was unintentionally excluded in our review,2 evaluated the efficacy of B. lactis DN-173 010 vs. a nonfermentable dairy product in 34 female IBS-C patients. Compared with the control product, there were trends towards reductions in bloating score with B. lactis DN-173 010 during AIP assessment (P = 0.084), and over the 4-week treatment period (P = 0.059). There were significant decreases in median percentage change in maximal distension as measured by AIP (P = 0.02) and GI transit times (P < 0.05) with B. lactis DN-173 010 vs. the control product. Our review concluded that B. animalis (or lactis) DN-173 010 together with B. infantis 35624 demonstrated efficacy for the treatment of bloating in IBS.2 Inclusion of Agrawal et al.’s study3 would not have changed our conclusions about the efficacy of probiotics for the treatment of bloating and/or distension in IBS. In their study, the trend towards reductions on bloating and flatulence that did not meet statistical significance may be due to small sample size given the positive findings from the 2007 study.4 Furthermore, B. lactis DN-173 010 had a positive effect on abdominal girth and GI transit, which are thought to play pathophysiologic roles in bloating and distension. Notwithstanding, more definitive studies are needed including those defining the clinical meaningfulness of the reductions in bloating score (i.e., −0.47 based on a six-point scale) and AIP measurements with B. lactis DN-173 010 vs. control product to help interpret the results, and those determining if AIP correlates with the symptom of visible abdominal distension, which is often reported by IBS patients and can be distinguished from the symptom of bloating.7 Declaration of personal interests: During the last 2 years, Dr. Schmulson has served as a consultant for Procter and Gamble, Novartis and Schering-Plough. He has been a speaker for Nycomed, Schering-Plough, Novartis and Mayoli-Spindler, and has received research funding from Nycomed and Nestle. Dr. Chang has served as a consultant for Takeda, Forest, Rose Pharma, GlaxoSmithKline, Ironwood, Salix, Ocera and Movetis. She has received research funding from Takeda, Rose Pharma and Prometheus. Declaration of funding interests: None." @default.
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• W1962582213 date "2011-08-02" @default.
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• W1962582213 title "Treatment of bloating and distension - role of probiotics: authors’ reply" @default.
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• W1962582213 doi "https://doi.org/10.1111/j.1365-2036.2011.04773.x" @default.
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