Probiotic reduces abdominal pain in irritable bowel syndrome

A large, prospective, randomized study from Italy showed that Lactobacillus rhamnosus GG (LGG), a probiotic bacterium, was effective for reducing the frequency and severity of pain in children with irritable bowel syndrome (IBS).

A total of 141 children from 5 to 14 years of age with IBS or functional abdominal pain, which may be a precursor of IBS in adults, received LGG or placebo for 8 weeks and entered follow-up for 8 weeks. Patients recorded the frequency and severity of pain each day using a visual analog scale and faces pain scale. In addition, investigators asked parents to assess their child's pain relief before and after treatment.

Compared with baseline, LGG, but not placebo, was associated with significant reduction of both frequency (P<.01) and severity (P<.01) of abdominal pain. These differences still were significant at the end of follow-up (P<.02 and P<.001, respectively). In addition, 48 children in the LGG group achieved treatment success at follow-up compared with 37 children in the placebo group, a difference that still was present at the end of follow-up.

Commentary

The improvement described herein was seen in patients with IBS, not those with functional abdominal pain, both as defined in the Rome II diagnostic criteria. The Rome Foundation developed this classification system to allow for diagnosis of functional gastrointestinal disorders based on clinical symptoms. Functional gastrointestinal disorders are "disorders of the digestive system in which symptoms cannot be explained by the presence of structural or tissue abnormality." The updated Rome III criteria were published in 2006 and are available online ( http://www.romecriteria.org/). This site is worth reviewing as you try to sort out patients with recurrent abdominal pain. And for those who meet criteria of IBS, a trial of LGG may be a good first therapeutic step.

-Michael Burke, MD