News Round-up

 

 

Personalised 'Cocktails' of Antibiotics, Probiotics and Prebiotics Hold Great Promise in Treating a Common Form of Irritable Bowel Syndrome

Symptoms improved in almost all patients and completely cleared up in some.

Personalised ‘cocktails’ of antibiotics, probiotics and prebiotics hold great promise in the treatment of a common form of irritable bowel syndrome (IBS), heard visitors to the ESCMID Global Congress (formerly ECCMID) in Barcelona, Spain (27-30 April).

Post-infection IBS (PI-IBS) is a form of irritable bowel syndrome that occurs after gastroenteritis or food poisoning.

Lead researcher Professor Maurizio Sanguinetti, of the Università Cattolica del Sacro Cuore, Rome, Italy, says: “Estimates vary, but research indicates that approximately 10-30% of individuals who experience acute gastroenteritis develop PI-IBS. Symptoms such as diarrhoea, constipation, bloating and abdominal pain can persist for months or even years after the initial infection.

Treatment focuses on managing symptoms and improving quality of life. It typically involves a combination of dietary modifications, lifestyle changes, anti-diarrhoeal drugs, probiotics and other medications and psychological therapies, such as cognitive behavioural therapy.

But symptoms can vary widely among individuals and may not always respond to conventional therapies, which means it can be challenging to treat. Given that gastroenteritis can disrupt the gut microbiota, the restoration of a healthy microbiota is a potential avenue of treatment.”

To investigate its potential, Professor Sanguinetti and colleagues conducted a pilot study in which 13 PI-IBS patients (8 males and 5 females; mean age, 31 years) were treated with targeted gut-microbiota therapy.

Nine of the patients (69.2%) had diarrhoea-dominant IBS (IBS-D) and 4 (30.8%) constipation-dominant IBS (IBS-C). Bloating and abdominal pain were present in 69.2% (9/13) and 76.9% (10/13) of patients, respectively.

First, the patient’s gut microbiota was analysed. Genetic profiling was used to identify the bacteria present in faecal samples and so the gut. The abundance of the different types of bacteria was also measured.

23% (3/13) of patients had lower than expected bacterial diversity.

23% (3/13) had high levels of Proteobacteria. These are pro-inflammatory bacteria and an increase in their numbers could worsen PI-IBS. 61.5% (8/13) had low levels of Akkermansia, a ‘protective’ bacterium, and 69% (9/13) had low levels of Bifidobacterium, another ‘protective’ microbe.

38.5% (5/13) of the patients had low levels of Firmicutes and 54% (7/13) had low levels of short-chain fatty acid-producing bacteria, both of which are also protective.

Then, a personalised therapy was designed for each patient, based on their results, with the goal of rebalancing their gut microbiota.

These consisted of short courses of the antibiotics rifaximin (9/13, 69% of patients) or paromomycin (4/13, 31%) to reduce levels of potentially harmful bacteria, followed by prebiotics and/or postbiotics to enhance the numbers of protective bacteria and compete with the harmful bacteria for space and resources.

The prebiotics were inulin and psyllium (9/13; 69%), the probiotics were Bifidobacterium (5/13; 38.5%), Lactobacillus (7/13; 54%), Escherichia coli Nissle 1917 (2/13; 15%) and multi-species-based (5/13; 38.5%).

Symptoms such as abdominal pain, bloating, constipation and diarrhoea were assessed using the gastrointestinal symptoms rating scale (GSRS).

12 weeks after the start of treatment, 93% (12/13) of patients experienced an improvement in symptoms and 38.5% (5/13) achieved total remission.

Professor Sanguinetti says: “A precision medicine approach, in which testing and careful analysis of the gut microbiota allows the development of personalised treatments holds great promise in the treatment of post-infection IBS.

While rigorous larger-scale studies are needed to confirm these preliminary findings, this type of testing will likely soon be widely used in the treatment of post-infection IBS and other similar conditions.”

NICE Have Updated Their Clinical Knowledge Summaries for Adult Malnutrition Visit: https://cks.nice.org.uk/topics/adult-malnutrition

 

 

Coffee Linked to Lower Recurrence of Bowel Cancer

More than 4 cups of coffee a day may lower risk of bowel cancer recurrence, according to new research funded by World Cancer Research Fund and published in the International Journal of Cancer. They also have a lower risk of death following their diagnosis.

The study found that participants who drank more than 4 cups of coffee had a 32% lower risk of cancer recurrence than participants who drank less than 2 cups per day, in terms of relative risk. In addition, the risk of dying was lower among coffee drinkers, and 3–5 cups of coffee per day seem sufficient to improve survival.

The research team was led by Professor Ellen Kampman, Professor of Nutrition and Disease at Wageningen University and Research in the Netherlands. Kampman stated: “We are now doing further research to confirm the effect we are seeing is causative rather than simply an association. We are hopeful, however, that the finding is real because it appears to be dose dependent – the more coffee drunk, the greater the effect. This has been previously supported by other, though smaller, studies.”

View: https://onlinelibrary.wiley.com/doi/10.1002/ijc.34879

 

 

Artificial Sweetener has Potential to Damage Gut

New research has discovered that neotame, one of the new generation of artificial sweeteners, is capable of damaging the human intestine and causing illness.

The study is the first to show that neotame can cause previously healthy gut bacteria to become diseased and invade the gut wall – potentially leading to health issues including irritable bowel syndrome and sepsis – and also cause a breakdown of the epithelial barrier, which forms part of the gut wall.

The research, which is published in the journal Frontiers in Nutrition and was carried out at Anglia Ruskin University (ARU), demonstrates that neotame can damage the intestinal epithelium directly, by causing the death of epithelial cells, and indirectly, by damaging bacteria commonly found in the gut.

The in vitro study identified a range of pathogenic responses following exposure of E. coli (Escherichia coli) and E. faecalis (Enterococcus faecalis) to neotame, which is found in drinks, foods and chewing gums, including biofilm formation and increased adhesion to and invasion of cells by diseased bacteria.

Some of the newest artificial sweeteners have a 1,000-fold sweeter taste compared to sugar, reducing the amount needed to be added to food and drink. Despite the smaller quantities used, the impact of neotame on the epithelium-microbiota relationship has the potential to cause poor gut health, which in turn could lead to metabolic and inflammatory diseases such as irritable bowel disease or insulin resistance.

This new research into neotame builds on previous work by Dr Havovi Chichger of Anglia Ruskin University (ARU), which discovered that saccharin, sucralose and aspartame, some of the most widely used artificial sweeteners, could cause similar damage in the gut.

Artificial sweeteners can play a role in helping with weight loss and aiding individuals with glucose intolerance and type 2 diabetes. However, this new study, led by Dr Aparna Shil, of Jahangirnagar University in Bangladesh, and Dr Chichger highlights the need for further research into the toxic effects of some of the artificial sweeteners that have been developed more recently.

Dr Chichger, Associate Professor in Biomedical Science at Anglia Ruskin University (ARU) and senior author of the study, said: “There is now growing awareness of the health impacts of sweeteners such as saccharin, sucralose and aspartame, with our own previous work demonstrating the problems they can cause to the wall of the intestine and the damage to the ‘good bacteria’ which form in our gut.

This can lead to a range of potential health issues including diarrhoea, intestinal inflammation, and even infections such as septicaemia if the bacteria were to enter the blood stream. Therefore, it is important to also study sweeteners that have been introduced more recently and our new research demonstrates that neotame causes similar problems, including gut bacteria becoming diseased.

Understanding the impact of these pathogenic changes occurring in the gut microbiota is vital. Our findings also demonstrate the need to better understand common food additives more widely and the molecular mechanisms underlying potential negative health impacts.”

^{Paper: The artificial sweetener neotame negatively regulates the intestinal epithelium directly through T1R3-signaling and indirectly through pathogenic changes to model gut bacteria. Frontiers in Nutrition. DOI: 10.3389/fnut.2024.1366409}

 

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