Metabiotic based on metabolites of <i>Bacillus subtilis</i> for correction of gastrointestinal symptoms in patients with post-COVID syndrome
Authors: Lapinskii I. V. , Serkova M. Yu. , Bakulin I. G. , Skalinskaya M. I. , Avalueva E. B. 
Published: January 2023

Purpose of the study. To evaluate the efficacy and safety of using a metabiotic preparation, which includes biologically active metabolites of the culture fluid of the probiotic bacterium Bacillus subtilis (B. subtilis) and fructooligosaccharides, for the correction of gastrointestinal symptoms in patients with post-COVID syndrome.

Materials and methods of the study. The study included 40 outpatients with post-COVID syndrome aged 18 to 60 years (mean age 38.25–8.70 years), who, after undergoing COVID-19, were disturbed by gastrointestinal complaints and asthenia. Patients were randomized into 2 groups. Group 1 (n = 20) consisted of patients who received metabiotic capsules in the regimen of 1 capsule 2 times a day for 28 days; group 2 (n = 20) – patients who did not receive additional support. The observation period was 28 days. The severity of gastroenterological symptoms was assessed using the GSRS (Gastrointestinal Symptom Rating Scale) quality of life questionnaire, and asthenia was assessed using the Asthenic Condition Scale (ASS) by L.D. Malkova. Patients of group 1 (n = 10) additionally underwent a study of feces to quantify the composition of the microbiota of the colon by real-time polymerase chain reaction (PCR), test Kolonoflor-16.

Research results. According to the results of assessing the quality of life in patients with post-COVID syndrome using the GSRS questionnaire, the main gastrointestinal complaints included: diarrhea, abdominal pain and dyspepsia; the severity in points was 14.1 points, 7.9 points, and 15.2 points, respectively, which corresponded to moderate manifestations of symptoms. Against the background of taking a metabiotic in patients of group 1, there was a statistically significant decrease in gastrointestinal complaints on the scale of the total measurement of symptoms (p < 0.0001), on the scales of abdominal pain syndrome (p < 0.0170), dyspeptic syndrome (p < 0.0001) and diarrheal syndrome (p < 0.0001). In patients of group 2 on the 28th day of the study, there was no significant change in symptoms. When assessing asthenia after taking metabotics, patients of the 1st group showed positive dynamics, the severity of asthenia before treatment was 51.5 ± 7.9 points, after treatment – 43.3 ± 5.9 points (p < 0.0500), in patients of group 2 there was no significant decrease in asthenic state indicators when assessed at the beginning and at the end of the observation period. On the 28th day, in patients of group 1 the representation of Lactobacillus spp. statistically significantly increased, normalization in the spectrum of Escherichia coli representation was noted, and the representation of UPM decreased. In the examined group, attention is drawn to the complete absence of Akkermansia muciniphila DNA in the feces of patients with post-COVID syndrome and the restoration of the representation of this bacterium after taking a metabiotic in 60 % of patients.

Conclusions. In patients with post-COVID syndrome, the structure of gastrointestinal complaints is dominated by manifestations of abdominal pain, dyspeptic and diarrheal syndromes, and there are phenomena of colon dysbacteriosis, expressed in a decrease in the representation of obligate microflora and an increase in TMR. The use of metabolic tyranny in patients with post-COVID syndrome for 28 days in a regimen of 1 capsule 2 times a day is effective and safe.