Therapeutic Outcome of Irritable Bowel Syndrome in Children: Role of Pro/Post-Biotics Mixture
Authors: Faid Asar Aya Abd Alhadi , El-Hodhud Mostafa Abdel-Aziz , Swilem Dina Abdelhamid Nabhan 
Published: August 2023

Background
Irritable bowel syndrome (IBS) is a common pediatric functional gastrointestinal disorder (FGID) with upper and lower gastrointestinal symptoms and extra-intestinal symptoms. It has a significant impact on daily activities, education and health related quality of life of affected children. The healthcare consultation rate is high in affected children and it leads to a significant annual healthcare cost.

Aim of the Work
Define the magnitude of response to treatment of IBS, identify the effect of pro/post biotics in treatment of IBS and define the time needed to reach a controlled IBS.

Patients and Methods
This study was a randomized add-on study with open label interventional study. This study was carried from July 2020 till collecting an adequate sample size. It was conducted on 70 patients who were diagnosed as IBS. each patient was subjected to three phases of the study: Phase I: Primary assessment: history taking, examination, and assessment score of pain, diarrhoea, constipation and quality of life. Phase II: Patients were divided into two equal groups: A and B. All patients in both groups received the standard treatment (diet modification, antispasmodic). Pro/post-biotics was added only to the treatment plan in group A.Phase III: reassessment of the patients using same assessment scores after 3 weeks, and after 3 months of receiving the treatment. Through comparing these scores before and after the treatment, we were able to evaluate the effect of each method of treatment on the patient’s symptoms

Results
Analysis of pain during this study showed that pain was 80% colicky in character and 78.6% at periumbilical area, with duration in range of 3 months up to 36 months. Analysis of symptoms of irritable bowel syndrome in children ranged from 4 - 16 years old showed that vomiting occurred only in 8.6%, diarrhea occurred in 42.9%, constipation occurred in 41.4%, and distention occurred in 70 %. Concerning the intervention comparison, abdominal pain improved in patients who received postbiotics and standard treatment improved by 83.21 % by the end of study compared to 69.57% in patients who received standard treatment only. Regarding diarrhea, patients who received postbiotics and standard treatment improved by 84.76 %, while patients who received standard treatment only improved by 68.16 % by the end of the study. Regarding quality of life, patients who received postbiotics and standard treatment improved by 84.11 % after 3 months, while patients who received standard treatment only improved by 74.46% by the end of the study. Comparison of intervention effects according to IBS subtypes regarding pain showed significant amelioration of abdominal pain (61.86%) in IBS-D group in comparison to (45.5%) in IBS-C group and (43.28%) in IBS-U group after 3 weeks. Regarding quality of life there was improvement in QOL in IBS-D group (52%), IBS-C group (42.5%) and in IBS-U group (50.64%) after 3 weeks. After 3 months of diet modification there was more improvement rate in IBS-D (73.6%), IBS-C (69.2%) and IBS-U (76.1%) which means that all the groups (IBS-C, IBS-D and IBS-U) had significant QOL improvement in similar rates.

Conclusion
Our data suggest that the standard therapy of IBS (especially FODMAP diet) is very effective alone for amelioration of IBS symptoms. Addition of postbiotics is very helpful to achieve early improvement of symptoms and quality of life of the IBS patients. This early effect is expected to be very important to avoid the non-compliance effect of delayed response.