The Effects Of Sequential Treatment With Antibiotics-probiotics On Patients With Diarrhea-predominant Irritable Bowel Syndrome

Objective: This study was aimed to evaluate the effects of sequential treatment with antibiotics-probiotics on patients with diarrhea-predominant irritable bowel syndrome(D-IBS), and to investigate the influence of overlapping upper and lower gastrointestinal symptoms on the efficacy of treatment in D-IBS suffers, and to approach the relationship between efficacy and quality of life in D-IBS suffers. Methods: All of 83 patients with D-IBS were divided into 3 groups. The patients in group A received"sequential treatment"with antibiotics,Dicetel and Glutamine enteric-coated capsules in the first week, and then followed with Dicetel, Glutamine enteric-coated capsules and probiotics(Bifidobacterium) for another 7 weeks . The patients in Group B received"adjusted treatment"with Dicetel , Glutamine enteric-coated capsules and probiotics(Bifidobacterium) for 8 weeks. The patients in Group C received"general treatment"with Dicetel and Glutamine enteric-coated capsules for 8 weeks. The gastrointestinal (GI) symptom scores, Bristol scores , defecation frequency and SF-36 scores were documented respectively before and after the treatment.Results:1. Change in the gastrointestinal symptom scoresBefore the treatment, there was no significant difference in the proportion of overlapping upper GI symptoms among the groups (58.3% in Group A, 50% in Group B, 60.9% in Group C, P=0.726).Comparisons of the entire GI symptom scores : No significant difference was observed among the groups before and during the treatment (in the 4th week and 8th week)(P>0.05). However, in the 12th week(4 weeks after the treatment), the score of Group A was significantly lower than that of Group C(P=0.041), while no significant difference was observed between Group A and Group B(P=0.716) ,nor between Group B and Group C(P=0.094). Comparisons of the lower GI symptom scores : The durations of abdominal pain during and after the treatment(in the 2th week,4th week, 8th week,12th week) were shortened significantly when compared to those prior to the treatment, the frequency of abdominal pain and the proportion of abnormal stool decreased significantly in all the groups during and after the treatment. Moreover, the proportion of mucous stool was lower in Group A and Group B. In the 4th week, the lower GI symptom score of Group A was significantly lower than that of Group B(P =0. 046),while no significant difference was observed between Group A and Group C( P=0.105), nor between Group B and Group C(P=0.973). In the 8th week , the score of Group A was significantly lower than that of Group C(P =0. 034), while no significant difference was observed between Group A and Group B( P=0.361), nor between Group B and Group C(P=0.147).In the 12th week, the scores of Group A and Group B were significantly lower respectively than that of Group C(P=0.010,0.046),while no significant difference was observed between Group A and Group B(P=0.349). The comparisons of score in the 12th week with that in the 8th week indicated that the score in the 12th week was higher than that in the 8th week(P=0.032) in Group C, but not in Group A and Group B( P=0.768,0.628 respectively).2.Bristol scores and defecation frequencyNo significant difference was observed in Bristol scores and defecation frequency among the groups before the treatment (P=0.654, 0.256 respectively). In the 8th week, the defecation frequency of Group A and Group B were lower than that of Group C (P=0.008,0.047), while no significant difference was observed between Group A and Group B. In the 12th week, the defecation frequency of Group A was lower than those of Group B and Group C respectively(P=0.020,0.004), while no significant difference was observed between Group B and Group C. However, no significant difference was observed in Bristol scores between Group A and Group B in the 12th week.3. SF-36 scoresNo significant difference was observed among the groups before and after the treatmen(tthe 12th week)(P>0.05). In Group A, all the SF-36scores including the total score in the 12th week were higher than that before the treatment apart from general hea1th and role-emotional. In Group B, all the SF-36scores including the total score were higher apart from general hea1th.However, in Group C, only the scores of physiologic function and body pain and mental health were higher.Conclusion: All the treatments greatly improved the lower GI symptoms in D-IBS suffers. However, adjusted treatment was better than general treatment in relieving the lower GI symptoms, and the sequential treatment was better in reducing the defecation frequency comparing with adjusted treatment and general treatment. A large proportion (>50%) of D-IBS suffers overlapped upper GI symptoms, which affected the efficacy of treatment. Anxiety and depression in D-IBS suffers might be caused by poor treatment and protracted illness, and recoverd while the GI symptoms was relived.