Lactobacillus Reuteri DSM 17938 Appears to Reduce Colic

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Reference

Savino F, Cordisco L, Tarasco V, et al. Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial. Pediatrics. 2010;126(3):e526-e533.

Design

Randomized, double-blind, placebo controlled study

Participants

Fifty exclusively breastfed colicky infants

Study Medication and Dosage

Infants were randomly assigned to receive either L. reuteri DSM 17938 [10(8) CFU] or placebo daily for 3 weeks. Parental questionnaires monitored daily crying time and adverse effects. Stool samples were collected for microbiologic analysis.

Key Findings

Those taking L. reuteri experienced a significant decrease in daily crying time. Stool microbiology revealed an increase in lactobacilli and decrease in Escherichia coli in the treatment group. L. reuteri was well tolerated and no adverse effects were noted.

Breastfeeding may serve as an equally powerful treatment, since it improves the microbial milieu of the gut.

Practice Implications

It is well known in the naturopathic field that probiotics address many gastrointestinal conditions effectively, even as a monotherapy. The same authors conducted a similar study in 2007, which found that a related probiotic strain, L. reuteri ATCC 77530, resulted in a decrease in colic symptoms in 95% of the treatment group vs. 7% in the control group.1 Critics of that study point out that it was unblinded, and controls were treated with simethicone.2 Therefore, blinding both groups in this study and removing interfering medications adds strength and significance. The mechanisms behind probiotics’ benefits are not fully understood. However, there are some clues in the literature: Savino and colleagues state that probiotics may improve gut motility and function3 and decrease visceral pain.4,5 Additionally, other research has shown that altered fecal microflora is found in infants with colic, and those children are found to have elevated levels of calprotectin in their stools.6 Interestingly calprotectin is a marker of intestinal inflammation and possibly increased intestinal permeability7,8 and can serve as a predictor of irritable bowel disease later in life.

Breastfeeding may serve as an equally powerful treatment, since it improves the microbial milieu of the gut. This explains why a review of 79 articles shows babies who are breastfed have a decreased risk of irritable bowel disease development later in life.9 At this time, there is no general consensus on the most effective probiotic strains for the treatment of colic. Additional strains that have shown efficacy in colic include Bifidobacterium lactis and Streptococcus Thermophilus.10 It is quite likely that other strains also have benefit, warranting further research in this area.

About the Author

Matthew Baral, ND, received his naturopathic medical degree from Bastyr University, Kenmore, Washington, in 2000. He is chair of the Department of Pediatric Medicine at the Southwest College of Naturopathic Medicine and Health Sciences (SCNM), Tempe, Arizona, where he teaches pediatrics in the classroom and supervises student clinicians on clinical rotations. Baral designed the first naturopathic pediatric residency program in naturopathic medicine and serves as its director at SCNM. He is also the founding and current president of the Pediatric Association of Naturopathic Physicians.
 

References

  1. Savino F, Pelle E, Palumeri E, Oggero R, Miniero R. Lactobacillus reuteri (American Type Culture Collection Strain 77530) versus simethicone in the treatment of infantile colic: a prospective randomized study. Pediatrics. 2007;119:e124-30.
  2. Cabana MD. Lactobacillus reuteri DSM 17938 appears to be effective in reducing crying time for colic. J Pediatr. 2011 Mar;158(3):516-7.
  3. Indrio F, Riezzo G, Raimondi F, et al. The effects of probiotics on feeding tolerance, bowel habits, and gastrointestinal motility in preterm newborns. J Pediatr. 2008; 152(6):801– 806
  4. Kunze WA, Mao YK, Wang B, et al. Lactobacillus reuteri enhances excitability of colonic AH neurons by inhibiting calcium dependent potassium channel opening. J Cell Mol Med. 2009;13(8B):2261–2270
  5. Wang B, Mao YK, Diorio C, et al. Lactobacillus reuteri ingestion and IK(Ca) channel blockade have similar effects on rat colon motility and myenteric neurones. Neurogastroenterol Motil. 2010;22(1):98 –107, e33
  6. Rhoads JM, Fatheree NY, Norori J, Liu Y, Lucke JF, Tyson JE, Ferris MJ. Altered fecal microflora and increased fecal calprotectin in infants with colic. J Pediatr. 2009 Dec;155(6):823-828.e1.
  7. Røseth AG, Schmidt PN, Fagerhol MK. Correlation between fecal excretion of indium-111–labeled granulocytes and calprotectin, a granulocyte marker protein, in patients with inflammatory bowel disease. Scand J Gastroenterol. 1999;34:50-4.
  8. Berstad A, Arslan G, Folvik G. Relationship between intestinal permeability and calprotectin concentration in gut lavage fluid. Scand J Gastroenterol. 2000;35:64-9.
  9. Barclay AR, Russell RK, Wilson ML, Gilmour WH, Satsangi J, Wilson DC. Systematic review: the role of breastfeeding in the development of pediatric inflammatory bowel disease. J Pediatr. 2009 Sep;155(3):421-6.
  10. Saavedra JM, Abi-Hanna A, Moore N, Yolken RH. Long-term consumption of infant formulas containing live probiotic bacteria: tolerance and safety. Am J Clin Nutr. 2004 Feb;79(2):261-7.