17893393_lCommentary by: Matthew Baral, ND

Reference: Lactobacillus reuteri DSM 17938 in Infantile Colic: A Randomized, Double-Blind, Placebo-Controlled Trial Pediatrics 2010;126;e526-e533

Francesco Savino, Lisa Cordisco, Valentina Tarasco, Elisabetta Palumeri, Roberto Calabrese, Roberto Oggero, Stefan Roos and Diego Matteuzzi

Design: Randomized, double-blind, placebo controlled study.

Participants: 50 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: There was a significant decrease in daily crying time in those taking L. reuteri.  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.

Practice Implications: It is well known in the naturopathic field that probiotics address gastrointestinal conditions effectively, even as a monotherapy.  The same authors conducted a similar study in 2007, which showed that a related probiotic strain, L reuteri ATCC 77530, resulted in 95% of the treatment group showing a decrease in colic symptoms 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 here.  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 function[3] 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 permeability,[7][8] and can serve as a predictor of irritable bowel disease later in life.  Therefore, it is easy to understand the implications; 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 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 have also been shown to improve colic such as Bifidobacterium lactis and Streptococcus Thermophilus.[10] It is most likely that other strains also have benefit, warranting further research in this area.

[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.





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