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Using Probiotics in Women with Irritable Bowel Syndrome

Maria Lens, RN, FNP-C Medicine Specialty: Gastroenterology/Oncology Email: lensmariarn@sbcglobal.net , or molens@usfca.edu. Using Probiotics in Women with Irritable Bowel Syndrome . Definitions.

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Using Probiotics in Women with Irritable Bowel Syndrome

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  1. Maria Lens, RN, FNP-CMedicine Specialty: Gastroenterology/OncologyEmail: lensmariarn@sbcglobal.net, or molens@usfca.edu

  2. Using Probiotics in Women with Irritable Bowel Syndrome

  3. Definitions • Probiotic= Probiotics are live microorganisms (in most cases, bacteria) that are similar to microorganisms found in the human intestine. They are also called "friendly bacteria" or "good bacteria” (NIH, 2009). • Action: It displaces the pathogens from an undesirable place by taking its place and shows anti-inflammatory response (O'Hara & Shanahan, 2007) .

  4. Problems and Purpose • Many patients having procedures for recurrent problems of diarrhea, constipation, flatulence, and abdominal pain (Cole et al., 2005). • Higher incidence if irritable bowel syndrome in female patients ratio is 2.5/1 (Cole et al., 2005). • 58 million Americans have IBS, 4 of 5 are female (NDDIK, 2007). • Patients with IBS have twice as much abdominal surgeries (Cole et al., 2005). • Miss 3-4 more days of work as the national average (NDDIK, 2007). • 1.3 million primary care visits each year (NNDIK., 2005), ($1,200,sigmoidoscopy), (5-6k, colonoscopy). • Pt’s are having unnecessary procedures and surgeries (cholecystectomy, hyterectomy), (Cole et al., 2005). • Alleviate the intensity of symptoms of female patients with (IBS).

  5. Methodology Checked databases on keywords: IBS, IBS and probiotics, irritable colon. Pub Med, Cochrane, Embase, CINAHL, UpToDate, and Stat!Ref, a database system for evidence-based practice journals. RCT’s used to form guideline. Double-blinded

  6. Results Lactobacillus: improvement in abdominal pain (Nobaek, Johansson, Molin, Ahrne, & Jeppsson, 2000). VSL#3: mostly found to help a particular symptom not all; mostly abdominal pain and bloating (Kim et al., 2003, Kim et al., 2005). Bifidobacterium helps alleviate sx’s better than Lactobacillus (O’Mahoney et al., 2005). Bifidobacterium: Helps with overall symptoms (Whorwell et al., 2006)

  7. Guideline Use standard therapy with women diagnosed with IBS. Include Bifiodobacterium infantis once a day. Future/consideration: pilot guideline in both women and male patients.

  8. Evalution and Monitoring Pilot guideline Use 6 point scale to measure intensity of symptoms.

  9. References Cole JA, Yeaw JM, Cutone JA, et al. (2005). The incidence of abdominal and pelvic surgery among patients with irritable bowel syndrome. Digestive Disease Science. 50 (12): 2268–75 doi:10.1007/s10620-005-3047-1. PMID 16416174. Duke K, Murhphy S, Smith M, et al. (2004). Probiotic Performance in IBD is not uniform: A multi-strain Comparison in the lymphocyte transfer model of enterocolitis. Gastroenterology. 126;A283-4 Heymann-Mönnikes I, Arnold R, Florin I, Herda C, Melfsen S, Mönnikes H. (2000). The combination of medical treatment plus multicomponent behavioral therapy is superior to medical treatment alone in the therapy of irritable bowel syndrome. American Journal of Gastroenterology. 95 (4): 981–94. PMID 10763948. Kaiser Permanente, Nursing Pathways Northern California, Research-Nursing Research Program. (2003-2007). Retrieved February 17, 2009 from http://nursingpathways.kp.org/ncal/research/nursingresearch program/index.html Longstreth, GF, et al. Gastroenterology 2006; 130:1480. Maxion-Bergemann S, Thielecke F, Abel F, Bergemann R (2006). Costs of irritable bowel syndrome in the UK and US. PharmacoEconomics. 24 (1): 21–37. doi:10.2165/00019053-200624010-00002. PMID 16445300. National Digestive Diseases Information Clearinghouse (NDDIC). (2007, September). Irritable Bowel Syndrome. Retrieved March 5, 2009, from http://digestive.niddk.nih. gov/ddiseases/pubs/ibs/ O'Hara, AM., Shanahan, F. (2007). Gut microbiota: mining for therapeutic potential. Clinical and Gastroenterology Hepatology. 5: 274-284. O'Mahony, L., McCarthy, J., Kelly, P., Hurley, G., Luo, F., Chen, K., O'Sullivan, O., Kiely, B.Collins, K., Shanahan, F., & Quigley, E. Lactobacillus and Bifidobacterium in Irritable Bowel Syndrome: Symptom Responses and Relationship to Cytokine Profiles. Clinical -Alimentary Tract. 2005;128; 541-551; 10:1053/j.gastro.2004.11.050 Quigley. Gastroenterology 2006;130:S2: A493. Rachmilewitz, D., Kayatura, Karnell, F., Hayashi, T., Reinus, C., Rudensky, B., Akira, S., Takeda, K., Lee, J., & Takabayashi, K., Toll-like receptor 9 signaling mediates the anit- Inflammatory effects of probiotics in murine experimental colitis. Gastroenterolgy. 2004;126: 520-528. Whorwell, P.J., Altringer, B.S., Morel, J., Bond, Y., Charbonneau, D., O'Mahony, L., Kiely, B., Shanahom, F., & Quigley, E. Efficacy of and Encapsulated ProbioticBifidobacteriuminfantis 35624 in Women with Irritable Bowel Syndrome. American Journal of Gastroenterology. 2006;101: 1581-1590. Up to Date, Rome III Diagnostic Criteria* For Irritable Bowel Syndrome, 2009, Retrieved March 1, 2009 from http://www.uptodate.com/online/content/image.do?imag eKey=gast_pix/rome_cri.htm&title=Rome%20criteria%20for%20IBSTables

  10. Questions

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