Irritable bowel syndrome in children: probiotics and vitamins

Irritable bowel syndrome (IBS) is a common pathology in childhood, accompanied by abdominal pain. It is characterized by a long relapsing course, low efficiency of complex therapy. The emergence of a new pathogenetic concept of the «gut-microbiotabrain» axis today made it possible to re-evaluate the mechanism and the onset of the onset of «visceral hypersensitivity», the main key pathogenetic factor in the development of IBS in children. Modern examination methods have made it possible to take a fresh look at the human microbiome, its functions, the role of the microbiota in the pathogenesis of IBS and other painful functional disorders of digestion. The use of probiotic bacteria for medical purposes has a centuries-old history, today their effects are overestimated at a highly indicative level, it is possible to choose the right probiotic strain for a specific clinical situation. The interaction of the gut microbiota and its active metabolites with food components and vitamins leads to a synergistic clinical anti-inflammatory and immune effect aimed at strengthening the intestinal barrier. The use of complex products containing the probiotic strain L. reuteri DSM 17938 with a proven clinical effect in the treatment of abdominal pain in children of different ages, and vitamin D, which has an epithelial and immunotropic effect, allows significantly increase the effectiveness of therapy for IBS in pediatric gastroenterological practice and improve the prognosis of the course of the disease in the future. 

1. Guandalini S. Are probiotics or prebiotics useful in pediatric irritable bowel syndrome or inflammatory bowel disease? // Front. Med. 28 August 2014. https://doi.org/10.3389/fmed.2014.00023.

2. Hyams J. S., Di Lorenzo C., Saps M., Shulman R. J., Staiano A. М., van Tilburg M. Childhood Functional Gastrointestinal Disorders: Child/Adolescent // Gastroenterology. 2016; 150: 1456–1468. https://doi.org/10.1053/j.gastro.2016.02.015.

3. Nizhevich A. A., Gimazetdinova R. Sh., Yakupova G. M., Tuygunov M. M., Valiulina A. YA. Sindrom razdrazhennogo kishechnika u detey i podrostkov: klinicheskaya kartina i semeynyye faktory riska [Irritable bowel syndrome in children and adolescents: clinical picture and family risk factors] Prakticheskaya meditsina. 2018, № 2 (113). Pp. 57–61.

4. Nizhevich A. A., Koroleva Ye., Astrelina Ye., Alyangin V. Maslyanaya kislota i inulin v kompleksnom lechenii abdominal'noy boli pri sindrome razdrazhennogo kishechnika [Butyric acid and inulin in the complex treatment of abdominal pain in irritable bowel syndrome] Vrach. 2015. № 10. pp. 35–39.

5. Bel'mer S. V., Khavkin A. I., Pechkurov D. V. Funktsional'nyye narusheniya organov pishchevareniya u detey. Printsipy diagnostiki i lecheniya (v svete Rimskikh kriteriyev IV). [Functional disorders of the digestive system in children. The principles of diagnosis and treatment (in the light of Rome IV criteria).] M.: GEOTARMedia, 2018. 18 p.

6. Skripchenko N. V., Fedorova L. A., Skripchenko Ye. Yu., Makarova Ye. G., Klepikova T. V., Ukraintsev S. Ye. Pitaniye i razvitiye mozga: vklad v budushcheye ili upushchennyye vozmozhnosti? [Nutrition and brain development: a contribution to the future or missed opportunities?] Pediatriya im. G. N. Speranskogo. 2020; 99 (3): pp 134–142. https://doi.org/10.24110/0031-403X-2020-99-3-134-142.

7. Rhee S. H., Pothoulakis C., Mayer E. A. Principles and clinical implications of the brain-gut-enteric microbiota axis // Nat. Rev. Gastroenterol. Hepatol. 2009; 6 (5): 306–314. DOI: 10.1038/nrgastro.2009.35.

8. Cryan J. F., O’Riordan K. J., Cowan C. S. M., Sandhu K. V., Bastiaanssen T. F. S., Boehme M., Dinan Т. G. The Microbiota-Gut-Brain Axis // Physiological Reviews. 2018; 99 (4): 1877–2013. DOI: 10.1152/physrev.00018.2018.

9. Stilling R., Dinan T., Cryan J. Microbial genes, brain&behavior – epigenetic regulation of the gutbrain axis // Genes, Brain and Behav. 2013; 13: 69–86.

10. Carabotti M., Scitocco, Maselli M., Severi C. The gut-brain axis: interaction between enteric microbiota, central and enteric nervous system // Annals of Gastroenterol. 2015; 28: 203–209. PMC4367209.

11. Khavkin A. I., Zhikhareva N. S. Podkhody k lecheniyu sindroma razdrazhennogo kishechnika u detey [Approaches to the treatment of irritable bowel syndrome in children] Voprosy sovremennoy pediatrii. 2004. T. 3, № 2. Pp. 30–34.

12. Zakharova I. N., Berezhnaya I. V., Klimov L. Ya., Kas'yanova A. N., Dedikova O. V., Kol'tsov K. A. Probiotiki pri respiratornykh zabolevaniyakh: yest' li puti vzaimodeystviya i perspektivy primeneniya? [Probiotics for respiratory diseases: are there ways of interaction and prospects for use?] Meditsinskiy sovet. 2019; 2: pp 173–182. DOI: 10.21518/2079-701X-2019-2-173-182.

13. Cornick S., Tawiah A., Chadee K. Roles and regulation of the mucus barrier in the gut // Tissue Barriers. 2015; 3 (1–2): e982426.DOI: 10.4161/21688370.2014.982426. eCollection 2015.

14. Maldonado-Contreras A. L., McCormick B. A. Intestinal epithelial cells and their role in innate mucosal immunity // Cell Tissue Res. 2011; 343 (1): 5–12. DOI: 10.1007/s00441-010-1082-5.

15. Boltin D., Perets T. T., Vilkin A., Niv Y. Mucin function in inflammatory bowel disease, an update // J Clin Gastroenterol. 2013; 47: 106–111.

16. Gorelov A. V., Kanner Ye. V., Maksimov M. L., Yermolayeva A. S., Voznesenskaya A. A., Dadasheva K. N. Kishechnaya mikrobiota: sovremennyye dokazatel'nyye dannyye effektivnosti primeneniya Lactobacillus rhamnosus i GG Bifidobacterium longum v praktike pediatra [Intestinal microbiota: current evidence of the effectiveness of the use of Lactobacillus rhamnosus and GG Bifidobacterium longum in pediatric practice] Meditsinskiy sovet. 2018, № 11, pp. 175–180.

17. Aleksandrova K., Romero-Mosquera B., Diet V. H. Gut Microbiome and Epigenetics: Emerging Links with Inflammatory Bowel Diseases and Prospects for Management and Prevention // Nutrients. 2017; 9: 962. DOI: 10.3390/nu9090962.

18. Mentella M. C., Scaldaferri F., Pizzoferrato M., Gasbarrini A., Miggiano G. A. D. Nutrition, IBD and Gut Microbiota: A Review // Nutrients. 2020, 12, 944. DOI: 10.3390/nu12040944.

19. https://www.hmpdacc.org/.

20. https://www.biocodexmicrobiotainstitute.com/ru/mikrobiota/.

21. Collado M. C., Rautava S., Aakko J., et al. Human gut colonisation may be initiated in utero by distinct microbial communities in the placenta and amniotic fluid // Sci Rep. 2016; 6: 23129. DOI: 10.1038/srep23129.

22. Di Giulio D. B. Diversity of microbes in amniotic fluid // Semin Fetal Neonatal Med. 2012; 17 (1): 2–11. DOI: 10.1016/j.siny.2011.10.001.