Evaluating the effect of Saccharomyces Boulardii as an add on therapy in children with concurrent Inflammatory Bowel Disease and Irritable Bowel Syndrome

Introduction: Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. Whereas inflammatory bowel disease (IBD) is an inflammatory disease, it could be divided in two major type, the ulcerative colitis (UC) and Crohn s disease (CD). In addition to the signs and symptoms similarities that these two diseases have, they also have some pathophysiological similarities. Despite various unknown aspects, fecal calprotectin is one mostly used biomarkers in diagnosis and follow up of IBD. There are some evidences that calprotectin levels are normal in IBS and could be used to distinguish IBS from active IBD. The combination of these two disorders causes patients to have to take moremedications. On the other hand, their quality of life is also reduced and some mental disorders. Due to the limited therapeutic effects and side effects of pharmacologic treatment, interest in the use of probiotics as a therapeutic agent has increased. Probiotics are living microorganisms that administered in controlled amounts could benefit the host. Saccharomyces Boulardii is a yeast which is used in IBS and also is usedas a medication for treatment and prevention of various types of diarrhea in children and adults. The aim of this study was to investigate the effectiveness of yeast S. boulardii as a treatment option in concurrency of IBS and IBD. Material and Methods: This triple blind placebo controlled clinical trial was done in 2017 in Mofid Children educational hospital, Tehran, Iran. 42 patients who aged less than 16 years old with mild tomoderate IBD in concurrency with IBS were selected. The patients were divided into two groups, control group and case group. Case group received S.boulardii capsules twice daily for eight weeks. Each capsule contained 250 milligrams of Saccharomyces boulardii yeast. Also, the control group received placebo capsules (which were filled by Avicel® and had the same shape and color) in the same regimen. At thebeginning and the end of the study, fecal calprotectin, abdominal pain and quality of life were evaluated. Abdominal pain was investigated by Visual Analog Scale (VAS score) and quality of life was examined by IMPACT III questionnaire. The statistical analysis of the findings was done by SPSS software V. 25. Results: In our study 42 patients were participated and divided into two equal group. At the end 38 patientsexcluded. There were no significant differences in the sex ratio and age. According to the result there was a decline in Calprotectin throughout the treatment period in case group (P value=0.000) but in control group there were no significant changes in Calprotectin (P value=0.332). And finally total score of the IMPACT III questionnaire that we used in this study was improved significantly in case group (P value=0.003).The differences of baseline and endpoint score of pain severity between two groups suggested significa nt differences between two groups (P<0.05). Conclusion: Probiotics are live microorganisms, which when administered in adequate amounts, confer a health benefit on the host. Theuse of S. boulardii as a therapeutic probiotic is supported by its mechanisms of action, pharmacokinetics, and efficacy from animal models and clinical trials. Hence, it can be used as an effective agent in concurrency of IBS and IBD to decreases the annoying symptoms.

Keywords:

Crohn s disease , Saccharomyces boulardii , Inflammatory bowel disease , Ulcerative colitis