Introduction

Irritable Bowel Syndrome (IBS) is a chronic disorder of the gut-brain interaction characterized by visceral hypersensitivity. There is growing evidence underscoring the beneficial impact of probiotics and postbiotics with psychobiotics properties in relieving stress-related gastrointestinal disorders in humans especially in patients suffering from IBS. We have previously shown that high GABA-producer L. lactis CNCM I-5388 exerts antinociceptive properties after 5- and 10-days oral treatment in an IBS-like rat model. We demonstrated, using both mutant L. lactis ΔgadB strains and GABA_B receptor antagonist that these antinociceptive properties were dependent on the GAD-enzymatic activity of L. lactis and mediated by host’s GABA_B receptors. In addition, we have shown that CNCM I-5388 displayed a high cell-bound GAD activity and survival in vitro under HCl-mediated acidic stress.

Aims & Methods

In this work, we were interested in studying the GABA-producer L. lactis CNCM I-5388 as an active-enzyme postbiotic to relieve visceral hypersensitivity mediated by a psychological stress.
L.lactis CNCM I-5388 was inactivated by ethanol (EtOH) while maintaining its GAD activity. Female Wistar rats were treated orally for 1, 5 or 10 days by the EtOH-treated nonviable L.lactis CNCM I-5388 form or the viable L. lactis CNCM I-5388 or vehicle. Visceral sensitivity in response to colorectal distension was measured by electromyography before and after partial restraint stress (PRS). GABA levels were quantified by HPLC both in the stomach collected from rats and in the gastric compartment of the TIM-1 human gut model in fed state.

Results

A daily treatment for 5 and 10 days by L. lactis CNCM I-5388 both in its viable and nonviable forms counteracted visceral hypersensitivity-induced by PRS in response to colorectal distension. However, after a single administration only viable L. lactis CNCM I-5388 tended to reduce visceral hypersensitivity. After 5-days treatment, the production of GABA within the stomach was enhanced in stressed rats treated with the viable or nonviable L. lactis CNCM I-5388 form. This increase was confirmed by using the TIM-1 human gut model.

Conclusion

Our results highlight that a postbiotic with an active-GAD of L. lactis CNCM I-5388, similarly to its viable psychobiotic form, exerts visceral antinociceptive properties in an IBS-like rat model. These effects are associated with GABA production in the stomach where the low pH promotes GAD activity. From a clinical point of view, this “active GAD-bag” concept offers a new therapeutic perspective in the management of visceral pain in IBS patients with a superior safety profile compared with GABA-producing pyschobiotics that could acquire antibiotic resistance and virulence factors in chronic use.

Disclosure

Jonna Koper, Elyse Parent, Nabil Bosco, Nathalie Ballet and Sophie Legrain-Raspaud are full-time employees of Lesaffre. None of the authors have a conflict of interest.

Introduction

Irritable bowel syndrome (IBS) is considered a disorder of the altered microbiota-gut-brain axis, where gut dysbiosis and impaired central nervous system processing play important roles. The latter, in the form of depression, anxiety, and gastrointestinal-specific anxiety (GSA), frequently coexist and exacerbate IBS. Probiotics might be a promising therapeutic approach to treat IBS and coexisting depression, anxiety, and GSA.

Aims & Methods

The aim of the trial was to compare the impact of standard care combined with multi-strain probiotics with standard care alone on depression, anxiety, and visceral sensitivity in patients with diarrheal IBS (IBS-D). It was a 12-week randomized trial that included 108 patients with IBS-D that were divided into 2 groups: a control group (n = 51) receiving only standard care (diet, peppermint oil) and an experimental group (n = 57) receiving a combination of standard care (diet, peppermint oil) and the study probiotic (based on Lactobacillus, Streptococcus, Bifidobacterium, and Saccharomyces boulardii strains). Patient Health Questionnaire-9 (PHQ-9) and Beck’s Depression Inventory (BDI) were used to assess depression; the Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression; and the Visceral Sensitivity Index (VSI) was used to assess GSA.

Results

Baseline data were not different between the study groups (p> 0.05). After 12 weeks of treatment, PHQ-9, BDI, and anxiety subscale of HADS were not different between the study groups (p> 0.05), while the central tendency of the depression subscale of HADS in the control group was higher (3 (2-4)) than in the experimental group (3 (2-3)), p = 0.046. VSI was higher in the control group (31±5) compared to the experimental group (29±5.7), p = 0.032, after 12 weeks of trial.

Conclusion

In patients with IBS, additional prescribing of a multi-strain probiotic led to a decrease in depression according to HADS, as well as a reduction in GSA and visceral sensitivity assessed by VSI compared to IBS standard care alone.

Introduction

Recents meta-analyses have shown that Tegoprazan (Tego) could be equal or superior to proton pump inhibitors in the eradication of Helicobacter pylori (HP). However, virtually all primary studies have been conducted in Asian populations, so validation in other regions is required.

Aims & Methods

Aim: To assess the efficacy and safety of Tego compared to Esomeprazole (Eso) in Latin population. Methods: We studied 117 consecutive treatment-naive HP infected patients [51.04±12.11 (48.85-53.24) years, 75% females] evidenced by endoscopic biopsy. Patients were randomized to receive either Tego (50 mg) or Eso (40 mg), both in combination with Amoxicillin (1 g) and Clarithromycin (500 mg), all administered twice daily for 14 days. Treatment efficacy was assessed using a urea breath test performed 35±2 days post-therapy. Treatment safety was monitored by recording adverse events. Additionally, dyspeptic symptoms, general laboratories and quality of life (SF-36 questionnaire) were assessed. Data expressed mean±SD and 95% CI or percentages, while statistical differences were evaluated with the unpaired and paired Student t test or the chi-square test, as appropriate. Alpha = 0.05.

Results

There were no differences between Tego and Eso groups in age [51±12.14 (47.79-54.21) vs. 51.08±12.28 (48.02-54.14) years respectively, p= 0.97] or sex (75.4% vs. 74.6% women respectively, p=0.76). Tego and Eso groups showed similar efficacy (94.55% vs 93.55% respectively, p=0.82) and adverse events (14.55% vs 22.58% respectively, p=0.26). Main symptoms in Tego group were diarrhea (n=4) and headache (n=2) meanwhile Eso group referred diarrhea (n=4) and abdominal pain (n=4). All adverse events were mild and suspend treatment was not required. Dyspeptic symptoms decreased after treatment in both Tego (78.88% vs 45.45%, p=0.0004) and Eso (79.03% vs 46.77%, p=0.0002) groups but there were no differences before (p=0.9108) and after (p=0.8864) treatment between them. There were no differences in the 18 components of the general laboratories (all in normal range) between groups before and after treatment. Physical component summary (CS) improved post treatment in both Tego [48.56±13.96 (44.87-52.25) vs 51.83±13.17 (48.35-55.31), p=0.03] and Eso [46.95±11.35 (44.13-49.78) vs 52.29±13.22 (49-55.58), p=0.01] groups. Mental CS showed no differences after treatment en Tego [47.35±5.99 (45.77-48.94) vs 47.8±6.48 (46.09-49.51), p=0.62] nor Eso [47.51±6.67 (45.86-49.17) vs 47.82±5.39 (46.47-49.16), p=0.78] groups. There was no difference in physical or mental CS between Tego and Eso groups before (p=0.49 and p=0.85, respectively) or post treatment (p=0.89 and p=0.98, respectively) Table 1.

Table 1. The 8 domains of SF-36 in both groups (*p<0.05 vs basal)

Conclusion

Our work shows that Tegoprazan is equally effective and safe as Esomeprazole for triple therapy to eradicate Helicobacter pylori in Latin population. We also found that eradication treatment improves general health, physical functioning, and physical component summary, which warrants further investigation. Clinical Trials registration: NCT06318104.

References

(/10.1080/14787210.2025.2459722) (10.1002/jgh3.70134)

Disclosure

We would like to thank Carnot Laboratories for providing tegoprazan for this study.