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CONTINUING PROFESSIONAL DEVELOPMENT
15. Jacobsen CN, Rosenfeldt Nielsen V, et al. Screening of
probiotic activities of forty-seven strains of Lactobacillus
spp. by in vitro techniques and evaluation of the
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16. Niedzielin K, Kordecki H, Birkenfeld B. A controlled, double-
blind, randomised study on the efficacy of Lactobacillus
plantarum 299v in patients with irritable bowel syndrome.
Eur J Gastro Hepat 2001;13(10):1143–7 .
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intestinal microflora is associated with reduction in
abdominal bloating and pain in patients with irritable
bowel syndrome. Am J Gastroenterol 2000;95(5):1231–8 .
18. Johansson ML, Nobaek S, Berggren A, et al. Survival of
lactobacillus plantarum DSM 9843 (299v), and effect on
the short-chain fatty acid content of faeces after ingestion
of a rose-hip drink with fermented oats. Int J Food
Microbiol 1998;42(1–2):29–38 .
19. Shepherd S, Gibson P. Fructose malabsorption and
symptoms of irritable bowel syndrome: guidelines
for effective dietary management. J Am Diet Assoc
20. Gibson PR, Shepherd SJ. Evidence-based dietary
management of functional gastrointestinal symptoms:
The FODMAP approach. J Gastroenterol Hepato 2010
21. Davis M. Drug management of visceral pain: concepts from
basic research. Pain Research and Treatment 2012. At: www.
22. Zhou Q, Price DD, Callam CS, et al. Effects of N-methyl-D -
aspartate receptor on temporal summation of second
pain (wind-up) in irritable bowel syndrome. J Pain 2011
23. Zhou Q, Fillingim RB, Riley JL 3rd, et al. Central and
peripheral hypersensitivity in irritable bowel syndrome.
24. Eby GA, Eby KL. Rapid recovery from major depression
using magnesium treatment. Med Hypotheses 2006;
25. Louzada P, Paula Lima AC, Mendonca-Silva DL, et al. Taurine
prevents neurotoxicity of beta-amyloid and glutamate
receptor agonists: activation of GABA receptors and
possible implications for Alzheimer’s disease and other
neurological disorders. FASEB J 2004;18(3):511–8 .
1. Dysbiosis is a condition that
a) A disturbance in the microbial
ecosystem within the gut that reduces
inflammation and favours health.
b) A disturbance in the microbial
ecosystem within the gut that leads to
unfavourable health outcomes.
c) A disturbance to cell replication.
d) A disturbance to cell replication within
the digestive lining.
2. Lactobacillus plantarum 299v has
a) Clinically trialled in IBS sufferers.
b) Shown to increase inflammatory stimuli.
c) Found to not have any effect on
digestive health in healthy individuals.
d) Shown to decrease mucin protein
production secreted on the surface of
intestinal epithelial cells.
3. FODMAP-containing foods have
been found to aggravate symptoms
of IBS. Which of the following should
be limited when reducing FODMAP
foods in the diet?
a) Vegetables such as mushrooms and
b) Grains such as quinoa and oats.
c) Dairy such as cheddar cheese and
d) Fruits such as grapes and passionfruit.
4. Which ONE of the following
statements about visceral
hypersensitivity and IBS is correct?
a) Visceral hypersensitivity is not
associated with the pathophysiology
b) IBS sufferers have a lower threshold for
c) Visceral hypersensitivity has no
relationship with a low tolerance of
d) The onset of IBS will never be linked to a
stressful time in an individual’s life.
often be linked to a particularly stressful
period in a person’s life, which may affect
neurotransmitter balance and allow
breakthrough visceral pain signalling
to be established. Indeed, up to 70% of
patients referred to tertiary centres with
IBS meet diagnostic criteria for anxiety
highlighting the need
to regulate nervous system function.
Nutrients such as magnesium25 and
taurine26 act to correct the NMDA:GABA
balance; therefore may be useful adjuncts
to a condition-specific probiotic and
Giving IBS sufferers their life
An unfortunately common condition, it is
now accepted that IBS isn’t just ‘all in the
head’; it has a complex and multifactorial
aetiology requiring the correction of
multiple targets to achieve the best
possible outcomes for its sufferers.
Addressing the altered intestinal
microbiota, and subsequent gut
barrier dysfunction, inflammation and
heightened pain phenomenon, is needed
to allow individuals to enjoy all aspects of
their life to the fullest without concern for
the location of the nearest bathroom.
1. Tack J, Vanuytsel T, Corsetti M. Modern management of
irritable bowel syndrome: more than motility. Dig Dis
2. MacCarville J, Caminero A, Verdu E. Novel perspectives on
therapeutic modulation of the gut microbiota. Therap Adv
Gastroenterol 2016;9(4):580–93 .
3. Basseri R, Weitsman S, Barlow GM, et al. Antibiotics for
the treatment of irritable bowel syndrome. Gastroenterol
Hepatol 2011;7(7):455–93 .
4. Gastroenterological Society of Australia. Information about
irritable bowel syndrome (IBS). 2010. At: www.gesa.org.au/
5. Carding S, Verbeke K, Vipond DT, et al. Dysbiosis of the
gut microbiota in disease. Microb Ecol Health Dis 2015;26.
6. Öhman L, Simrén M. Pathogenesis of IBS: role of
inflammation, immunity and neuroimmune interactions.
Nat Rev Gastroenterol Hepatol 2010;7:163–73.
7. Philpott H, Gibson P, Thien F. Irritable bowel syndrome
– an inflammatory disease involving mast cells. Asia Pac
8. International scientific association of probiotics and
prebiotics (ISAPP). Probiotics: a consumer guide for making
smart choices. 2016. At: http://isappscience.org/probiotics/
9. Zhang Y, Guo C, Mu D, et al. Effects of probiotic type, dose
and treatment duration on irritable bowel syndrome
diagnosed by ROME III criteria: a meta-analysis. BMC
10. Chapman C, Gibson HR. Health benefits of probiotics: are
mixtures more effective than single strains? Eur J Nutr
11. Tsuchiya J, Barreto R, Okura R, et al. Single blind follow-up
study on the effectiveness of a symbiotic preparation in
irritable bowel syndrome. Chin J Dig Dis 2004;5:169–174 .
12. Hong YS, Hong KS, Park MH et al. Metabonomic
understanding of probiotic effects in humans with irritable
bowel syndrome. J Clin Gastroenterol 2011;45(5):415–25.
13. Ducrotte P, Sawant P, Jayanthi V. Clinical trial: Lactobacillus
plantarum 299v (DSM 9843) improves symptoms of irritable
bowel syndrome. World J Gastroenterol 2012;18(30):4012–8.
14. Mack DR, Michail S, Wei S, et al. Probiotics inhibit
enteropathogenic E.coli adherence in vitro by inducing
intestinal mucin gene expression. Am J Physiol 1999;276(4
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