This study aimed to evaluate the effects of a synbiotic, comprised of a mixture of Lactobacillus and Bifidobacterium, together with fructooligosaccharide, on bowel symptoms, fecal calprotectin levels, fecal microbiota, and safety in FDR patients with high fecal calprotectin levels.

An individual with functional diarrhea is someone who has had more than 25% loose or watery stools (Bristol stool types 6 or 7) for the past three months without having predominant abdominal pain or bothersome bloating.

As a result, patients with irritable bowel syndrome with diarrhea (IBS-D) should not be diagnosed with FDR. A recent global prevalence survey shows that FDR accounts for 4.7% of functional gastrointestinal disorders (FGIDs), more than one-tenth of all FGIDs.

Due to its higher prevalence than IBS (4%) in the survey, FDR is one of the functional digestive diseases most likely to result in hospital visits.

Although the pathophysiology of FDR remains unclear, emerging evidence suggests altered gut microbiota may be critical to FDR pathogenesis; alterations in gut microbiota may also play a role in IBS-D.

A recent meta-analysis found that patients with IBS-D had decreased microbial diversity and richness in their gut microbiota. In addition, compared to healthy controls or IBS patients with constipation, Lactobacillus, Bifidobacterium, and Faecalibacterium prausnitzii significantly reduced.

For patients with functional bowel disorders, synbiotics, such as probiotics and prebiotics, are helpful.

The study involved forty patients, 20 of whom were randomly assigned to the synbiotic group and 19 to the placebo group completed the study (8 weeks).

A sachet of multi-strain synbiotic was given twice a day to the synbiotic group, while one sachet of placebo was administered twice daily to the placebo group. Probiotics, prebiotics, antibiotics, H2 blockers, and proton pump inhibitors were prohibited during the study period. 

The main objective of this study was to compare the effects of the synbiotic on daily intestinal symptoms to a placebo. 

Hence, the researchers recorded the frequency of bowel movements, the number of diarrhea events, the hardness of their stool (as determined by the Bristol stool scale), and their satisfaction with bowel movements daily.

Changes in the symptoms of functional diarrhea, fecal calprotectin levels, and gut microbiota were assessed as a result of the intervention.

Synbiotic participants had an increase in bowel movements at 4 and 8 weeks, with a significant increase in solid rather than loose stools (p < 0.05). There was a substantial increase in bowel movement satisfaction in the synbiotic group but not in the placebo group.

An analysis of intestinal flora at the end of the intervention showed that Lactobacillales at the order level were increased only in the synbiotic group.

Consequently, a significant decrease in log-transformed fecal calprotectin levels was observed in the synbiotic group by week 8, but not significantly different from the placebo.

The results suggest that functional diarrhea patients with high fecal calprotectin levels may benefit from taking a synbiotic containing multi-strains for eight weeks.

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