TOPLINE:

Individuals who take probiotics containing Bacillus subtilis and Enterococcus faecium after colonoscopy show higher levels of beneficial bacteria and earlier improvements in gastrointestinal symptoms than those receiving a placebo.

METHODOLOGY:

• Colonoscopy preparation with polyethylene glycol electrolyte can flush out bacteria and introduce oxygen into the normally anaerobic colon. Associated dysbiosis and postprocedure symptoms may be reduced with postcolonoscopy probiotics, but supporting evidence is limited.
• Researchers investigated the impact of bowel cleansing on gut microbiota and evaluated whether probiotics could restore microbiota balance and alleviate gastrointestinal symptoms among patients scheduled for colonoscopy between November 2020 and February 2022.
• Patients were randomly assigned to either a probiotic group that received capsules of live combined B subtilis and E faecium (0.5 g three times daily for 4 weeks) after colonoscopy or a placebo group that received identical placebo capsules.
• Fecal samples were collected before bowel preparation and at 1 and 4 weeks after colonoscopy. Intestinal microbiota composition was assessed using 16S ribosomal RNA sequencing.
• Gastrointestinal symptom rating scale (GSRS) total scores were obtained from patients at 1 day, 1 week, and 4 weeks after colonoscopy.

TAKEAWAY:

• There were 301 participants (59.8% female; mean age, 41.89 years), with no notable baseline differences between the placebo (n = 152) and probiotic groups (n = 149).
• Significant differences in alpha and beta diversity were observed after colonoscopy in the placebo group (P = .011 and P < .001, respectively), including growth of pathogens such as Pseudomonas and Klebsiella.
• At 4 weeks, samples from the probiotic group had notably greater enrichment of beneficial bacteria such as Enterococcus, Bacilli, and Lactobacillales than both 4-week placebo samples and the probiotic group’s precolonoscopy samples.
• Patients in the probiotic group experienced significant improvements in GSRS total scores within the first week (P = .005) and fewer days of abdominal discomfort (P = .034) than those in the placebo group.
• Among probiotic group patients who did not achieve GSRS improvement, significant changes in both alpha and beta diversity were still observed from baseline to 4 weeks, including elevated Bacteroides concentration.

IN PRACTICE:

“The administration of probiotics (E faecium and B subtilis) can potentially recalibrate the gut microbiota after colonoscopy, and this may encourage the enrichment of beneficial strains such as Lactobacillales, heighten energy metabolism, and alleviate abdominal discomfort, thus enabling patients to revert to their normal state more swiftly,” the authors of the study wrote.

SOURCE:

The study was led by Haoqi Wei, Jue Wang, Xiao Xiao, and Xu Xiao, Army Medical University, The First Affiliated Hospital of Chongqing Medical University, Chongqing Emergency Medical Center, Chongqing, China. It was published online in the Journal of Gastroenterology and Hepatology.

LIMITATIONS:

The trial only tested one type of probiotic and did not account for personalized supplementation. Objective markers such as calprotectin and motility measures were not assessed.

DISCLOSURES:

The study was supported by the Joint Medical Research Project of the Chongqing Science and Technology Commission and the Chongqing Middle-Aged and Young Medical High-End Talent Project. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.