By: Kristin IzzoPreceptors: Lauren Melnick, MS, RD, LD & Anne Furman, RD, LDNTRN 561 Fall 2014November 24, 2014

LACTOBACILLUS SALIVARIUS SALIVARIUS

Small Intestinal Bacterial Overgrowth13

SBS, Liver, gastric bypass…Symptoms, translocation2,4,18, & complications

Probiotic therapy1,3 ,10,21,24

Gut Micro-biomeRole of Antibiotics

BACKGROUND

Previous ResearchSafe and tolerable in adult patients3,23,24

Food sources – yogurt, miso, & kefir…Why this strain?19

Lactobacillus Salivarius Salivarius (LSS)

BACKGROUND CONTINUED

Specific Aim 1:Determine if a daily intake of 108 of LSS will reduce severity of symptoms of SIBO

Who:Cleveland Clinic Center for Gut Rehabilitation and Transplantation

Expectation:6-month time periodDecreased symptoms associated with SIBO

SPECIFIC AIMS

Impaired gut barrierMechanism poorly understood18

Decrease and/or prevent SIBO4,10,18,27

Decrease risk for morbidity & mortality11,23

Public HealthEstablish standard of care Improve quality of lifeAffordable

SIGNIFICANCE

Patients in Gut RehabilitationPresenting with diarrhea, constipation, n/v, gas, bloating, or abdominal pain

Measures – taken by phoneSymptoms/Severity – Original Likert ScaleCompliance

Diet instruction – Low residueProbiotic use instruction

RESEARCH METHODS

Statistical AnalysisMantel-Haenszel - ordinal variablesSpearman’s correlation coeffi cient –SIBO symptoms and supplement association

Student’s t-test – continuous variablesFisher’s exact and Pearson’s chi-square – categorical variables

Kaplan-Meier plot and log rank test – time-to symptoms of SIBO between subjects

RESEARCH METHODS

Power CalculationQuality Improvement StudyOriginal data collection scale If validated, could be used in future studies

Not clear how many participants will be needed for significance

RESEARCH METHODS

Breath TestExpense

DietVariable and compliance

Other Treatments Independent variable

Self-reported severity Subjective

POTENTIAL LIMITATIONS

Future ImplicationsSpecific disease statesProbiotic independent of other treatmentsValidated scale toolRecommended diet

ALTERNATIVE APPROACHES

RecruitNovember 2014 – January 2015

Follow Symptoms and ComplianceBaseline3 months6 months (final)

PROJECT TIMELINE

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2. Berg RD, Garl ington AW. Translocation of certain indigenous bacteria from the gastrointestinal tract to the mesenteric lymph nodes and other organs in a gnotobiotic mouse model. Infect Immun . 1979;23(2):403-411.

3. Chatterjee S, Kar P, Das T, et al . Randomised placebo-control led double bl ind multicentric tr ial on effi cacy and safety of lactobaci l lus acidophi lus LA-5 and bifi dobacterium BB-12 for prevention of antibiotic-associated diarrhoea. J Assoc Physicians India . 2013;61(10):708-712.

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5. Godoy BZ, Faintuch J , Marin ML, Nogueira MA, Pinto VB, Pol lara WM. Off label pharmacological therapy in patients with short bowel syndrome. Eur Rev Med Pharmacol Sci . 2013;17(24):3285-3290. doi: 6165 [pi i ] .

6. Haiser HJ, Turnbaugh PJ . Is i t t ime for a metagenomic basis of therapeutics? Science . 2012;336(6086):1253-1255. doi: 10.1126/science.1224396 [doi].

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