Probiotics are live microorganisms capable of colonizing the intestinal tract, altering the microflora, and exerting a positive effect on the host. The mechanism by which probiotics exert positive effects remains to be elucidated. However, purported mechanisms include antagonizing pathogens through the production of antimicrobial or antibacterial compounds, decreasing gut pH by stimulating lactic-acid producing bacteria, preventing colonization of pathogenic microorganisms by competing for binding sites, improving immune function, competing with pathogens for nutrients and growth factors, producing lactase to aid lactose digestion, and signaling cells to stop production of virulence factors. Probiotics have been used for the treatment of diarrhea and constipation. Preoperative probiotics were examined for prevention of infection in patients undergoing colorectal surgery.
Higashikawa, F., Noda, M., Awaya, T., Nomura, K., Oku, H., & Sugiyama, M. (2010). Improvement of constipation and liver function by plant-derived lactic acid bacteria: A double-blind, randomized trial. Nutrition, 26, 367–374.
To evaluate the effects of yogurts made with different types of lactic acid bacteria (LAB) on the gastrointestinal system.
Participants were recruited via advertisement. Consenting patients were assigned using stratified randomization by defecation frequencies to receive one of three types of yogurt.
Participants consumed 100 g of yogurt daily for a six-week period. Data were collected from clinic visits at two-week intervals.
This was a randomized, double-blind study.
Bristol Stool Form Scale
In healthy adults, Lb. plantarum SN13T may improve serum lipid levels and liver function. Actual effects in relieving constipation are unclear.
Effects in relieving constipation are unclear in healthy adults. Additional studies are warranted that include a larger sample and patients with cancer.
Liu, J., & Huang, X.E. (2014). Efficacy of bifidobacterium tetragenous viable bacteria tablets for cancer patients with functional constipation. Asian Pacific Journal of Cancer Prevention, 15, 10241–10244.
To determine the efficacy and tolerance of using a probiotic to treat functional constipation in patients receiving chemotherapy
All patients received chemotherapy appropriate for their diagnosis. Patients were divided into two groups. The treatment group received, in addition to chemotherapy, Bifidobacterium tetragenous viable bacteria tablets three times a day for four weeks.
There was significant improvement of functional constipation (p < 0.05) with the use of four Bifidobacterium tetragenous viable bacteria tablets.
Probiotics may be beneficial for some patients receiving chemotherapy who suffer from functional constipation.
Additional research on the use of probiotics and a variety of chemotherapy regimens in patients with functional constipation needs to be completed.
Ohigashi, S., Hoshino, Y., Ohde, S., & Onodera, H. (2011). Functional outcome, quality of life, and efficacy of probiotics in postoperative patients with colorectal cancer. Surgery Today, 41, 1200–1206.
To compare functional outcome and quality of life (QOL) in patients who received surgical resection for rectal versus colon cancer, and to review the efficacy of the use of probiotics in bowel function afterwards.
A questionnaire was sent to 193 patients with non–stage IV colon cancer. Some patients with stage III disease received adjuvant chemotherapy over the six-month postoperative period, but no patients were undergoing chemotherapy when the questionnaire was administered. Seventy-seven respondents agreed to take probiotics. Patients received a probiotic that contained Bacillus natto and Lactobacillus acidophilus as the principal ingredients.
Patients took three tablets after meals TID for a total of nine tablets. The questionnaire was readministered three months after probiotic initiation.
This was a questionnaire-based study with a cross-sectional design.
Some improvements were observed in all groups after the administration of probiotics. Changes in defecation and related symptoms differed according to disease location over time. The role of probiotic use cannot be determined from this study report.
The study did not provide sufficient evidence to demonstrate the efficacy of probiotic use for managing bowel symptoms in patients after colorectal surgery. However, the study showed differences in bowel symptoms based on initial tumor location and surgical area.
Bharucha, A.E., Pemberton, J.H., & Locke, G.R., 3rd. (2013). American Gastroenterological Association technical review on constipation. Gastroenterology, 144, 218–238.
To identify rational, effective, and cost-effective treatment approaches for patients with constipation.
In this evidence-based guideline, material was selected from reviews and focused literature searches of peer-reviewed published studies.
Databases searched, search keywords, and inclusion criteria were not stated.
Studies were excluded if they reported on children or patients with constipation as a secondary symptom caused by problems such as spinal cord injury.
The study has clinical applicability to older adult and palliative care.
Evidence was categorized according to the U.S. Preventive Services Task Force grading system. Rome II criteria were used to define constipation. The resource identified causes of constipation, approaches for assessment, and recommendations for management based on evidence review. In addition to opiates, other causative agents associated with constipation in patients with cancer were antidepressants, anticholinergic agents, vinca alkaloids, vincristine, and cyclophosphamide.
Limited high-quality evidence exists for effective interventions in managing constipation.