Outcome of treatment with butyric acid in irritable bowel syndrome – preliminary report

Tarnowski, W et al., Gastroenterologia Praktyczna, 2011:1(8),43-48

Introduction

Irritable bowel syndrome (IBS) leads to a range of disabling gastrointestinal symptoms that significantly affect quality of life and can lead to frequent work absenteeism. Although IBS is the most common functional gastrointestinal disorder, its underlying causes are yet to be fully explained and most treatments are symptomatic and ineffective. Butyric acid (or ‘butyrate’), produced by degradation of carbohydrates by large intestinal microorganisms, has been actively researched for many years for the essential roles it plays in the health of colonocytes as a source of energy, proliferation regulator, apoptosis inhibitor, and via anti-inflammatory effects. Butyrate also prevents the excessive loss of water and sodium and regulates bowel motility. Until recently, the clinical use of butyrate has been limited by intense proximal metabolism. However, new lipid matrix formulations that allow for slow release of butyrate have made the administration of this vital molecule practically possible.

Aims and Methods

A Polish study of 59 with newly diagnosed IBS diagnosed on the basis of the Rome II Criteria evaluated the clinical usefulness and effect on quality of life of protected butyrate as additive therapy. Enrolled patients were randomised to treatment with either (i) first-line conservative treatment (n=29) depending on the IBS type (constipation/mixed ± bloating, diarrhea) in addition to a 10-day antibiotic therapy, or (ii) first-line conservative treatment, a 10-day antibiotic therapy + sodium butyrate 300 mg daily (n=30). Patients were assessed at baseline and 6 weeks according to symptom severity self-report scales (0-5) that assessed abdominal discomfort or pain, disturbance in bowel habits (the frequency of diarrhea/constipation), bloating, and other symptoms (urgency, feeling of incomplete bowel movement, straining during defecation, mucus in the stool, nausea, vomiting). The impact of treatment on quality of life was also assessed using the standard IBS-QoL questionnaire.

Results

Patients in both treatment arms were well matched at baseline in terms of demographics, clinical characteristics, and quality of life scores. After 6 weeks of treatment, patients receiving butyrate had significant improvements in discomfort and pain, defecation disorders, and quality of life compared with patients who received conventional treatment only (P<0.05). Bloating and other disease symptoms, including urgency and feeling of incomplete bowel movement also improved with butyrate but to a similar extent to that seen with conventional treatment.

Discussion

The enhanced improvements in symptoms and quality of life with butyrate over conventional treatments may relate its important physiological role in regulating intestinal motility, sodium / water absorption and the local immune system in the intestinal mucosa. The finding that IBS significantly reduces butyric acid production provides additional support for a role for butyrate in IBS. Further studies are needed to confirm the benefits of butyrate, especially with long-term administration. However, these results suggest that a protected butyrate formulation can lessen the clinical symptoms of IBS with associated improvements in quality of life even during short-term administration.

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