by Noelle Patno, PhD
Colonoscopy is one of the most common medical procedures, used for screening various bowel diseases, including colon cancer, to examine for any pathological findings (e.g. polyps, ulcers, or inflamed tissue). Barriers to colonoscopy include patients’ fears related to invasiveness, pain, or complications.1
Complications may be as minor as bloating or as severe as bowel perforation (rare); factors that may predict increased risk for complication include insufficient bowel preparation (not completely cleaned out and therefore more difficult to visualize the tissue) or incomplete colonoscopy (for example, not completely scoped due to not fully cleaned intestine or tumor obstruction).2
In reality, the incidence of minor adverse events is quite low, typically occurring within the first two days after the colonoscopy and uncommon after two weeks.3 Most people go to work the day after the colonoscopy, but in some cases, feeling sleepy, weak, or significantly bloated and in abdominal pain may cause people to miss work.4 While the majority of studies related to colonoscopy evaluate new technologies to improve bowel preparation5-7 and pain during the procedure,8,9 less research focuses on the majority of minor symptoms occurring post-procedure. One of these pain-reducing techniques is carbon dioxide insufflation, (not available at all sites for colonoscopy procedures) which can reduce pain during and after colonoscopy.8-9 Experiences after colonoscopy render it less likely for patients to return for future endoscopies if they are needed,10 so more techniques to improve the post-colonoscopy experience are warranted.
Since the gut microbiota is severely disrupted if not obliterated during bowel cleansing (and this dysbiosis contributes to symptoms of bloating and pain), probiotics may be a potential option to improve gastrointestinal (GI) symptoms post-colonoscopy. Recently, a combination of probiotic strains consumed post-colonoscopy was evaluated for the endpoints of bloating, abdominal pain, and altered bowel function.11
Study characteristics include:11
Major findings include:11
1) Pain reduction by ~19 hours for those consuming the NCFM + Bi-07 probiotic. Specifically, the number of pain days post-colonoscopy decreased from 2.78 to 1.99 (p=0.032).
2) Subgroup analyses demonstrated that patients with pre-existing abdominal pain receiving the probiotic intervention experienced fewer pain days (2.16 vs. 4.08, p=0.0498)
3) There were non-significant decreases in bloating (2.52 vs. 2 days, p=0.111) and time to return to normal bowel habits (3.42 to 3.05, p=0.280).
The authors propose that the dual-strain probiotic supplement may have facilitated improvements via several possible mechanisms: inhibiting pathogens from binding, modulating the immune system, and improving colonic motility and transit, as well as affect the sensitivity of the intestines.11 Lactobacillus acidophilus NCFM12 and Bifidobacterium lactis Bi-07 have been isolated from human sources and have been extensively studied in preclinical and clinical studies and widely used, particularly together in RCTs demonstrating immune benefits in children13 and adults.14 NCFM and Bi-07 have been shown to aid in pain relief from bloating in a double-blind, placebo-controlled trial in patients with functional bowel disorder15 as well as in case reports of irritable bowel syndrome.16
The D’Souza et al. publication described above demonstrates another application for the NCFM and Bi-07 probiotic strain combination, beyond its immune and GI benefits, for the specific attenuation of pain post-colonoscopy.11
Noelle Patno, PhD
Dr. Noelle Patno is the Nutrition Scientist for Digestive Health at Metagenics. Dr. Patno received her PhD in Molecular Metabolism and Nutrition and Masters in Translational Science from the University of Chicago, studying the role of microbial components in intestinal epithelial cell survival related to inflammatory bowel disease. Prior to her graduate studies, Dr. Patno received a chemical engineering degree from Stanford University and worked as an engineer. She has personal experience and interest in preventive nutrition and nutritional therapies for chronic disease, and her current role involves researching and developing probiotics, prebiotics, and other nutritional programs for the promotion of digestive and overall health.