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Targeting gut microbiota to successfully treat infant colic

A small Italian trial into infant colic found that drops containing a particular probiotic strain reduced the duration of daily crying by more than 50% in 80% of the 40 infants who received the probiotic once daily for 28 days, with beneficial effects on sleep duration and on stool frequency and consistency.

Probiotics – or "good bacteria" – have been used to treat infant colic with varying success. In a new trial, investigators have shown that drops containing a particular probiotic strain (Bifidobacterium animalis subsp. lactis BB-12) reduced the duration of daily crying by more than 50% in 80% of the 40 infants who received the probiotic once daily for 28 days, with beneficial effects on sleep duration and on stool frequency and consistency.

This compared with only 32.5% of the 40 infants who received placebo.

Infant colic is a very common gastrointestinal disorder affecting up to 25% of infants in the first 3 months of life, and although it is a benign condition, it is source of major distress for the infants and their families. It is associated with maternal postpartum depression, early breastfeeding cessation, parental guilt and frustration, shaken baby syndrome, multiple physician visits, drugs use, formula changing, and long-term adverse outcomes such as allergies and behaviour and sleep problems.

The effect seen in the study was associated with a positive modulation of the gut microbiome, with increased bacterial production of butyrate, a short chain fatty acid that is able to positively regulate intestinal transit time, pain perception, the gut-brain axis, and inflammation.

"Our study provides evidence on the important role of gut microbiota as a target of intervention against infant colic," said senior author Dr Roberto Berni Canani, of the University of Naples "Federico II," in Italy. "It is relevant to underline that this trial studied a specific well-characterised probiotic strain, and that these findings cannot be extrapolated for other probiotic strains."

Abstract
Background: The pathogenesis of infant colic is poorly defined. Gut microbiota seems to be involved, supporting the potential therapeutic role of probiotics.
Aims: To assess the rate of infants with a reduction of ≥50% of mean daily crying duration after 28 days of intervention with the probiotic Bifidobacterium animalis subsp. lactis BB‐12® (BB‐12). Secondary outcomes were daily number of crying episodes, sleeping time, number of bowel movements and stool consistency.
Methods: Randomized controlled trial (RCT) on otherwise healthy exclusively breastfed infants with infant colic randomly allocated to receive BB‐12 (1 × 109 CFU/day) or placebo for 28 days. Gut microbiota structure and butyrate, beta‐defensin‐2 (HBD‐2), cathelicidin (LL‐37), secretory IgA (sIgA) and faecal calprotectin levels were assessed.

Results: Eighty infants were randomised, 40/group. The rate of infants with reduction of ≥50% of mean daily crying duration was higher in infants treated with BB‐12, starting from the end of 2nd week. No infant relapsed when treatment was stopped. The mean number of crying episodes decreased in both groups, but with a higher effect in BB‐12 group (−4.7 ± 3.4 vs −2.3 ± 2.2, P < 0.05). Mean daily stool frequency decreased in both groups but the effect was significantly higher in the BB‐12 group; stool consistency was similar between the two groups. An increase in Bifidobacterium abundance (with significant correlation with crying time reduction), butyrate and HBD‐2, LL‐37, sIgA levels associated with a decrease in faecal calprotectin level were observed in the BB‐12 group.
Conclusions: Supplementation with BB‐12 is effective in managing infant colic. The effect could derive from immune and non‐immune mechanisms associated with a modulation of gut microbiota structure and function.

Authors
Rita Nocerino, Francesca De Filippis, Gaetano Cecere, Antonio Marino, Maria Micillo, Carmen Di Scala, Carmen de Caro, Antonio Calignano, Cristina Bruno, Lorella Paparo, Anna M Iannicelli, Linda Cosenza, Ylenia Maddalena, Giusy della Gatta, Serena Coppola, Laura Carucci, Danilo Ercolini, Roberto Berni Canan

[link url="https://www.sciencedaily.com/releases/2019/12/191204145840.htm"]Wiley material[/link]

[link url="https://onlinelibrary.wiley.com/doi/full/10.1111/apt.15561"]Alimentary Pharmacology & Therapeutics abstract[/link]

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