Efficacy of L. reuteri DSM 17938 in the Treatment of Infantile Colic
Infantile colic represents a syndrome of behavioral disorders in infants characterized by episodes of uncontrollable crying, wailing, and restlessness without an identifiable cause. This is a common health issue affecting an estimated 5–40% of infants. There are no uniform criteria for the treatment of this benign condition yet, but available studies show a beneficial effect from administering probiotics containing Limosilactobacillus reuteri (previously known as Lactobacillus reuteri) compared with placebo and other treatment methods.
Stressful Symptoms of Infantile Colic
The main diagnostic signs of infantile colic include episodes of crying and screaming lasting at least 3 hours a day, occurring at least 3 days a week, for a minimum of 3 weeks (the so-called rule of 3). The child also shows no signs of poor growth, malnutrition, fever, infectious disease, or other illnesses. Infantile colic can manifest as early as 1–2 weeks of age with maximum crying and restlessness occurring at 6–8 weeks. These issues then gradually subside and disappear between the 3rd and 4th months of age.
Although this is a benign condition, infantile colic is a stressful situation for parents, often leading to seeking medical care. The exact etiology of the condition has not yet been fully elucidated, but some studies suggest differences in the gut microbiota composition between infants suffering from colic and healthy infants.
Efficacy of Various Treatment Methods in Clinical Research
Savino et al. published a study in 2004 evaluating the composition of gut microflora in exclusively breastfed infants. In the group of infants suffering from colic, there was more frequent absence of intestinal colonization by bacteria of the genus Lactobacillus and more frequent colonization by anaerobic gram-negative bacteria. Following these findings, further clinical studies were published, noting a positive effect from administering probiotics containing L. reuteri DSM 17938 on alleviating symptoms of infantile colic.
Various other treatment methods are also employed in the therapy of infantile colic, such as dietary and nutritional measures, pharmacotherapy, phytotherapy, acupuncture, manipulation, and massage. The aim of the study conducted by Gutiérrez-Castrellón et al. in 2017 was to supplement the lacking comprehensive data on the efficacy of individual treatment regimens.
Methodology and Results
To perform the analysis, studies published between 1960 and 2015 were searched in various internet databases. The primary aim was to assess the efficacy of individual treatment methods based on the duration of the child's crying after 21–28 days of therapy. A total of 32 randomized clinical trials involving 2242 participants met the inclusion criteria. The studies assessed 9 treatment interventions in total (probiotics containing L. reuteri DSM 17938 [n = 175]; dietary and nutritional measures [n = 324]; pharmacotherapy [n = 150]; phytotherapy [n = 133]; acupuncture [n = 81]; manipulation [n = 136]; massage [n = 48]; education [n = 84]; placebo [n = 1111]).
The average age of the children was 35 days (8 days to 3 months), with girls constituting 56% of the study group. The risk of bias was rated as low for studies with L. reuteri and moderate for the other studies. In a plot analysis, studies comparing L. reuteri or dietary measures or acupuncture to controls were evaluated as having the greatest impact.
Regarding efficacy, superiority was identified for L. reuteri DSM 17938 (WMD –51.3 hours; 95% confidence interval [CI] –72.2 to –30.5 hours; p = 0.0001) and dietary measures (WMD –37.4 hours; 95% CI –56.1 to –18.7 hours; p = 0.0001) when considering the weighted mean difference (WMD) and heterogeneity of the studies. The SUCRA method ranked the efficacy of individual treatment modalities, showing that administering probiotics with L. reuteri DSM 17938 was the most effective therapeutic approach.
Conclusion
The results of the above-described network meta-analysis of clinical studies concluded that the most effective modality in the therapy of infantile colic is probiotics containing L. reuteri DSM 17938 in a dose of 108 CFU/day compared not only to placebo but also to other treatment options. Superiority compared with other methods was also demonstrated for dietary measures.
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Sources:
1. Gutiérrez-Castrellón P., Indrio F., Bolio-Galvis A. et al. Efficacy of Lactobacillus reuteri DSM 17938 for infantile colic: systematic review with network meta-analysis. Medicine (Baltimore) 2017; 96 (51): e9375, doi: 10.1097/MD.0000000000009375.
2. Savino F., Cresi F., Pautasso S. et al. Intestinal microflora in breastfed colicky and non-colicky infants. Acta Paediatr 2004; 93 (6): 825–829, doi: 10.1111/j.1651-2227.2004.tb03025.x.
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