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By: Kristin IzzoPreceptors: Lauren Melnick, MS, RD, LD & Anne Furman, RD, LDNTRN 561 Fall 2014November 24, 2014
LACTOBACILLUS SALIVARIUS SALIVARIUS
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Small Intestinal Bacterial Overgrowth13
SBS, Liver, gastric bypass…Symptoms, translocation2,4,18, & complications
Probiotic therapy1,3 ,10,21,24
Gut Micro-biomeRole of Antibiotics
BACKGROUND
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Previous ResearchSafe and tolerable in adult patients3,23,24
Food sources – yogurt, miso, & kefir…Why this strain?19
Lactobacillus Salivarius Salivarius (LSS)
BACKGROUND CONTINUED
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Specific Aim 1:Determine if a daily intake of 108 of LSS will reduce severity of symptoms of SIBO
Who:Cleveland Clinic Center for Gut Rehabilitation and Transplantation
Expectation:6-month time periodDecreased symptoms associated with SIBO
SPECIFIC AIMS
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Impaired gut barrierMechanism poorly understood18
Decrease and/or prevent SIBO4,10,18,27
Decrease risk for morbidity & mortality11,23
Public HealthEstablish standard of care Improve quality of lifeAffordable
SIGNIFICANCE
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Patients in Gut RehabilitationPresenting with diarrhea, constipation, n/v, gas, bloating, or abdominal pain
Measures – taken by phoneSymptoms/Severity – Original Likert ScaleCompliance
Diet instruction – Low residueProbiotic use instruction
RESEARCH METHODS
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Statistical AnalysisMantel-Haenszel - ordinal variablesSpearman’s correlation coeffi cient –SIBO symptoms and supplement association
Student’s t-test – continuous variablesFisher’s exact and Pearson’s chi-square – categorical variables
Kaplan-Meier plot and log rank test – time-to symptoms of SIBO between subjects
RESEARCH METHODS
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Power CalculationQuality Improvement StudyOriginal data collection scale If validated, could be used in future studies
Not clear how many participants will be needed for significance
RESEARCH METHODS
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Breath TestExpense
DietVariable and compliance
Other Treatments Independent variable
Self-reported severity Subjective
POTENTIAL LIMITATIONS
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Future ImplicationsSpecific disease statesProbiotic independent of other treatmentsValidated scale toolRecommended diet
ALTERNATIVE APPROACHES
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RecruitNovember 2014 – January 2015
Follow Symptoms and ComplianceBaseline3 months6 months (final)
PROJECT TIMELINE
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3. Chatterjee S, Kar P, Das T, et al . Randomised placebo-control led double bl ind multicentric tr ial on effi cacy and safety of lactobaci l lus acidophi lus LA-5 and bifi dobacterium BB-12 for prevention of antibiotic-associated diarrhoea. J Assoc Physicians India . 2013;61(10):708-712.
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