S1099 Effect of Bacillus coagulans as a Psychobiotic on Anxiety, Depression, and Quality of Life in Patients With Irritable Bowel Syndrome: A Systematic Review

Introduction: Five to 10% of people worldwide suffer from irritable bowel syndrome (IBS). Up to one-third of these patients also have comorbid anxiety or depression. Psychobiotics are defined as probiotics that, when ingested in adequate amounts, confer mental health benefits to the host through interactions with the gut microbiota. With the gut–brain axis being increasingly recognized as a critical mediator between gastrointestinal and psychological symptoms, we sought to review randomized controlled trials (RCTs) assessing the impact of live strains of Bacillus coagulans (B. coagulans) on anxiety, depression, and quality of life (QoL) in adults with IBS. Methods: We conducted a thorough search of PubMed, Embase, and ClinicalTrials.gov. To find randomized controlled trials assessing the impact of live strains of B. coagulans on anxiety, depression, and quality of life (QoL) in adult irritable bowel syndrome (IBS) patients diagnosed with Rome III or IV criteria. Only studies with a placebo-control group and validated measures of anxiety, depression, and QoL (such as the Hamilton Depression Rating Scale, Montgomery–Åsberg Depression Rating Scale, Center for Epidemiologic Studies Depression Scale, IBS-QoL, Perceived Stress Scale, etc.) were included. We have excluded studies that used heat-treated strains. Three double-blind, placebo-controlled RCTs met the eligibility criteria for our systematic review. Results: Majeed et al. concluded that B. coagulans MTCC 5856 considerably improved depression and IBS-QoL. At 90 days, the mean HAM-D score was 5.9 ± 4.88 for the probiotic group compared to 12.5 ± 8.70 for the placebo group (P = 0.005). MADRS and CES-D both indicated a preference for probiotics (6.0 ± 5.79 vs 12.6 ± 8.00, P = 0.007; 8.0 ± 6.17 vs 16.7 ± 13.03, P = 0.009). Probiotics resulted in a greater improvement in IBS-QoL scores (56.1 ± 31.26 vs 84.1 ± 34.67; P = 0.010). In Gupta et al., endline IBS-specific anxiety scores (DSFQ) were reported as 0.32 ± 0.95 for the probiotic group and 1.00 ± 0.58 for the placebo group (P = 0 .0177). Shaikh et al reported a mean PSS of 19.76 ± 5.09 for the probiotic group and 22.86 ± 4.13 for the placebo group at 12 weeks (P = 0.001). Also, DSFQ scores favored the probiotic group (0.74 ± 0.50) more than the placebo group (1.34 ± 0.57), with P < 0.001. Conclusion: Our systematic review of RCTs suggests that for individuals with IBS, B. coagulans supplementation may significantly improve depression, anxiety, and QoL. These findings emphasize the potential use of B. coagulans as a psychobiotic in treating IBS-related psychological issues. However, additional studies with diverse populations and bigger sample sizes are required to strengthen these conclusions.