What about using Streptococcus faecalis and Clostridium butyricum for gastrointestinal issues?

Streptococcus faecalis and Clostridium butyricum for Gastrointestinal Issues

There is insufficient evidence to recommend Streptococcus faecalis and Clostridium butyricum for general gastrointestinal disorders, with the exception of specific conditions like acute infectious diarrhea where they may provide benefit. 1

Current Evidence and Recommendations

Regulatory Status and Guidelines

• According to the British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS) guidelines, there is insufficient evidence to recommend fecal microbiota treatments (including specific bacterial strains) for any gastrointestinal or non-gastrointestinal disease apart from recurrent Clostridioides difficile infection 1
• The American Gastroenterological Association (AGA) does not specifically recommend Streptococcus faecalis or Clostridium butyricum in their clinical practice guidelines for gastrointestinal disorders 1

Evidence for Clostridium butyricum

Clostridium butyricum has shown some promising results in specific conditions:

• Irritable Bowel Syndrome - Diarrhea predominant (IBS-D): A randomized, double-blind, placebo-controlled trial showed C. butyricum improved overall IBS-D symptoms, quality of life, and stool frequency compared to placebo 2
• Acute Infectious Diarrhea: A mixture containing C. butyricum (along with Bacillus mesentericus and Enterococcus faecalis) reduced the duration of diarrhea (60.1 hours vs 86.3 hours) and shortened hospital stays in children with acute diarrhea 3
• Mechanism of Action: C. butyricum produces butyrate, increases levels of beneficial bacteria, and inhibits pathogenic bacteria, which may help maintain gut homeostasis 4

Evidence for Streptococcus faecalis (Enterococcus faecalis)

• Limited evidence exists for Streptococcus faecalis as a standalone probiotic
• It has been used in combination with other probiotics for acute infectious diarrhea with some success 3
• The BSG guidelines do not specifically recommend Streptococcus faecalis for any gastrointestinal condition 1

Clinical Application Algorithm

1. Assess the specific gastrointestinal condition:

   • For recurrent Clostridioides difficile infection: Follow established FMT protocols per guidelines 1
   • For IBS-D: Consider C. butyricum as a potential adjunctive therapy if first-line treatments fail 2
   • For acute infectious diarrhea in children: Consider probiotic mixtures containing C. butyricum 3

2. Evaluate patient factors:

   • Avoid in immunocompromised patients
   • Use caution in patients with central venous catheters or severe cardiac valvular disease 5

3. Dosing considerations:

   • For IBS-D: Follow clinical trial protocols (typically multi-week course) 2
   • For acute diarrhea: Consider 7-day course as used in clinical trials 3

Important Caveats and Limitations

• Most studies on C. butyricum have small sample sizes and limited follow-up
• Strain specificity is crucial - effects observed with one strain may not apply to others
• Quality control of probiotic products varies significantly between manufacturers
• The BSG guidelines explicitly state there is insufficient evidence for microbiota-based treatments beyond C. difficile infection 1
• Potential for adverse effects exists, including mild gas, bloating, and temporary changes in bowel habits 5

Monitoring and Follow-up

• Monitor for symptom improvement within 2-4 weeks
• Assess for adverse effects, particularly in the first few days of treatment
• Consider discontinuation if no benefit is observed after 4 weeks of consistent use

While some evidence suggests potential benefits of C. butyricum for specific gastrointestinal conditions, larger, well-designed studies are needed before making broad recommendations for their use in clinical practice.