Evaluation of the combined use of linaclotide and probiotics on clinical treatment efficacy and quality of life in patients with constipation-predominant irritable bowel syndrome

Abstract

Objective: To evaluate the effects of combining linaclotide with Bifid Triple Viable Capsules on clinical outcomes and quality of life (QoL) in patients with constipation-predominant irritable bowel syndrome (IBS-C).

Methods: A retrospective analysis was performed on data from 189 IBS-C patients treated between April 2021 and January 2024. The control group (91 patients) received linaclotide, while the combined group (98 patients) received linaclotide plus Bifid Triple Viable Capsules. Outcomes assessed included bowel movement frequency, stool consistency scores, constipation severity, anxiety (Self-Rating Anxiety Scale, SAS), depression (Self-Rating Depression Scale, SDS), QoL (Irritable Bowel Syndrome Quality of Life, IBS-QoL), and symptom severity (Irritable Bowel Syndrome Severity Scoring System, IBS-SSS). Logistic regression identified independent risk factors for QoL improvement.

Results: Both groups showed significant increases in bowel movement frequency after treatment (P < 0.001). The combined group experienced a significantly greater improvement compared to the control group (P < 0.001). Stool consistency scores improved significantly in both groups (P < 0.001), but no significant difference was observed between groups (P > 0.05). Both groups showed significant reductions in constipation severity, with the combined group showing greater improvement (P < 0.001). SAS and SDS scores decreased significantly in both groups (P < 0.001). The combined group showed greater reductions in SAS (P < 0.05) and SDS (P < 0.001). IBS-QoL scores improved significantly in both groups, with the combined group achieving greater improvement (P < 0.001). IBS-SSS scores decreased significantly, with the combined group experiencing a greater reduction (P < 0.001). IBS-QoL scores were positively correlated with bowel movement frequency (r = 0.289, P < 0.001) and negatively correlated with stool consistency scores (r = -0.154, P = 0.036), constipation severity (r = -0.386, P < 0.001), SDS scores (r = -0.150, P = 0.040), and IBS-SSS scores (r = -0.347, P < 0.001). Logistic regression identified treatment regimen (OR = 0.163, P = 0.017), age (OR = 4.666, P = 0.002), monthly income (OR = 0.065, P < 0.001), post-treatment bowel movement frequency (OR = 0.055, P < 0.001), and post-treatment constipation severity (OR = 5.545, P = 0.007) as independent factors influencing QoL improvement.

Conclusion: The combined use of linaclotide and Bifid Triple Viable Capsules significantly enhances bowel movement frequency, reduces constipation severity, and improves QoL and psychological well-being in IBS-C patients. This approach offers a promising strategy for the comprehensive management of IBS-C.

Keywords: Constipation-predominant irritable bowel syndrome; clinical efficacy; linaclotide; probiotics; quality of life.

Figure 1

Comparison of bowel movement frequency, stool consistency score, and constipation severity. A: The image shows bowel movement frequency before and after treatment in the control and combination groups. B: The image shows stool consistency scores before and after treatment in the control and combination groups. C: The image shows constipation severity before and after treatment in the control and combination groups. Note: ns P > 0.05, ****P < 0.0001.

Figure 2

Comparison of SAS and SDS scores. A: This image shows SAS scores before and after treatment in the control and combination groups. B: This image shows SDS scores before and after treatment in the control and combination groups. Note: ns P > 0.05, *P < 0.05, ****P < 0.0001; SAS, Self-Rating Anxiety Scale; SDS, Self-Rating Depression Scale.

Figure 3

Comparison of IBS-QoL and IBS-SSS scores. A: The image shows IBS-QoL scores before and after treatment in the control and combination groups. B: The image shows IBS-SSS scores before and after treatment in the control and combination groups. Note: ns P > 0.05, ****P < 0.0001; IBS-QoL, Irritable Bowel Syndrome Quality of Life; IBS-SSS, Irritable Bowel Syndrome Severity Scoring System.

Figure 4

Correlation analysis of IBS-QoL scores with other indicators after treatment. A: This image shows the correlation between post-treatment IBS-QoL scores and post-treatment number of bowel movements. B: This image shows the correlation between post-treatment IBS-QoL scores and post-treatment stool consistency scores. C: This image shows the correlation between post-treatment IBS-QoL scores and post-treatment constipation severity. D: This image shows the correlation between post-treatment IBS-QoL scores and post-treatment anxiety scores. E: This image shows the correlation between post-treatment IBS-QoL scores and post-treatment depression scores. F: This image shows the correlation between post-treatment IBS-QoL scores and post-treatment IBS-SSS scores. Note: SAS, Self-Rating Anxiety Scale; SDS, Self-Rating Depression Scale; IBS-QoL, Irritable Bowel Syndrome Quality of Life; IBS-SSS, Irritable Bowel Syndrome Severity Scoring System.

Figure 5

ROC curve for characteristic factors of improved and unimproved patients.

Figure 6

Univariate logistic regression analysis. Note: IBS-SSS, Irritable Bowel Syndrome Severity Scoring System.

Figure 7

Multivariate logistic regression analysis. Note: IBS-SSS, Irritable Bowel Syndrome Severity Scoring System.