Timko, J. (2010). Probiotics as prevention of radiation-induced diarrhoea. Journal of Radiotherapy in Practice, 9(4), 201–208.

To evaluate the efficacy of probiotics in the prevention of radiation-induced diarrhea

Patients who had undergone adjuvant, postoperative radiation to the abdominal or pelvic area, alone or in combination with chemotherapy, and were admitted to the hospital were randomized to one of two groups: “5” Strain Dophilus (L group) or Hylak Tropfen Forte drops (H group).

• The study reported on 42 patients.
• The median age of patients in the L group was 62 years with a range of 34–82 years, and the median age of patients in the H group was 67 years with a range of 43–83 years.     
• The sample was 66% male and 33% female.
• The majority of patients in the L group had colorectal cancer and the majority of patients in the H group had prostate or rectosigmoid junction cancer.
• The number of patients in the L group with a body mass index (BMI) of normal weight was equal to the number of patients with an overweight BMI. In the H group, more patients had an overweight BMI than a normal BMI.
• In the L group, 55% of patients also received chemotherapy. In the H group, 50% of patients also received chemotherapy.
   

This study was conducted at a single-site, inpatient setting in Ruzomberok, Slovakia.

All patients were undergoing the active treatment phase of care.

This was a randomized, parallel-group, nonplacebo controlled trial.

Patient diaries were used to record the number and consistency of stools, presence of bleeding or abdominal pain, and use of antidiarrheals or antibiotics.

• Patients in the L group had a higher number of daily bowel movements (BMs) (n = 4.16, range = 1.2–9.7) than in the H group (n = 2.52, range = 0.7–5.3).
• In the second week, the weekly number of BMs was significantly higher in the L group (p < 0.01) compared to the H group.
• The number of BMs in the H group increased at week 3.
• A significant increase was reported in the number of BMs in patients receiving only radiation versus radiation plus chemotherapy.
• Fewer patients in the L group (27%) required an antidiarrheal (specifically diphenoxylate) compared to the H group (55%).
• Fewer patients in the L group (9%) required antibiotics versus in the H group (25%).
• Abdominal pain was similar between groups with 25% of patients reporting the side effect in the L group compared to 22% in the H group.
• One subject in the H group reported blood in the stool at day 9.

Probiotics  may be effective in the prevention of radiation-induced diarrhea.

• The sample size was small, with fewer than 100 patients.
• A control group was not included.
• Patients' diets and the radiation technique could have varied between groups.

The use of probiotics may have some benefit in the prevention of radiation-induced diarrhea; however, more studies (including control arms) are needed.