Lactobacillus reuteri DSM 17938 and Agave Inulin in Children with Cerebral Palsy and Chronic Constipation: A Double-Blind Randomized Placebo Controlled Clinical Trial

Abstract

The main objective was to assess the efficacy of a probiotic (<i>Lactobacillus reuteri</i> DSM 17938), a prebiotic (agave inulin), and a synbiotic on the stool characteristics in children with cerebral palsy and chronic constipation. Thirty-seven children with cerebral palsy and chronic constipation were included. The probiotic group received 1 × 10⁸ colony forming unit (cfu) of <i>L. reuteri</i> DSM 17938 plus placebo, the prebiotic group received 4 g of agave inulin plus placebo, the synbiotic group received <i>L. reuteri</i> DSM 17938 plus agave inulin, and the placebo group received two placebos for 28 days. The probiotic group showed a significant decrease in stool pH (<i>p</i> = 0.014). Stool consistency improved in the prebiotic group (<i>p</i> = 0.008). The probiotic, prebiotic, and synbiotic groups showed a significant improvement in the history of excessive stool retention, the presence of fecal mass in the rectum, and the history of painful defecation. <i>L. reuteri</i> concentration in feces was higher in the probiotic group than in the placebo group (<i>p</i> = 0.001) and showed an inverse correlation with stool pH in the probiotic group (<i>r</i> = -0.762, <i>p</i> = 0.028). This study showed that the use of <i>L. reuteri</i> DSM 17938 and/or agave inulin improved the stool characteristics such as the history of painful defecation and the presence of fecal mass in the rectum against placebo in children with cerebral palsy and chronic constipation.