{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T23:46:42Z","timestamp":1790725602377,"version":"4.1.0"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,31]],"date-time":"2020-12-31T00:00:00Z","timestamp":1609372800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004515","name":"Universiti Kebangsaan Malaysia","doi-asserted-by":"publisher","award":["FF-2018-387"],"award-info":[{"award-number":["FF-2018-387"]}],"id":[{"id":"10.13039\/501100004515","id-type":"DOI","asserted-by":"publisher"}]},{"name":"B-CROBES SDN BHD"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>We determined the effectiveness of a multi-strain probiotic (Hexbio<jats:sup>\u00ae<\/jats:sup>) containing microbial cell preparation MCP<jats:sup>\u00ae<\/jats:sup>BCMC<jats:sup>\u00ae<\/jats:sup> on constipation symptoms and gut motility in PD patients with constipation.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>PD patients with constipation (ROME III criteria) were randomized to receive a multi-strain probiotic (<jats:italic>Lactobacillus sp<\/jats:italic> and <jats:italic>Bifidobacterium sp at<\/jats:italic> 30 X 10<jats:sup>9<\/jats:sup> CFU) with fructo-oligosaccaride or placebo (fermented milk) twice daily for 8 weeks. Primary outcomes were changes in the presence of constipation symptoms using 9 items of Garrigues Questionnaire (GQ), which included an item on bowel opening frequency. Secondary outcomes were gut transit time (GTT), quality of life (PDQ39-SI), motor (MDS-UPDRS) and non-motor symptoms (NMSS).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of 55 recruited, 48 patients completed the study: 22 received probiotic and 26 received placebo. At 8 weeks, there was a significantly higher mean weekly BOF in the probiotic group compared to placebo [SD 4.18 (1.44) vs SD 2.81(1.06); (mean difference 1.37, 95% CI 0.68, 2.07, uncorrected <jats:italic>p<\/jats:italic>&lt;0.001)]. Patients in the probiotic group reported five times higher odds (odds ratio = 5.48, 95% CI 1.57, 19.12, uncorrected <jats:italic>p<\/jats:italic> = 0.008) for having higher BOF (&lt; 3 to 3\u20135 to &gt;5 times\/week) compared to the placebo group. The GTT in the probiotic group [77.32 (SD55.35) hours] reduced significantly compared to placebo [113.54 (SD 61.54) hours]; mean difference -36.22, 95% CI -68.90, -3.54, uncorrected <jats:italic>p<\/jats:italic> = 0.030). The mean change in GTT was 58.04 (SD59.04) hour vs 20.73 (SD60.48) hours respectively (mean difference 37.32, 95% CI 4.00, 70.63, uncorrected <jats:italic>p<\/jats:italic> = 0.028). No between-groups differences were observed in the NMSS, PDQ39-SI, MDS-UPDRS II and MDS-UPDRS III scores. Four patients in the probiotics group experienced mild reversible side effects.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This study showed that consumption of a multi-strain probiotic (Hexbio<jats:sup>\u00ae<\/jats:sup>) over 8 weeks improved bowel opening frequency and whole gut transit time in PD patients with constipation.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0244680","type":"journal-article","created":{"date-parts":[[2020,12,31]],"date-time":"2020-12-31T19:19:29Z","timestamp":1609442369000},"page":"e0244680","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":167,"title":["Multi-strain probiotics (Hexbio) containing MCP BCMC strains improved constipation and gut motility in Parkinson\u2019s disease: A randomised controlled trial"],"prefix":"10.1371","volume":"15","author":[{"given":"Azliza","family":"Ibrahim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raja Affendi Raja","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohd Rizal Abdul","family":"Manaf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norfazilah","family":"Ahmad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farah Waheeda","family":"Tajurruddin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wong Zhi","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siti Hajar Md","family":"Desa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6684-7488","authenticated-orcid":true,"given":"Norlinah Mohamed","family":"Ibrahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,12,31]]},"reference":[{"issue":"6","key":"pone.0244680.ref001","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/S1474-4422(15)00007-1","article-title":"Gastrointestinal dysfunction in Parkinson\u2019s disease","volume":"14","author":"A Fasano","year":"2015","journal-title":"The Lancet Neurology"},{"issue":"1","key":"pone.0244680.ref002","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1038\/s41598-017-16790-8","article-title":"Parkinson disease with constipation: clinical features and relevant factors","volume":"8","author":"Q-J Yu","year":"2018","journal-title":"Sci Rep"},{"key":"pone.0244680.ref003","first-page":"811","volume-title":"International Review of Neurobiology","author":"F Stocchi","year":"2017"},{"issue":"10","key":"pone.0244680.ref004","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1002\/mds.26307","article-title":"Colonic bacterial composition in Parkinson\u2019s disease","volume":"30","author":"A Keshavarzian","year":"2015","journal-title":"Movement Disorders"},{"issue":"3","key":"pone.0244680.ref005","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1002\/mds.26069","article-title":"Gut microbiota are related to Parkinson\u2019s disease and clinical phenotype","volume":"30","author":"F Scheperjans","year":"2015","journal-title":"Movement disorders: official journal of the Movement Disorder Society"},{"issue":"9","key":"pone.0244680.ref006","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1002\/mds.21243","article-title":"Macrogol for the treatment of constipation in Parkinson\u2019s disease. 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