{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T17:48:52Z","timestamp":1781545732927,"version":"3.54.5"},"reference-count":55,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T00:00:00Z","timestamp":1747267200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Diarrhea-predominant irritable bowel syndrome (IBS-D) is a functional gastrointestinal disorder characterized by altered motility, abdominal pain, and dysbiosis\u2014particularly reduced biodiversity and a lower abundance of butyrate-producing bacteria. Strategies that modulate the gut microbiota may offer therapeutic benefit. Clostridium butyricum (C. butyricum) CBM588 is a butyrate-producing probiotic with immunomodulatory properties and potential efficacy in treating gastrointestinal disorders. This pragmatic, prospective, open-label, single-arm interventional study assessed the clinical, microbial, and safety-related effects of an 8-week CBM588 supplementation, along with a low-fiber and low-residue diet, in 205 patients with IBS-D who attended Quisisana Nursing Home Hospital, Rome, Italy, between November 2024 and February 2025. The primary outcomes included the global symptom response, the Bristol Stool Scale (BSS), stool frequency, diarrhea episodes, abdominal pain (severity and frequency), bloating, bowel dissatisfaction, quality of life (QoL), safety, and treatment tolerability\u2014measured using the IBS Symptom Severity Scale (IBS-SSS) and a standardized tolerability scale. CBM588, in patients treated with a low-fiber and low-residue diet, significantly improved all clinical endpoints, with a &gt;80% reduction in diarrhea episodes; ~60% reductions in stool frequency and abdominal pain; and &gt;50% improvements in bloating, bowel dissatisfaction, and QoL. Treatment was well tolerated (mean tolerability score 8.95 \u00b1 0.88), with &gt;95% adherence, and no serious adverse events were reported. The secondary outcomes included changes in gut microbiota. In a subset of patients, 16S rRNA gene sequencing showed increased \u03b1-diversity and enrichment of butyrate-producing genera (Agathobacter, Butyricicoccus, Coprococcus), which correlated with symptom improvement. Bloating increased in some patients, possibly related to fermentation activity. These findings support the C. butyricum CBM588 probiotic strain as a safe, well-tolerated, and microbiota-targeted intervention for IBS-D. Randomized controlled trials are warranted to confirm efficacy.<\/jats:p>","DOI":"10.3390\/microorganisms13051139","type":"journal-article","created":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T05:11:57Z","timestamp":1747372317000},"page":"1139","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Irritable Bowel Syndrome with Diarrhea (IBS-D): Effects of Clostridium butyricum CBM588 Probiotic on Gastrointestinal Symptoms, Quality of Life, and Gut Microbiota in a Prospective Real-Life Interventional Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6654-8675","authenticated-orcid":false,"given":"Francesco","family":"Di Pierro","sequence":"first","affiliation":[{"name":"Microbiota International Clinical Society, 10123 Turin, Italy"},{"name":"Scientific & Research Department, Velleja Research, 20125 Milan, Italy"},{"name":"Department of Medicine and Technological Innovation, University of Insubria, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Ficuccilli","sequence":"additional","affiliation":[{"name":"Nursing Home Quisisana, 00197 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Tessieri","sequence":"additional","affiliation":[{"name":"Nursing Home Quisisana, 00197 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Menasci","sequence":"additional","affiliation":[{"name":"Nursing Home Quisisana, 00197 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Pasquale","sequence":"additional","affiliation":[{"name":"Nursing Home Quisisana, 00197 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amjad","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Liaquat University of Medical & Health Sciences (LUMHS), Jamshoro 76090, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fazle","family":"Rabbani","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Lady Reading Hospital (LRH), Peshawar 25000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazia Mumtaz","family":"Memon","sequence":"additional","affiliation":[{"name":"Department of Pathology, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro 76090, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Cazzaniga","sequence":"additional","affiliation":[{"name":"Scientific & Research Department, Velleja Research, 20125 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3922-9115","authenticated-orcid":false,"given":"Alexander","family":"Bertuccioli","sequence":"additional","affiliation":[{"name":"Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2115-1701","authenticated-orcid":false,"given":"Mariarosaria","family":"Matera","sequence":"additional","affiliation":[{"name":"Department of Pediatric Emergencies, Misericordia Hospital, 58100 Grosseto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2326-2328","authenticated-orcid":false,"given":"Ilaria","family":"Cavecchia","sequence":"additional","affiliation":[{"name":"Microbiota International Clinical Society, 10123 Turin, Italy"},{"name":"Microbiomic Department, Koelliker Hospital, 10134 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martino","family":"Recchia","sequence":"additional","affiliation":[{"name":"Unit of Clinical Epidemiology and Biostatistics, Mario Negri Institute Alumni Association (MNIAA), 20156 Milan, 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