{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T12:20:58Z","timestamp":1783686058432,"version":"3.55.0"},"reference-count":34,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Actial Farmaceutica Srl"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Irritable bowel syndrome (IBS)-like symptoms are common in patients with ulcerative colitis (UC) in sustained clinical and endoscopic remission and are associated with impaired quality of life. Evidence for targeted treatments in this setting remains limited. Objective: To evaluate the efficacy of the multistrain probiotic VSL#3\u00ae in patients with UC in stable remission and IBS-like symptoms. Methods: In this randomized, double-blind, explorative, placebo-controlled trial, adults with UC in stable remission for \u22656 months and Rome IV C1 or C4 symptoms received VSL#3\u00ae 450 billion colony-forming units or placebo twice daily for 8 weeks. The primary endpoint was symptom relief at week 8 assessed by the 5-point Subject\u2019s Global Assessment of Relief scale. Secondary endpoints included Irritable Bowel Syndrome Symptom Severity Scale scores (IBS-SSS), bowel habits, biochemical remission assessed through fecal calprotectin, IBS-QoL, and IBDQ. Results: Fifty-five patients were randomized. The primary endpoint did not differ significantly between groups. Between-group differences in IBS-SSS total score were not statistically significant at week 8; however, numerically greater and directionally consistent reductions in symptom severity and abdominal pain were observed with VSL#3\u00ae across visits, persisting at follow-up. In exploratory subgroup analyses, restricted to patients with higher abdominal pain and bloating scores at baseline, significant intragroup improvements in abdominal pain and bloating were observed with VSL#3\u00ae but not with placebo. Quality of life improvements were numerically greater and more sustained with VSL#3\u00ae. Conclusions: Within the limitations of the small sample size, these results show a signal of benefit in the quality of life of UC patients with IBS-like symptoms and suggest a potential complementary role for VSL#3\u00ae in symptom-oriented management, particularly for abdominal pain and bloating. Larger, adequately powered randomized trials are warranted to confirm these exploratory findings.<\/jats:p>","DOI":"10.3390\/nu18142257","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T11:43:34Z","timestamp":1783683814000},"page":"2257","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["VSL#3\u00ae May Reduce Abdominal Pain and Bloating in Ulcerative Colitis Remission with IBS-like Symptoms: An Exploratory Randomized, Double-Blind Placebo-Controlled Trial"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4449-2292","authenticated-orcid":false,"given":"Natalia","family":"Borruel Sainz","sequence":"first","affiliation":[{"name":"Crohn\u2019s and Colitis Attention Unit, Gastroenterology Department, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2478-8923","authenticated-orcid":false,"given":"Xavier","family":"Serra-Ruiz","sequence":"additional","affiliation":[{"name":"Crohn\u2019s and Colitis Attention Unit, Gastroenterology Department, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4051-0836","authenticated-orcid":false,"given":"Francisco","family":"Guarner Aguilar","sequence":"additional","affiliation":[{"name":"Crohn\u2019s and Colitis Attention Unit, Gastroenterology Department, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabiana","family":"Castiglione","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, \u201cFederico II\u201d University of Naples, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9554-4785","authenticated-orcid":false,"given":"Olga Maria","family":"Nardone","sequence":"additional","affiliation":[{"name":"Department of Public Health, \u201cFederico II\u201d University of Naples, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5515-1197","authenticated-orcid":false,"given":"Lucrezia","family":"Laterza","sequence":"additional","affiliation":[{"name":"IBD Unit, Centro di Malattie dell\u2019Apparato Digerente (CeMAD), UOC Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4712-1616","authenticated-orcid":false,"given":"Fabio","family":"Cascella","sequence":"additional","affiliation":[{"name":"IBD Unit, Centro di Malattie dell\u2019Apparato Digerente (CeMAD), UOC Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6230-1779","authenticated-orcid":false,"given":"Antonio","family":"Gasbarrini","sequence":"additional","affiliation":[{"name":"IBD Unit, Centro di Malattie dell\u2019Apparato Digerente (CeMAD), UOC Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3647-5070","authenticated-orcid":false,"given":"Agnieszka","family":"Dobrowolska","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, ul. Przybyszewskiego 49, 60-355 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina","family":"Kanikowska","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, ul. Przybyszewskiego 49, 60-355 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pal","family":"Miheller","sequence":"additional","affiliation":[{"name":"Institute of Surgery, Transplantation and Gastroenterology, Semmelweis University, \u00dcll\u0151i u 78, 1082 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orsolya","family":"Menyh\u00e1rt","sequence":"additional","affiliation":[{"name":"Institute of Surgery, Transplantation and Gastroenterology, Semmelweis University, \u00dcll\u0151i u 78, 1082 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3482-0109","authenticated-orcid":false,"given":"Daniele","family":"Noviello","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore di Milano Policlinico, Department of Pathophysiology and Transplantation, University of Milan, 20122 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8077-8175","authenticated-orcid":false,"given":"Flavio","family":"Caprioli","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore di Milano Policlinico, Department of Pathophysiology and Transplantation, University of Milan, 20122 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"ref_1","first-page":"756-e578","article-title":"Characterization of IBS-like Symptoms in Patients with Ulcerative Colitis in Clinical Remission","volume":"25","author":"Strid","year":"2013","journal-title":"Neurogastroenterol. 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