Effectiveness of Probiotics in the Treatment of Irritable Bowel Syndrome

Abstract

Recently, the use of tegaserod and alosetron -- drugs approved for the treatment of irritable bowel syndrome (IBS) -- has been restricted because of adverse events. This has resulted in a need for additional modalities for the treatment of IBS. Our objective was to determine the effectiveness of probiotics in the global relief of symptoms associated with IBS and in the improvement of flatulence, abdominal pain, transit time, and bacterial counts. Using the MEDLINE database from 1966-October 2007 and manually searching article references for relevant articles and abstracts, we identified 14 blinded, placebo-controlled clinical trials of the effectiveness of probiotics in the treatment of IBS. Of 11 studies in which overall symptom relief was assessed, seven indicated a significant improvement with probiotics versus placebo. Five of eight investigations of abdominal pain and distention revealed a benefit with probiotic use. Four studies demonstrated an improvement in symptomatic flatulence in probiotic treatment groups, whereas one study showed no significant benefit. Four of five studies of the effects of probiotics on colonic transit time revealed a benefit compared with placebo. As probiotics have shown benefit and possess a favorable adverse-effect profile, their use may represent an option for symptom relief in patients with IBS. However, additional data are necessary before probiotics can become a standard of care in the treatment of IBS, a complex and chronic condition.

Effect of probiotic species on irritable bowel syndrome symptoms: A bring up to date meta-analysis

“…Although other published reviews and meta-analyses have studied the effects of probiotics in IBS patients (7)(8)(9)(10)(11)(12)71), our study evaluated the efficacy of probiotics on a wide variety of IBS symptoms. This allowed us to determine whether a specific probiotic species is beneficial for treating individual IBS symptoms.…”

“…If a study could not be included/excluded based on the Title/Abstract field, the full text of the article was reviewed. Furthermore, the reference lists of studies that met inclusion criteria, pertinent review articles, and meta-analyses (7)(8)(9)(10)(11)(12) were sought manually to identify additional relevant publications.…”

“…Furthermore, several authors have studied the relationship between probiotic intake and blood cytokine levels (4) or changes in fecal microbiota (5,6). Several reviews and meta-analyses that have evaluated the role of probiotics in IBS therapy have concluded that probiotics appear to improve overall IBS symptoms (7)(8)(9)(10)(11)(12). However, a meta-analysis that includes any probiotic in the evaluation of symptom relief may not be the best method for assessing the efficacy of specific probiotics (11)(12)(13).…”

Functional Abdominal Bloating with Distention

“…These are small molecules that are rapidly fermentable and osmotically active and could cause luminal distention. Probiotics and even nonabsorbable antibiotics like rifaximin are being studied [39, 40]. Weight loss may help but is unproven, as are girdles and abdominal exercises.…”

Are Probiotic Effects Dose-Related?

“…Although the etiology of IBS remains elusive, there is growing recognition of the role played by intestinal infections and disturbances of the colonic microflora in the genesis of this condition [21][22][23]. Furthermore, it has been shown that modified commensal gut flora may lead to mucosal inflammation.…”