Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice - an evidence-based international guide

Abstract

BackgroundEvidence suggests that the gut microbiota play an important role in gastrointestinal problems.AimTo give clinicians a practical reference guide on the role of specified probiotics in managing particular lower gastrointestinal symptoms/problems by means of a systematic review-based consensus.MethodsSystematic literature searching identified randomised, placebo-controlled trials in adults; evidence for each symptom/problem was graded and statements developed (consensus process; 10-member panel). As results cannot be generalised between different probiotics, individual probiotics were identified for each statement.ResultsThirty seven studies were included; mostly on irritable bowel syndrome [IBS; 19 studies; treatment responder rates: 18–80% (specific probiotics), 5–50% (placebo)] or antibiotic-associated diarrhoea (AAD; 10 studies). Statements with 100% agreement and ‘high’ evidence levels indicated that: (i) specific probiotics help reduce overall symptom burden and abdominal pain in some IBS patients; (ii) in patients receiving antibiotics/Helicobacter pylori eradication therapy, specified probiotics are helpful as adjuvants to prevent/reduce the duration/intensity of AAD; (iii) probiotics have favourable safety in patients in primary care. Items with 70–100% agreement and ‘moderate’ evidence were: (i) specific probiotics help relieve overall symptom burden in some patients with diarrhoea-predominant IBS, and reduce bloating/distension and improve bowel movement frequency/consistency in some IBS patients and (ii) with some probiotics, improved symptoms have led to improvement in quality of life.ConclusionsSpecified probiotics can provide benefit in IBS and antibiotic-associated diarrhoea; relatively few studies in other indications suggested benefits warranting further research. This study provides practical guidance on which probiotic to select for a specific problem.

The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic

“…Wellcontrolled intervention trials, systematic reviews and metaanalyses provide convinc ing evidence of the benefits of probiotics, including ones with valuable public health implications. 68,72 Clarifying the proper scope and appropriate use of the term pro biotic is important so that all stakeholders in the probiotic field, as depicted in Figure 1, share an understanding of probiotics that is consistent with current research. This clarification will facilitate continued advances in probiotic research and will ensure probiotic benefits are properly communicated to consumers and patients.…”

Probiotic Therapy of the Irritable Bowel Syndrome: Why Is the Evidence Still Poor and What Can Be Done About It?

“…27 Over the years general assessments have remained rather similar, presuming an overall positive effect whilst claiming a lack of high-quality data: "Probiotics may improve symptoms of irritable bowel syndrome and can be used as supplement to standard therapy." 19 "While our analyses suggest that probiotic use may be associated with improvement in IBS symptoms compared to placebo, these results should be interpreted with caution given the methodological limitations of contributing studies.…”

Therapeutic Modulation of Gut Microbiota in Functional Bowel Disorders

“…68,69 A systematic review of 18 RCTs involving 1806 IBS patients and consensus voting reported a high grade of evidence for the effect of probiotics on abdominal pain, and a good consensus agreement. 57 The abdominal pain was significantly alleviated in 5 of the 6…”