In 2013, the European Society for Primary Care Gastroenterology published evidence-based, international guidelines on the use of probiotics in the management of lower gastrointestinal (GI) symptoms. Since then, several clinical studies of probiotics in the management of lower GI symptoms have been published. Considering this new evidence, researchers decided to reevaluate the original consensus statements. They reviewed randomized, placebo-controlled trials on the effects of probiotics on lower GI symptoms published between 2012 and 2017, using a modified Delphi process.

A total of 70 studies investigating 54 different probiotics (containing 108 strains, either alone or in combination) were included in the analysis. Most of the studies focused on irritable bowel syndrome (IBS), diarrhea associated with the use of antibiotics, or diarrhea associated with Helicobacter pylori eradication therapy.

There was strong evidence that specific probiotics reduce overall symptom burden and abdominal pain in some patients with IBS. The evidence also supports the use of specific probiotics as adjuvant therapy to prevent or reduce the duration of antibiotic-associated diarrhea and to prevent or reduce the duration or intensity of diarrhea in patients receiving H. pylori eradication therapy. There was also some evidence that probiotics may help reduce bloating or distension and improve the frequency or consistency of bowel movements in some patients with IBS. Improvement of symptoms with probiotics has been shown to improve aspects of health-related quality of life. No adverse events were reported with any of the probiotics studied.

The consensus panel concluded that specific probiotics play a role in the management of IBS symptoms and can be used as an adjunct to conventional therapy. Probiotic strains should be chosen based on the patient's symptoms, the clinical indication, and the available evidence. For a chronic GI problem, therapy should be continued for one month.

REFERENCE