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

Abstract

BACKGROUND:

Evidence suggests that the gut microbiota play an important role in gastrointestinal problems.

AIM:

To 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.

METHODS:

Systematic 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.

RESULTS:

Thirty 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.

CONCLUSIONS:

Specified 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.

• Authors: A P S Hungin, C Mulligan, B Pot, P Whorwell, L Agréus, P Fracasso, C Lionis, J Mendive, J-M Philippart de Foy, G Rubin, C Winchester, N de Wit, European Society for Primary Care Gastroenterology
• Journal: Alimentary pharmacology & therapeutics (Aliment Pharmacol Ther) Vol. 38 Issue 8 Pg. 864-86 (Oct 2013) ISSN: 1365-2036 [Electronic] England
• PMID: 23981066 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review, Systematic Review)
• Copyright: © 2013 John Wiley & Sons Ltd.

Chemical References

• Anti-Bacterial Agents

Topics

• Abdominal Pain (therapy)
• Anti-Bacterial Agents (adverse effects)
• Delphi Technique
• Diarrhea (chemically induced, therapy)
• Humans
• Irritable Bowel Syndrome (therapy)
• Probiotics (therapeutic use)
• Randomized Controlled Trials as Topic