Probiotics in the Management of Lower GI Symptoms
The practical clinical implications of the consensus statements are summarised for each grade of evidence in Table 4. It should be noted that effects are strain-/formulation-specific and cannot be extrapolated from one probiotic to another. Furthermore, specific probiotics will have different effects in different patients; a probiotic that does not work in one indication may have evidence supporting a beneficial effect in a different indication or for a different symptom. When trying a probiotic therapy for a chronic GI problem, it is critically important that the product is taken in adequate doses on a regular basis (e.g. just before a meal) for a reasonable period of time, which should be at least a month, unless it cannot be tolerated for any reason. Regular consumption is important because probiotic strains are transient and will generally be washed out within days, although strain-specific differences occur, for example, linked to the production of pili or mucus-binding proteins by the probiotic bacteria.
The need for objective, evidence-based guidance on the role of probiotics is becoming increasingly important as public awareness of probiotics grows. This consensus is intended as a practical reference to help physicians make appropriate, evidence-based recommendations to patients who might benefit from probiotic treatment. Overall, the randomised, placebo-controlled trials included in our analysis support, with a high evidence level, a role for specific probiotics in the management of overall symptoms and abdominal pain in patients with IBS, and for preventing or reducing diarrhoea in patients receiving antibiotics or H. pylori eradication triple therapy. The trials support, with a moderate evidence level, a role for specific probiotics in managing overall symptoms in patients with IBS-D; improving bowel movements and bloating/distension in patients with IBS; and improving some aspects of health-related quality of life.
Conclusions and Clinical Implications
The practical clinical implications of the consensus statements are summarised for each grade of evidence in Table 4. It should be noted that effects are strain-/formulation-specific and cannot be extrapolated from one probiotic to another. Furthermore, specific probiotics will have different effects in different patients; a probiotic that does not work in one indication may have evidence supporting a beneficial effect in a different indication or for a different symptom. When trying a probiotic therapy for a chronic GI problem, it is critically important that the product is taken in adequate doses on a regular basis (e.g. just before a meal) for a reasonable period of time, which should be at least a month, unless it cannot be tolerated for any reason. Regular consumption is important because probiotic strains are transient and will generally be washed out within days, although strain-specific differences occur, for example, linked to the production of pili or mucus-binding proteins by the probiotic bacteria.
The need for objective, evidence-based guidance on the role of probiotics is becoming increasingly important as public awareness of probiotics grows. This consensus is intended as a practical reference to help physicians make appropriate, evidence-based recommendations to patients who might benefit from probiotic treatment. Overall, the randomised, placebo-controlled trials included in our analysis support, with a high evidence level, a role for specific probiotics in the management of overall symptoms and abdominal pain in patients with IBS, and for preventing or reducing diarrhoea in patients receiving antibiotics or H. pylori eradication triple therapy. The trials support, with a moderate evidence level, a role for specific probiotics in managing overall symptoms in patients with IBS-D; improving bowel movements and bloating/distension in patients with IBS; and improving some aspects of health-related quality of life.
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