Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice – an evidence‐based international guide. Issue 8 (27th August 2013)

• Record Type: Journal Article
• Authors: Hungin, A. P. S.; Mulligan, C.; Pot, B.; Whorwell, P.; Agréus, L.; Fracasso, P.; Lionis, C.; Mendive, J.; Philippart de Foy, J.‐M.; Rubin, G.; Winchester, C.; de, N.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 38:Issue 8(2013)
• Page Start: 864
• Page End: 886
• Publication Date: 2013-08-27
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.12460
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt12460-abs-0001"> <title>Summary</title> <sec id="apt12460-sec-0001" sec-type="section"> <title>Background</title> <p>Evidence suggests that the gut microbiota play an important role in gastrointestinal problems.</p> </sec> <sec id="apt12460-sec-0002" sec-type="section"> <title>Aim</title> <p>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.</p> </sec> <sec id="apt12460-sec-0003" sec-type="section"> <title>Methods</title> <p>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.</p> </sec> <sec id="apt12460-sec-0004" sec-type="section"> <title>Results</title> <p>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/<italic>Helicobacter pylori</italic> 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.</p> </sec> <sec id="apt12460-sec-0005" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> </abstract>