Probiotics: what are the benefits?
Probiotics are intended to modulate the intestinal microbiota. However, their efficacy has yet to be defined, even though available data encourage continued research to identify the most effective strains in the treatment of FGIDs.
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ACTION IN IBS
The definition of probiotics, namely “a living microorganism which, when administered in sufficient quantity, exerts a beneficial effect on the health of the host”,20 refers, in practice, to three large families used in the health and food industries for over-the-counter products: lactobacillus, bifidobacterium and yeasts. The effect of probiotics on FGID symptoms has been the subject of a limited number of publications and it is difficult to identify commensal bacteria of particular value in FGIDs.21 In IBS, a positive effect is however observed; and results in animals suggest that the efficacy of probiotics is linked to effects that impact the pathways acting on visceral motility and hypersensitivity, inflammation and local immune activity, the integrity of the intestinal barrier, the composition of the microbiota and the gut-brain axis.
A PROBIOTIC FOR EACH SYMPTOM
The controversy remains regarding rhythm, urgency, rumbling, and the feeling of incomplete evacuation: inefficacy of probiotics in some studies, partial efficacy in others (no action on rhythm). However, in infantile colic, the use of probiotics based on bifidobacteria could help restore the balance of the gastrointestinal microbiota and exert a beneficial effect on immune defenses. Some studies have shown that supplementation with Lactobacillus reuteri could reduce colic.22, 23 Other microorganisms such as Bifidobacterium breve, a dominant species found in children fed on mother’s milk, might also represent approaches to be investigated.24 In children suffering from IBS, L. rhamnosus and L. reuteri would seem to reduce the frequency and severity of abdominal pain.25, 26 A meta-analysis confirms the efficacy of probiotics in adults on symptoms associated with IBS (more for IBS-D than IBS-C), without naming any strain in particular.27 The World Gastroenterology Organisation recommends the use of B. infantis to reduce abdominal pain, bloating, and normalize bowel movements.28 Functional constipation is thought to be improved by means of an Artichoke-L paracasei combination.29 These observations open the way to detailed research into intake of synbiotics (combination of pre- and probiotics).
20 FAO/OMS, Joint Food and Agriculture Organization of the United Nations/ World Health Organization. Working Group. Report on drafting guidelines for the evaluation of probiotics in food, 2002.
21 Lee HJ, Choi JK, Ryu HS, et al. Therapeutic Modulation of Gut Microbiota in Functional Bowel Disorders. J Neurogastroenterol Motil. 2017;23(1):9-19.
22 Indrio F, Di Mauro A, Riezzo G, et al. Prophylactic use of a probiotic in the prevention of colic, regurgitation, and functional constipation: a randomized clinical trial. JAMA Pediatr. 2014;168(3):228-233.
23 Savino F, Cordisco L, Tarasco V, et al. Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial. Pediatrics. 2010;126(3):e526-e533.
24 Giglione E, Prodam F, Bellone S, et al. The Association of Bifidobacterium breve BR03 and B632 is Effective to Prevent Colics in Bottle-fed Infants: A Pilot, Controlled, Randomized, and Double-Blind Study. J Clin Gastroenterol. 2016;50 Suppl 2, Proceedings from the 8th Probiotics, Prebiotics & New Foods for Microbiota and Human Health meeting held in Rome, Italy on September 13-15, 2015:S164-S167.
25 Francavilla R, Miniello V, Magistà AM, et al. A randomized controlled trial of Lactobacillus GG in children with functional abdominal pain. Pediatrics. 2010;126(6):e1445-e1452.
26 Jadrešin O, Hojsak I, Mišak Z, et al. Lactobacillus reuteri DSM 17938 in the Treatment of Functional Abdominal Pain in Children: RCT Study. J Pediatr Gastroenterol Nutr. 2017;64(6):925-929.
27 Ford AC, Quigley EM, Lacy BE, et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol. 2014;109(10):1547-1562.
28 WGO. World Gastroenterology Organisation Global Guidelines Irritable Bowel Syndrome: a Global Perspective
29 Riezzo G, Orlando A, D'Attoma B, et al. Randomised clinical trial: efficacy of Lactobacillus paracasei-enriched artichokes in the treatment of patients with functional constipation--a double-blind, controlled, crossover study. Aliment Pharmacol Ther. 2012;35(4):441-450.