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Question answered:29/01/08 Warning! this question is over two years old.
The NLH Q & A Service answered an identical question in November 2007 (1). We have reproduced their answer below:
“CKS have a 2005 guideline on IBS [1] and this reports:
“There are conflicting reports of the efficacy of probiotics in irritable bowel syndrome (IBS) [DTB, 2004].
- Four small placebo-controlled double-blind randomized trials (n = 168), lasting 4–6 weeks, found that probiotics (Lactobacillus acidophilus, L plantarum, and/or Bifidobacterium breve) reduced symptoms of IBS.
- However, two trials (n = 49) lasting 8 weeks found that probiotics (VSL#3 or L casei) did not reduce global or individual symptoms.”
Recently (2007), the British Society of Gastroenterology (BSG) have published “Guidelines on the irritable bowel syndrome: mechanisms and practical management” [2] and this discusses probiotics:
“Probiotics are a more attractive though possibly less effective way of altering bowel flora, and five randomised placebo controlled trials of probiotics have shown benefit for some symptoms, notably bloating and flatulence, using a variety of probiotic agents including Lactobacillus rhamnosus plantarum and VSL#3, a mixture of lactobacilli, bifidobacteria, and a streptococcus. A more recent study using Bifidobacterium infantis suggested benefit and linked this to a downregulation of immune response, but this finding also needs to be replicated. A subsequent larger study has confirmed the benefit of B infantis, though problems with formulation mean that further studies are needed before this can be firmly recommended.”
Finally, a further RCT has been published since the BSG guidance. In this trial [3] the authors studied the effects of fermented milk containing Bifidobacterium animalis DN-173 010 and yoghurt strains on the IBS in a multicentre, double-blind, controlled trial. Overall, they concluded:
“This study suggests a beneficial effect of a probiotic food on discomfort HRQoL score and bloating in constipation-predominant IBS, and on stool frequency in subjects with <3 stools/week.””
A search of the literature since this question was answered revealed one trial of eight-six patients with irritable bowel who participated in this randomized, placebo-controlled 5-month intervention.
“Patients were randomized to receive daily either multispecies probiotic supplementation or placebo. Irritable bowel syndrome symptoms, quality of life, microarray-based intestinal microbiota stability (n = 20), serum cytokines and sensitive C-reactive protein were monitored. The composite irritable bowel syndrome score had at 5 months decreased 14 points (95% CI: -19 to -9) from baseline with the multispecies probiotic vs. three points (95% CI: -8 to 1) with placebo (P = 0.0083). Especially, distension and abdominal pain were affected. A stabilization of the microbiota was observed, as the microbiota similarity index increased with the probiotic supplementation (1.9 +/- 3.1), while it decreased with placebo (-2.9 +/- 1.7). No differences were seen in C-reactive protein.“
The authors of the study conclude:
“This multispecies probiotic seems to be an effective and safe option to alleviate symptoms of irritable bowel syndrome, and to stabilize the intestinal microbiota.”
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