Do probiotics really work?

Gabrielle Fundaro, PhD, CISSN, CHC

Do probiotics really work?

Irritable bowel syndrome
Other namesSpastic colon, nervous colon, mucous colitis, spastic bowel[1]
Irritable bowel syndrome.jpg
Drawing of the pain of IBS
SymptomsDiarrhea, constipation, abdominal pain[1]
Usual onsetBefore 45 years old[1]
DurationLong term[2]
Diagnostic methodBased on symptoms, exclusion of other diseases[3]
Differential diagnosisCeliac disease, giardiasis, non-celiac gluten sensitivity, microscopic colitis, inflammatory bowel disease, bile acid malabsorption, colon cancer[3][4]
TreatmentSymptomatic (dietary changes, medication, probiotics, counseling)[5]
PrognosisNormal life expectancy[6]
Frequency10–15% (developed world)[1][7] and 15–45% (globally) [8]
Video about the irritable bowel syndrome

Irritable bowel syndrome (IBS), referred to previously as spastic or nervous colon, and spastic bowel, is a functional gastrointestinal disorder characterized by a group of symptoms accompanied together that include abdominal pain and changes in the consistency of bowel movements.[1] These symptoms occur over a long time, often years.[2] It has been classified into four main types depending on whether diarrhea is common, constipation is common, both are common, or neither occurs very often (IBS-D, IBS-C, IBS-M, or IBS-U, respectively).[1] IBS negatively affects quality of life and may result in missed school or work.[9] Disorders such as anxiety, major depression, and chronic fatigue syndrome are common among people with IBS.[1][10]

The causes of IBS are not clear.[2] Theories include combinations of gut–brain axis problems, gut motility disorders, pain sensitivity, infections including small intestinal bacterial overgrowth, neurotransmitters, genetic factors, and food sensitivity.[2] Onset may be triggered by an intestinal infection[11] or stressful life event.[12]

Diagnosis is based on symptoms in the absence of worrisome features and once other potential conditions have been ruled out.[3] Worrisome features include onset at greater than 50 years of age, weight loss, blood in the stool, or a family history of inflammatory bowel disease.[3] Other conditions that may present similarly include celiac disease, microscopic colitis, inflammatory bowel disease, bile acid malabsorption, and colon cancer.[3]

There is no known cure for IBS.[5] Treatment is carried out to improve symptoms.[5] This may include dietary changes, medication, probiotics, and counseling.[5] Dietary measures include increasing soluble fiber intake, a gluten-free diet, or a short-term diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs).[3][13][14] The medication loperamide may be used to help with diarrhea while laxatives may be used to help with constipation.[3] Antidepressants may improve overall symptoms and reduce pain.[3] Patient education and a good doctor–patient relationship are an important part of care.[3][15]

About 10–15% of people in the developed world are believed to be affected by IBS.[1][7] It is estimated that 15–45% of people globally are affected by IBS.[8] It is more common in South America and less common in Southeast Asia.[3] It is twice as common in women as men and typically occurs before age 45.[1] The condition appears to become less common with age.[3] IBS does not affect life expectancy or lead to other serious diseases.[6] The first description of the condition was in 1820, while the current term irritable bowel syndrome came into use in 1944.[16]

  1. ^ a b c d e f g h i "Definition and Facts for Irritable Bowel Syndrome". NIDDKD. February 23, 2015. Archived from the original on April 2, 2016. Retrieved March 29, 2016.
  2. ^ a b c d e "Symptoms and Causes of Irritable Bowel Syndrome". NIDDK. February 23, 2015. Archived from the original on April 5, 2016. Retrieved March 29, 2016.
  3. ^ a b c d e f g h i j k Chey WD, Kurlander J, Eswaran S (March 2015). "Irritable bowel syndrome: a clinical review". JAMA. 313 (9): 949–58. doi:10.1001/jama.2015.0954. PMID 25734736. S2CID 205062386.
  4. ^ Cite error: The named reference LevyBernstein2014 was invoked but never defined (see the help page).
  5. ^ a b c d "Treatment for Irritable Bowel Syndrome". NIDDK. February 23, 2015. Archived from the original on April 6, 2016. Retrieved March 29, 2016.
  6. ^ a b Quigley EM (2013). "Treatment level 1". Irritable Bowel Syndrome: Diagnosis and Clinical Management (First ed.). Chichester, West Sussex: Wiley-Blackwell. ISBN 9781118444740. Archived from the original on September 8, 2017.
  7. ^ a b Maxion-Bergemann S, Thielecke F, Abel F, Bergemann R (2006). "Costs of irritable bowel syndrome in the UK and US". PharmacoEconomics. 24 (1): 21–37. doi:10.2165/00019053-200624010-00002. PMID 16445300. S2CID 45376327.
  8. ^ a b Alexandros Hadjivasilis, Constantinos Tsioutis, Adamantios Michalinos, Dimitrios Ntourakis, Dimitrios K. Christodoulou, and Aris P. Agouridis (2019). "New insights into irritable bowel syndrome: from pathophysiology to treatment". Ann Gastroenterol. 32 (6): 554–564. doi:10.20524/aog.2019.0428. PMC 6826071. PMID 31700231.CS1 maint: uses authors parameter (link)
  9. ^ Hulisz D (2004). "The burden of illness of irritable bowel syndrome: current challenges and hope for the future". Journal of Managed Care Pharmacy. 10 (4): 299–309. doi:10.18553/jmcp.2004.10.4.299. PMID 15298528. S2CID 9413379.
  10. ^ Whitehead WE, Palsson O, Jones KR (April 2002). "Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications?". Gastroenterology. 122 (4): 1140–56. doi:10.1053/gast.2002.32392. PMID 11910364.
  11. ^ Spiller R, Garsed K (May 2009). "Postinfectious irritable bowel syndrome". Gastroenterology. 136 (6): 1979–88. doi:10.1053/j.gastro.2009.02.074. PMID 19457422.
  12. ^ Chang L (March 2011). "The role of stress on physiologic responses and clinical symptoms in irritable bowel syndrome". Gastroenterology. 140 (3): 761–5. doi:10.1053/j.gastro.2011.01.032. PMC 3039211. PMID 21256129.
  13. ^ Moayyedi P, Quigley EM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, Soffer EE, Spiegel BM, Ford AC (September 2014). "The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis". The American Journal of Gastroenterology. 109 (9): 1367–74. doi:10.1038/ajg.2014.195. PMID 25070054. S2CID 8076372.
  14. ^ Cite error: The named reference Rao2015 was invoked but never defined (see the help page).
  15. ^ Mayer EA (April 2008). "Clinical practice. Irritable bowel syndrome". The New England Journal of Medicine. 358 (16): 1692–9. doi:10.1056/NEJMcp0801447. PMC 3816529. PMID 18420501.
  16. ^ Hatch MC (2000). Women and Health. San Diego, Calif: Academic Press. p. 1098. ISBN 9780122881459. Archived from the original on September 8, 2017.