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Probiotics in the management of irritable bowel syndrome and inflammatory bowel disease

Whelan, Kevina; Quigley, Eamonn M.M.b

Current Opinion in Gastroenterology: March 2013 - Volume 29 - Issue 2 - p 184–189
doi: 10.1097/MOG.0b013e32835d7bba
NUTRITION: Edited by David H. Alpers and William F. Stenson

Purpose of review: There is direct evidence that the pathogenesis of inflammatory bowel disease (IBD) involves the gastrointestinal microbiota and some evidence that the microbiota might also play a similar role in irritable bowel syndrome (IBS). The aim of this article is to review the emerging evidence for the mechanisms and effectiveness of probiotics in the management of these disorders.

Recent findings: The composition of the gastrointestinal microbiota is strongly influenced by factors including age, diet and disease. Probiotics may be effective through their impact on the host gastrointestinal microbiota and promotion of mucosal immunoregulation. Probiotics are considered to be well tolerated, although the quality of studies and health claims has been variable. There are many short-term studies demonstrating the effectiveness of probiotics in IBS, although recommendations should be made for specific strains and for specific symptoms. Within IBD, a number of trials have shown the benefits of a range of probiotics in pouchitis and in ulcerative colitis, although current evidence in Crohn's disease is less promising.

Summary: Clearly, some probiotics have considerable potential in the management of IBS and IBD; however, the benefits are strain specific. High-quality trials of probiotics in gastrointestinal disorders as well as laboratory investigations of their mechanism of action are required in order to understand who responds and why.

aKing's College London, School of Medicine, Diabetes and Nutritional Sciences Division, London, UK

bAlimentary Pharmabiotic Centre, Department of Medicine, University College Cork, Cork, Ireland

Correspondence to Kevin Whelan, King's College London, Diabetes and Nutritional Sciences Division, 150 Stamford Street, London SE1 9NH, UK. E-mail: kevin.whelan@kcl.ac.uk

© 2013 Lippincott Williams & Wilkins, Inc.