Prebiotics and probiotics for irritable bowel syndrome

Posted on Mon, 7 Jan 19

An updated review of clinical studies found evidence for probiotics for symptom relief, but no clear superiority of any particular product. Current evidence does not strongly support the use of prebiotics. 

There is increasing interest in the use of prebiotics and probiotics for reducing symptoms of irritable bowel syndrome (IBS), with a large number of new clinical studies. A recently updated systematic review with meta-analysis set out to assess their efficacy.

The reviewers identified 53 studies of different probiotics and 3 that examined prebiotics. They also reviewed 2 studies of synbiotics, which are combinations of probiotics and prebiotics, and 8 studies of antibiotics, which, like prebiotics and probiotics may influence the gut microbiome and thus IBS. 

Probiotics had evidence of benefit with a number needed to treat of 7 (the number of people that need to be treated for one to benefit compared with a control or placebo). However, efficacy of various strains or combinations of strains varied with some not superior to placebo. 

Of those probiotics that were effective for overall symptoms, combinations of strains included a six-strain combination of a combination of Bifidobacterium longum, B. bifidum, B. lactis, Lactobacillus acidophilus, L. rhamnosus and Streptococcus thermophiles, a seven-strain combination of three Bifidobacterium, three Lactobacillus and one Streptococcus and VSL#3. And single strains that demonstrated global benefit included Lactobacillus plantarum DSM 9843 (299v), Escherichia coli DSM17252, and Streptococcus faecium.*

Prebiotic studies did not demonstrated benefit for fructooligosaccharides but did suggest some evidence of benefit for trans-galactooligosaccharides. 

“This systematic review and meta-analysis has demonstrated that particular combinations of probiotics, or specific species and strains, appear to have beneficial effects in IBS in terms of effect on global IBS symptoms and abdominal pain, but it is not possible to draw definitive conclusions about their efficacy,” wrote the study authors. “For probiotics, it remains unclear whether a particular combination of probiotics, or a specific species or strain, is more likely to be effective, or whether there is a particular IBS subtype that is more likely to benefit.”

*Note: Some of these are not commercially available for use. Currently, the best practice for the use of probiotics is to trial a good quality product for 4-weeks, and if there is a poor or no treatment response to trial a different product to see if it is more effective. Microbiome testing is unnecessary. Here is a guide to some commercially available probiotic single-strain or multi-strain products with evidence from human clinical trials. 

Reference: 

Ford AC, Harris LA, Lacy BE, Quigley EMM, Moayyedi P. Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Aliment Pharmacol Ther. 2018 Nov;48(10):1044-1060.