From the Guidelines
Probiotics do not help with bloating or distention in Irritable Bowel Syndrome (IBS), as no studies have examined their efficacy in specifically treating these symptoms, and the newest guidelines have not endorsed their use for global symptoms in IBS. According to the most recent study 1, treatment with probiotics and medical foods is not recommended for bloating or distention. While some studies have shown improvements in global GI symptoms with probiotics, these findings are not consistent, and probiotics may even be associated with developing new onset of brain fogginess, bloating, and lactic acidosis 1. The British, European, and American guidelines for IBS and FD have not endorsed the use of probiotics to treat global symptoms in these conditions 1.
Some key points to consider when evaluating the effectiveness of probiotics in IBS include:
- The lack of evidence supporting their use for bloating and distention specifically 1
- The potential for probiotics to cause adverse effects such as brain fogginess, bloating, and lactic acidosis 1
- The inconsistent results of studies examining the efficacy of probiotics in IBS, likely due to the heterogeneous nature of the disorder 1
- The availability of alternative treatments for bloating and distention, such as anorectal biofeedback therapy, central neuromodulators, and gut-related medications 1
In terms of alternative treatments, anorectal biofeedback therapy has been shown to be effective in reducing bloating symptoms in patients with IBS-C and chronic constipation 1. Central neuromodulators, such as antidepressants, have also been found to reduce visceral sensations and improve psychological comorbidities in IBS patients 1. Gut-related medications, such as secretagogues and 5-hydroxytryptamine 4 receptor agonists, have been shown to be effective in treating abdominal bloating in patients with IBS-C 1.
From the Research
Probiotics in IBS
Probiotics have been studied for their potential benefits in managing irritable bowel syndrome (IBS) symptoms. While some studies suggest that probiotics can be beneficial in reducing global IBS symptoms, abdominal pain, and improving quality of life, the evidence is not consistent across all studies.
Limitations of Probiotics in IBS
- The optimal strain, dose, formulation, and duration of probiotic therapy for IBS are not well defined 2
- The certainty of evidence for the efficacy of probiotics in IBS is generally low to very low, according to the GRADE criteria 3
- Some studies have reported no significant benefit of probiotics on global symptom scores, with high inter-study heterogeneity 4
Specific Symptoms Not Improved by Probiotics
- There is very low certainty in the evidence for a benefit of probiotics on abdominal bloating or distension 3
- Some studies have reported no significant benefit of probiotics on distension scores, except when used for a shorter treatment time (less than eight weeks) 4
Combination Therapies
- The addition of an antispasmodic to a probiotic may improve its observed effects on IBS symptoms, including quality of life, abdominal pain, and stool consistency 5
- However, the evidence for the efficacy of combination therapies is limited, and more studies are needed to confirm their effectiveness.