Is Florastor (Saccharomyces boulardii) effective for treating abdominal bloating?

Florastor (Saccharomyces boulardii) for Abdominal Bloating

Saccharomyces boulardii (Florastor) is not recommended for the treatment of abdominal bloating as studies show no significant difference between S. boulardii and placebo for abdominal pain scores in patients with irritable bowel syndrome. 1

Evidence on S. boulardii for Bloating

• Three studies testing S. boulardii among 232 adults with IBS found no difference between S. boulardii and placebo for abdominal pain scores (standardized MD, 0.26; 95% CI, −0.09 to 0.61) 1
• The American Gastroenterological Association (AGA) makes no recommendations for the use of probiotics in patients with irritable bowel syndrome due to significant heterogeneity in study designs and outcomes 1
• The AGA suggests using probiotics only in the context of clinical trials for patients with IBS symptoms, including bloating 1
• While the FDA label mentions bloating as an indication for S. boulardii, this is a general statement not supported by high-quality evidence 2

Recommended Approaches for Managing Abdominal Bloating

First-line treatments:

• Regular exercise is strongly recommended for all patients with IBS and bloating symptoms 1
• First-line dietary advice should be offered to all patients 1
• Soluble fiber (e.g., ispaghula) can be effective for global symptoms and abdominal pain in IBS, starting at a low dose (3-4 g/day) and gradually increasing to avoid worsening bloating 1
• A low FODMAP diet may be considered as a second-line dietary therapy for global symptoms and abdominal pain, but should be supervised by a trained dietitian 1

Treatment considerations:

• The AGA specifically states that "treatment with probiotics and medical foods is not recommended for bloating or distention" 1
• Probiotics may actually be associated with developing new onset of brain fogginess, bloating, and lactic acidosis in some patients 1
• For patients with both bloating and constipation, avoid medications with anticholinergic effects as they may worsen constipation 3
• Brain-gut behavioral therapies and diaphragmatic breathing may be beneficial regardless of the underlying cause of bloating 1

Diagnostic Considerations

• Evaluate for potential underlying causes of bloating such as:
  • Carbohydrate intolerances (lactose, fructose, sucrose) 1
  • Small intestinal bacterial overgrowth (SIBO) 1
  • Constipation or pelvic floor dyssynergia 1
  • Celiac disease or non-celiac gluten sensitivity 1

Clinical Pitfalls to Avoid

• Avoid recommending probiotics based solely on manufacturer claims without supporting evidence 1
• Do not rely on probiotics as a primary treatment for bloating when other evidence-based approaches are available 1
• Be cautious about potential adverse effects of probiotics, especially in immunocompromised patients 1
• Avoid prolonged dietary restrictions without evidence of benefit, as they may lead to nutritional deficiencies 1

In conclusion, while S. boulardii has demonstrated benefits for certain gastrointestinal conditions such as antibiotic-associated diarrhea 4, 5, the current evidence does not support its use specifically for abdominal bloating. Patients with bloating symptoms should be offered evidence-based approaches including dietary modifications, exercise, and potentially medications targeting specific underlying mechanisms.