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Probiotics in functional bowel disorders

https://doi.org/10.1016/j.bpg.2016.01.003Get rights and content

Abstract

Functional bowel disorders (FBDs) are the most common gastrointestinal (GI) disorders seen by gastroenterologists and primary care physicians. The disorders affect patients functioning and quality of life (QOL) and are associated with significant healthcare burden. The current theory regarding the development of FBDs suggests brain-gut axis dysfunctions associated abnormal GI motility and sensation. Recent data suggest that alterations in the intestinal microbiota may have a role in the pathogenesis of FBDs; or at least have the potential to affect intestinal functions that are thought to be relevant to the development of functional GI symptoms. This has led to growing interest of healthcare providers and patients in targeting the intestinal microbiota for the treatment of FBDs. In this article we discuss the potential role probiotic interventions in the treatment of FBDs. We review the evidence from pre-clinical and clinical studies and discuss the current recommendations for the use of probiotics for FBDs in clinical practice.

Section snippets

Functional bowel disorders

Functional bowel disorders (FBDs) are a group of functional gastrointestinal (GI) disorders characterized by symptoms attributed to the middle and lower GI tract not explained by unified structural and/or biochemical abnormalities [1], [2]. FBDs include IBS, functional bloating, functional constipation, functional diarrhea, and unspecified functional bowel disorder [1]. In the absence of identifiable unified etiopathophysiology the diagnosis of FBDs relies on clinical presentation, use of

The role of the intestinal microbiota in functional bowel disorders

The intestinal microbiota, the complex community of microorganisms residing in the GI tract is believed to contain greater than 1,000 different bacterial species that can reach viable numbers of 1014 bacteria per gram of luminal content. The highest density of the human intestinal microbiota is in the colon and is dominated by two main bacterial genera Firmicutes (64%) and Bacteroidetes (23%) followed by Proteobacteria (8%) and Actinobacteria (3%) [9], [10]. The intestinal microbiota plays an

The scientific basis for the use of probiotics in functional bowel disorders

The probiotic concept suggests that supplementation of the intestinal microbiota with the right types and numbers of live microorganisms can improve the microbiota characteristics and promote health [32], [33], [34]. In theory, certain probiotics can help restore the proper balance of the intestinal microbiota, lead to better digestive and intestinal function, and possibly improve GI symptoms.

Several randomized control trials (RCT's) comparing the effects of probiotics versus placebo in

Conclusions and clinical implications of current data

Emerging data from microbiome research in patients with FBDs suggests a role for the intestinal microbiota in IBS and possibly in other FBDs including abdominal bloating and constipation. This together with the growing interest of the general public in healthy food, direct-to-consumer advertisement and clinical data on beneficial effects of probiotics in various GI conditions such as infectious diarrhea, antibiotic associated diarrhea and some forms of inflammatory bowel disorders, has led to

Conflict of interest statement

Keren Hod: None.

Yehuda Ringel: Consultant, advisory board and research grants with Nestle, Procter & Gamble, Salix Pharmaceuticals, Danisco, Prometheus Therapeutics and Diagnostics.

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