Probiotics and prebiotics in the management of irritable bowel syndrome

Abstract

Irritable bowel syndrome (IBS) is a common disorder of the gastrointestinal tract, about which there has been considerable recent research. The aim of this article is to briefly review the aspects of IBS pathogenesis that involve the gastrointestinal microbiota, and then to critically appraise the recent and emerging evidence for the use of probiotics and prebiotics in its management. The increased risk of developing IBS following gastroenteritis and the co-existence of dysbiosis, elevated luminal gas production and immune activation, indicate that the gastrointestinal microbiota may be a therapeutic target in IBS. Most systematic reviews indicate that probiotics have a beneficial impact on global IBS symptoms, abdominal pain and flatulence. However, recent trials indicate that different probiotics can improve, have no effect, or even worsen symptoms, confirming that benefits are likely to be strain and symptom-specific. There are no recent clinical trials of prebiotics in IBS, although previous studies indicate potential benefit at lower doses. Clearly, some probiotics have considerable potential in the management of IBS; however, the benefits are likely to be strain-specific. Preliminary studies suggest low doses of prebiotics may improve symptoms of IBS, although further robust clinical trials are required.