title: Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice -- an evidence-based international guide.
abstract: BACKGROUND
  Evidence suggests that the gut microbiota play an important role in gastrointestinal problems.
  
  
  OBJECTIVE
  To give clinicians a practical reference guide on the role of specified probiotics in managing particular lower gastrointestinal symptoms/problems by means of a systematic review-based consensus.
  
  
  METHODS
  Systematic literature searching identified randomised, placebo-controlled trials in adults; evidence for each symptom/problem was graded and statements developed (consensus process; 10-member panel). As results cannot be generalised between different probiotics, individual probiotics were identified for each statement.
  
  
  RESULTS
  Thirty seven studies were included; mostly on irritable bowel syndrome [IBS; 19 studies; treatment responder rates: 18-80% (specific probiotics), 5-50% (placebo)] or antibiotic-associated diarrhoea (AAD; 10 studies). Statements with 100% agreement and 'high' evidence levels indicated that: (i) specific probiotics help reduce overall symptom burden and abdominal pain in some IBS patients; (ii) in patients receiving antibiotics/Helicobacter pylori eradication therapy, specified probiotics are helpful as adjuvants to prevent/reduce the duration/intensity of AAD; (iii) probiotics have favourable safety in patients in primary care. Items with 70-100% agreement and 'moderate' evidence were: (i) specific probiotics help relieve overall symptom burden in some patients with diarrhoea-predominant IBS, and reduce bloating/distension and improve bowel movement frequency/consistency in some IBS patients and (ii) with some probiotics, improved symptoms have led to improvement in quality of life.
  
  
  CONCLUSIONS
  Specified probiotics can provide benefit in IBS and antibiotic-associated diarrhoea; relatively few studies in other indications suggested benefits warranting further research. This study provides practical guidance on which probiotic to select for a specific problem.
authors: School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.
authors: A P S
authors: AP
authors: Hungin
authors: C
authors: C
authors: Mulligan
authors: B
authors: B
authors: Pot
authors: P
authors: P
authors: Whorwell
authors: L
authors: L
authors: Agréus
authors: P
authors: P
authors: Fracasso
authors: C
authors: C
authors: Lionis
authors: J
authors: J
authors: Mendive
authors: J-M
authors: JM
authors: Philippart de Foy
authors: G
authors: G
authors: Rubin
authors: C
authors: C
authors: Winchester
authors: N
authors: N
authors: de Wit
mesh_terms: D015746:Abdominal Pain / Q000628:therapy*; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D003697:Delphi Technique; D003967:Diarrhea / Q000139:chemically induced / Q000628:therapy*; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000628:therapy*; D019936:Probiotics / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000900:Anti-Bacterial Agents
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