title: Probiotics, fibre and herbal medicinal products for functional and inflammatory bowel disorders.
abstract: Functional bowel disorders (FBD), mainly irritable bowel syndrome (IBS) and functional constipation (FC, also called chronic idiopathic constipation), are very common worldwide. Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease, although less common, has a strong impact on patients' quality of life, as well as being highly expensive for our healthcare. A definite cure for those disorders is still yet to come. Over the years, several therapeutic approaches complementary or alternative to traditional pharmacological treatments, including probiotics, prebiotics, synbiotics, fibre and herbal medicinal products, have been investigated for the management of both groups of diseases. However, most available studies are biased by several drawbacks, including small samples and poor methodological quality. Probiotics, in particular Saccharomyces boulardii and Lactobacilli (among which Lactobacillus rhamnosus), synbiotics, psyllium, and some herbal medicinal products, primarily peppermint oil, seem to be effective in ameliorating IBS symptoms. Synbiotics and fibre seem to be beneficial in FC patients. The probiotic combination VSL#3 may be effective in inducing remission in patients with mild-to-moderate ulcerative colitis, in whom Escherichia coli Nissle 1917 seems to be as effective as mesalamine in maintaining remission. No definite conclusions can be drawn as to the efficacy of fibre and herbal medicinal products in IBD patients due to the low number of studies and the lack of randomized controlled trials that replicate the results obtained in the individual studies conducted so far. Thus, further, well-designed studies are needed to address the real role of these therapeutic options in the management of both FBD and IBD.
  
  
  
  This article is part of a themed section on Principles of Pharmacological Research of Nutraceuticals. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.11/issuetoc.
authors.affiliation: Institute of Pharmacology, School of Medicine, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Currò
authors.affiliation: Department of Internal Medicine, School of Medicine, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Ianiro
authors.affiliation: Department of Internal Medicine, School of Medicine, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Pecere
authors.affiliation: Department of Clinical and Experimental Medicine, University of Sassari, V.le S. Pietro, 8, 07100, Sassari, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bibbò
authors.affiliation: Department of Internal Medicine, School of Medicine, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cammarota
mesh_terms: D000818:Animals; D003248:Constipation / Q000178:diet therapy / Q000188:drug therapy; D004043:Dietary Fiber / Q000008:administration & dosage; D019587:Dietary Supplements; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000178:diet therapy / Q000188:drug therapy; D043183:Irritable Bowel Syndrome / Q000178:diet therapy / Q000188:drug therapy; D008517:Phytotherapy / Q000379:methods; D028321:Plant Preparations / Q000008:administration & dosage; D056692:Prebiotics / Q000008:administration & dosage*; D019936:Probiotics / Q000008:administration & dosage*; D011788:Quality of Life
chemical_list: D004043:Dietary Fiber; D028321:Plant Preparations; D056692:Prebiotics