14 responses to “Probiotic therapy has changed my approach to treating patients with irritable bowel syndrome”

  1. Thanks! Do probiotics treat infant colic as well?

  2. I looked quickly at the PubMed links for the articles cited … amongst related articles at PubMed are at least 2 more recent trials, which appear to be double blind, which suggest no benefit from this treatment.

    Cochrane systematic reviews:

    a) apparently found no benefit in children from a few studies:


    b) protocol for adults with diarrhea-predominant IBS:


    The abstracts of studies cited suggest that many people improve with an “intervention”, but it didn’t look to me as if these studies suggest that the intervention has been proven to work, compared with the control.

    Thomas L. Perry, M.D.

  3. Thank you for this. But why use a yogurt like Activa which contains cornstarch instead of just plain yogurt?

  4. 1. I am not aware of strong clinical evidence that probiotics treat infant colic (but that doesn’t mean the evidence does not exist)

    2. Systematic reviews or other combined anaylsis such as meta-analysis would only be valid ways to critique the data if they were only dealing with one strain of a probiotic (which I don’t believe is the case in these reviews). An important concept to appreciate is that all probiotics differ in there potential ways to treat disease. An analogy I use is to compare them to antibiotics in that we would only use certain antibiotics to treat certain conditions, and obviously reviewing all types of antibiotics to treat one condition would not make sense. As we further our knowledge in understanding the way we can use probiotics we are learning which strains and which dose are optimal to treat disease.

    When evaluating therapies to treat functional disease such as IBS, placebo control is critical as there is a significant placebo response to any intervention in a clinical study. The cited studies were placebo controlled and the active group was superioir to the placebo group in certain critical endpoints reported.

    3. A great point. Until we have good data that probiotic enhanced yogurt is superior to plain yogurt I would not have a strong preference for one over the other as we know regular yogurt has bacteria in it as well (in fact this is why lactose intolerant pts can tolerate yogurt because the bacteria digest the lactose).

  5. the ayurvedics have been doing this for millenia. Not a new or startling discovery…

  6. As someone who has IBS I found this article very interesting. However since I have IBS very much under control with a low fat high soluble fibre diet I wonder if there would be much in the way of benefit for me.

    I would also add while a Soluble fiber supplement is a excellent way to treat IBS I wouldn’t recommend a psyllium based product like Metamucil as it’s more likely to cause bloating than other types of fiber. Not a good thing if your already prone to painful bloating because of IBS. A fibre supplement is also only part of a diet based approach to IBS. In my experience keeping your diet low in fat and free from caffeine will also help.

  7. Is there any evidence that iberogast works for IBS?

    What is the name of a soluble fiber supplement?

  8. Great article. Few comments :
    1. Lactobacillus reuteri in infantile colic: Savino et al in Paediatrics (2008)
    2. NICE guidelines do suggest only soluble fibre in IBS , not the insoluble or combination. Examples of soluble fibre supplements: Benefibre; Mixed fibre:Metamucil
    3. Iberogast – some evidence, see Cocgrane review
    4. Enteric coated peppermint oil capsules (formerly Colpermin, now available as Pepogest and others)

    Hope this helps

  9. […] Probiotic therapy has changed my approach to treating patients 26 Jul 2010. Tuzen and Activa yogurt are two examples of probiotics I use for. for one over the other as we know regular yogurt has bacteria in it as. – Probiotic therapy has changed my approach to treating patients […]

  10. There remain many challenges in managing IBS, largely due to its heterogeneity. There is much variability in regard to many parameters, including the following:
    1. pathophysiology (“afferent” vs “efferent” signalling in the Enteric Nervous System);
    2. predominant symptom(s);
    3. precipitating and/or aggravating factors (post-infectious, “stress”, diet-related, deeper emotional trauma, etc);
    4. overlap with upper GI and non-GI symptoms (dyspepsia, somatic pain, abnormal sleep, fatigue, etc);
    5. severity and life impact;
    6. response to various treatments, including placebo;
    7. clinical trial evidence.
    Perhaps more than with any other type of agent, clinical trial reports on effectiveness of various probiotics for IBS have varied tremendously, probably due to the heterogeneity of not only IBS, but of different probiotics.
    Dr. Bressler has emphasized that not all probiotics are the same. There are differences in the literature in regard to treating various conidtions (GI and otherwise). There are also differences in concentrations and viability of different organisms. Moreover, while there are a number of putative mechanisms by which probiotics may effect biologic response in the host (patient), these have remained theoretical for the most part.
    We still need more information. However, due to the variables described above, we must be cautious in interpreting individual study results.

  11. Have you considered the role of SIBO in IBS? Dr. Pimentel at Cedars Sinai suggests that in a majority of IBS cases addressing SIBO has had great success. He also believes that supplementing with probiotics may only serve to reduce symptoms or in some cases exacerbate rather than eliminating the originating problem.

    Can you comment on the use of rifaximin as a protocol against SIBO and potentially IBS?

  12. in my opinion, IBS is a terribly difficult disease to treat and thus any novel evidenced-based therapies are certainly welcome

  13. I’d just gone thru a recent “rush” of newly diagnosed IBS patients – you know, as a GP sometimes you have unrelated people with similar conditions come to you in waves. This is very helpful. i never thought to view probiotics as a heterogeneous group – “just like antibiotics”! but yeah, why not! It’s a really enlightening point, that when we’re evaluating studies and evidence, and recommending therapeutic options, that we keep in mind which specific condition we’re treating and which agent – not which “group” of agents – just like not all BP meds are created equal for all kinds of hypertensive patients etc. This is practice-changing for me in the context of recommending probiotics, which I already do regularly.

  14. Kefir is far better than Yogurt. Also if you combine Cooked Oats with the regular consumption of Kefir you have a mix that just can’t be beat! You can also add in S. Boullardi for the treatment of diahrrea if you want or add in other good bacteria known to help in certain ways and also onions which like Oatmeal feed the good bacteria.
    Note: Some varieties of Kefir are superior to other types. A patient needs to try 2-3 different types to see which ones provide the desired effect. Kefir needs to also be consumed regularly and for more than a couple of weeks which means your patient needs to commit themselves to trying it. Bacteria need to take hold and become established before any results are noticed.

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