Systematic review: Probiotics in the management of lower gastrointestinal symptoms—An updated evidence-based international consensus

Hungin, A. P. S.; Mitchell, C. R.; Whorwell, P.; Mulligan, C.; Cole, O.; Agréus, L.; Fracasso, P.; Lionis, C.; Mendive, J.; Philippart de Foy, J.‐M.; Seifert, B.; Wensaas, K.‐A.; Winchester, C.; de Wit, N.; the European Society for Primary Care Gastroenterology

doi:10.1111/apt.14539

Cited by 154Gastrointestinal motility and disordersProbiotics and Fermented FoodsGut microbiota and health

Systematic review: Probiotics in the management of lower gastrointestinal symptoms—An updated evidence-based international consensus

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Hungin, A. P. S., Mitchell, C. R., Whorwell, P., Mulligan, C., Cole, O., Agréus, L., Fracasso, P., Lionis, C. +7 more·2018·Alimentary Pharmacology & Therapeutics

DOI 10.1111/apt.14539PMC PMC5900870

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Abstract

BACKGROUND: In 2013, a systematic review and Delphi consensus reported that specific probiotics can benefit adult patients with irritable bowel syndrome (IBS) and other gastrointestinal (GI) problems. AIM: To update the consensus with new evidence. METHODS: A systematic review identified randomised, placebo-controlled trials published between January 2012 and June 2017. Evidence was graded, previously developed statements were reassessed by an 8-expert panel, and agreement was reached via Delphi consensus. RESULTS: A total of 70 studies were included (IBS, 34; diarrhoea associated with antibiotics, 13; diarrhoea associated with Helicobacter pylori eradication therapy, 7; other conditions, 16). Of 15 studies that examined global IBS symptoms as a primary endpoint, 8 reported significant benefits of probiotics vs placebo. Consensus statements with 100% agreement and "high" evidence level indicated that specific probiotics help reduce overall symptom burden and abdominal pain in some patients with IBS and duration/intensity of diarrhoea in patients prescribed antibiotics or H. pylori eradication therapy, and have favourable safety. Statements with 70%-100% agreement and "moderate" evidence indicated that, in some patients with IBS, specific probiotics help reduce bloating/distension and improve bowel movement frequency/consistency. CONCLUSIONS: This updated review indicates that specific probiotics are beneficial in certain lower GI problems, although many of the new publications did not report benefits of probiotics, possibly due to inclusion of new, less efficacious preparations. Specific probiotics can relieve lower GI symptoms in IBS, prevent diarrhoea associated with antibiotics and H. pylori eradication therapy, and show favourable safety. This study will help clinicians recommend/prescribe probiotics for specific symptoms.

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Probiotics are beneficial in improving overall symptoms in patients with IBS, but there are contradictory reports on improvements in specific symptoms.
“Based on the international consensus and existing evidence, probiotics are beneficial in improving overall symptoms in patients with IBS [29,30,31,32,33,34,35], but there are still contradictory reports on improvements in specific symptoms [36,37,38].”
From Effectiveness and Safety of Probiotics for Patients with Constipation-Predominant Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of 10 Randomized Controlled Trials (2022) · cites this paper as [33]
Some systematic reviews and meta-analyses have supported that specific probiotic strains may be effective in certain areas.
“While there is limited evidence around many probiotics, some systematic reviews and meta-analyses have supported that specific strains may be effective in certain areas [43,44,45,46].”
From Effect of Diet on the Gut Microbiota: Rethinking Intervention Duration (2019) · cites this paper as [45]

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Authors: Hungin, A. P. S., Mitchell, C. R., Whorwell, P., Mulligan, C., Cole, O., Agréus, L., Fracasso, P., Lionis, C., Mendive, J., Philippart de Foy, J. ‐., Seifert, B., Wensaas, K. ‐., Winchester, C., de Wit, N., & the European Society for Primary Care Gastroenterology
Affiliations: Newcastle upon Tyne UK
Oxford UK
Manchester UK
Brighton UK
Stockholm Sweden
Rome Italy
Heraklion Greece
Barcelona Spain
Brussels Belgium
Prague Czech Republic
Bergen Norway
Utrecht The Netherlands
Corresponding author: Hungin, A. P. S.
ORCID: Hungin, A. P. S.
Mitchell, C. R.
Whorwell, P.
Cole, O.
Agréus, L.
Fracasso, P.
Lionis, C.
Mendive, J.
Seifert, B.
Wensaas, K.‐A.
Winchester, C.
Venue: Alimentary Pharmacology & Therapeutics
Publisher: Wiley
Published: 2018-02-20
Volume: 47
Issue: 8
Pages: 1054-1070
ISSN: 0269-2813 (ISSN-L)
1365-2036
DOI: 10.1111/apt.14539
PMC: PMC5900870
OpenAlex: W2789742979
Cited by: 154
References: 110
Citations by year: 2026: 9 · 2025: 11 · 2024: 20 · 2023: 22 · 2022: 21 · 2021: 22 · 2020: 18 · 2019: 20 · 2018: 11
FWCI: 3.16
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc
creativecommons.org/licenses/by-nc/4.0/ (vor)
Locations: Alimentary Pharmacology & Therapeutics (publishedVersion, cc-by-nc)
Europe PMC (PubMed Central) (publishedVersion, other-oa)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
Research Explorer (The University of Manchester) (submittedVersion, cc-by-nc)
Newcastle University ePrints (Newcastle Univesity) (cc-by-nc)
Funders: Danone
Topics: Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
Keywords: probiotics, irritable bowel syndrome, antibiotic-associated diarrhea, H. pylori eradication therapy, lower gastrointestinal symptoms, abdominal pain, bloating, stool frequency, probiotic safety, evidence-based recommendations
MeSH terms: Animals, Diarrhea, Humans, Randomized Controlled Trials as Topic, Helicobacter pylori, Helicobacter Infections, Probiotics, Irritable Bowel Syndrome

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Systematic review: Probiotics in the management of lower gastrointestinal symptoms—An updated evidence-based international consensus

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