AGA Releases New Guidelines On Using Probiotics For IBS

The American Gastroenterology Association (AGA) released new guidelines for treating certain gastrointestinal disorders with probiotics. Experts did not find enough evidence to support the use of probiotics for IBS. They recommend that children and adults with IBS only use probiotics in clinical trials.1,2

Probiotics are live microorganisms, like bacteria, that support a healthy gut. They may improve IBS symptoms by blocking harmful bacteria and reducing inflammation.3 Some studies show symptom relief with specific probiotics. However, most studies have been small, short, and difficult to compare.1

Therefore, experts cannot yet recommend treating IBS with probiotics. Some specific probiotics may help specific symptoms. But the costs may outweigh the potential benefits. If you are currently taking probiotics, talk to your doctor to determine if you should continue.

How might probiotics treat IBS?

Many IBS symptoms have been linked to changes in the gut bacterial environment. For example, many people with IBS have lower amounts of Lactobacillus and Bifidobacterium. These are two types of bacteria that support a healthy gut.4

We do not know if these changes are a cause or a result of IBS. But some research shows that imbalanced gut bacteria may increase inflammation and sensitivity to gas. Using probiotics may rebalance the gut bacteria and improve symptoms.4

Some studies have shown that probiotics improve symptoms by:3,5

  • Reducing growth of harmful bacteria
  • Strengthening the barrier between the gut and the body
  • Reducing inflammation
  • Slowing bowel movements
  • Reducing gas produced by bacteria
  • Reducing sensitivity to normal amounts of gas

Some randomized clinical trials (RCTs) show that specific types of Lactobacillus and Bifidobacterium improve specific symptoms. And there are minimal health risks linked with taking probiotics.6,7

Why is there uncertainty about probiotics?

Probiotics are not considered drugs and are not regulated tightly. Because of this, many probiotics on the market have not been proven to be effective. But millions of Americans still use probiotics for their potential health benefits.1

Many of the studies showing the effectiveness of probiotics have small test populations and short durations. And they vary widely in their methodology. It is hard to make conclusions from studies that use different probiotics, test populations, dosages, and measures of success.1

Studies show that specific probiotics tend to treat single symptoms, rather than IBS as a whole. In 2016, experts determined that these studies do not provide enough evidence to recommend any probiotics to treat IBS. It is unlikely for any probiotic treatment to improve all IBS symptoms.6

How were the new guidelines made?

The evidence for probiotic treatment of gastrointestinal disorders has been confusing. To clarify this, the AGA made new guidelines based on a literature review. Experts wrote clinical questions that identified specific populations, treatments, and health outcomes. Another set of experts then reviewed the literature to answer these questions.

They then presented their findings and wrote final recommendations. They considered several factors in determining each recommendation:1

  • Quality of evidence for successful outcomes
  • Balance between benefits and harms of probiotic treatment
  • Patients’ values and preferences
  • Cost of probiotics
  • Health equity

What do the new guidelines say?

The AGA found that there is not enough evidence to support using probiotics to treat most gastrointestinal conditions. This includes IBS, Crohn’s disease, and ulcerative colitis. They recommend that probiotics should only be used in a clinical trial setting.1

This recommendation for IBS is based on a review of 76 RCTs that used 44 different probiotic treatments. Most studies reporting benefits only used data from a single RCT. Only 2 probiotic formulations had the same outcome in more than multiple RCTs. But these studies used small sample sizes and participants with different IBS subtypes.1

Therefore, the quality of evidence for success was very low. Further studies are needed to determine whether probiotics should be used to treat IBS.1

Questions to ask your doctor

If you are taking probiotics to treat IBS, you may want to consider stopping. Probiotics are costly, and there is minimal evidence of benefits. Talk to your doctor for information specific to your situation. Here are some questions you may want to ask them:

  • Is there any evidence of a specific probiotic relieving my most bothersome symptom?
  • Are there any potential health risks if I take probiotics?
  • Is the potential benefit of probiotics worth the costs?
  • Can I safely try specific probiotics to see if they help?

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