Professional Guidelines on Probiotic Use for IBS: A Quick Overview

When it comes to using probiotics for managing IBS symptoms, professional consensus varies widely. Different organizations have taken different stances, primarily due to the quality of available evidence. Here’s a breakdown:

Conservative Stances

Some organizations, including the American College of Gastroenterology (ACG) (1), the American Gastroenterological Association (AGA) (2), and the Asian Neurogastroenterology and Motility Association (ANMA) (3), have adopted cautious guidelines. Their conservative stance against the use of probiotics in IBS stems from concerns about the quality of the supporting evidence.

More Open Stances

On the other hand, several organizations have shown more openness to the use of probiotics for IBS, although their recommendations come with various conditions and levels of endorsement. These organizations include:

  • Experts of Yale Workshop on Probiotics (4)
  • British Society of Gastroenterology (5)
  • British Dietetic Association (BDA) (6)
  • Canadian Association of Gastroenterology (7)
  • German Society for Digestive and Metabolic Diseases (8)
  • Japanese Society of Gastroenterology (JSGE) (9)
  • Korean Society of Neurogastroenterology and Motility (KSNM) (10)
  • Polish Society of Gastroenterology (11)
  • Romanian Society of Neurogastroenterology (12)
  • World Gastroenterology Organisation (WGO) Guidelines on Probiotics and Prebiotics (13)

The Path Forward

While professional opinions vary globally, one thing is clear: more high-quality research on probiotics is needed to unify these perceptions. With better evidence, the medical community could reach a more solid consensus on the use of probiotics for IBS, potentially leading to more effective and consistent treatment guidelines.

Key Takeaway

If you’re considering probiotics for IBS, it’s important to consult with your healthcare provider, as recommendations can vary. Keep an eye on emerging research, as the landscape of probiotic use in IBS continues to evolve with new evidence.

Probiotic Guidelines for IBS by Organization or Country

Organization/
Country/Year		 Statement Summary Recommendation Level Evidence Quality Rating
American College of Gastroenterology (ACG) Clinical Guideline: Management of IBS/USA/2021 (1) “We suggest against probiotics for the treatment of global IBS symptoms.” Conditional Very low
American Gastroenterological Association (AGA)/USA/2020. (2) “In symptomatic children and adults with irritable bowel syndrome, we recommend the use of probiotics only in the context of a clinical trial.” No recommendation N/A
Experts of Yale Workshop on Probiotics/USA/2015 (4) Recommended 4 probiotics, but no summary statement was provided. The recommended strains included:
-Bifidobacterium infantis 35624
-VSL #3
-B. animalis
-L. plantarum 299v		 N/A Each recommended strain was given an effectiveness letter ranking of either a B or C, though the meaning of these rankings was not explicitly stated
The Asian Neurogastroenterology and Motility Association (ANMA) – Second Asian Consensus/Asia/2019 (3) “The effectiveness of probiotics has not been fully validated in IBS.” No recommendations moderate
British Society of Gastroenterology/UK/2021 (5) “Probiotics, as a group, may be an effective treatment for global symptoms and abdominal pain in IBS, but it is not possible to recommend a specific species or strain. It is reasonable to advise patients wishing to try probiotics to take them for up to 12 weeks, and to discontinue them if there is no improvement in symptoms.” Weak Very Low
British Dietetic Association (BDA)/UK/2016 (6) “Probiotics are unlikely to provide substantial benefit to IBS symptoms. However, individuals choosing to try probiotics are advised to select one product at a time and monitor the effects. They should try it for a minimum of 4 weeks at the dose recommended by the manufacturer. Taking a probiotic product is considered safe in IBS.” Grade B
(The meaning of grade rankings was not explained)		 N/A
Canadian Association of Gastroenterology/ Canada/2019 (7) “We suggest offering IBS patients probiotics to improve IBS symptoms.” Conditional Low-quality
German Society for Digestive and Metabolic Diseases/Germany/ 2011 (8) Probiotics recommended in most/some IBS patients with pain and diarrhea, constipation and bloating/abdominal distension/meteorism/flatulence:
Bifidobacterium infantis 35624
Bifidobacterium animalis ssp . lactis DN-173 010
Lactobacillus casei Shirota
Lactobacillus plantarum 299v
Lactobacillus rhamnosus GG (only in children)
E. coli Nissle 1917		 Level A

Meaning for physicians:
Different decisions are appropriate for different patients, depending on the patient’s situation but also on personal opinions and preferences.
Meaning for patients:
The majority of patients (> 50%) would decide in favor of the intervention, but many would not.

 Strong consensus
Japanese Society of Gastroenterology (JSGE)/Japan/2021 (9) “Probiotics are effective in treating IBS. Probiotics are recommended for IBS.” Strong recommendation Level A (High)
Korean Society of Neurogastroenterology and Motility (KSNM)/Korea/2018 (10) “Probiotics may be considered to relieve global symptoms, bloating, and flatulence in irritable bowel syndrome patients.” Weak (2) Low Quality (C)
Polish Society of Gastroenterology/Poland/ 2018 (11) “We suggest using certain strains or combinations of probiotic strains tested for their efficacy in IBS, rather than probiotics as a group to reduce overall symptoms of IBS as well as bloating and diarrhea in patients with IBS…
It is not possible to determine the efficacy of individual strains included in combined preparations or the efficacy of other configurations (blends) of the aforementioned strains”

Monostrains:
– Bifidobacterium bifidum MIMBb75
– Bifidobacterium infantis 35624
– Bifidobacterium lactis – Escherichia coli DSM17252
– Lactobacillus acidophilus SDC 2012, 2013
– Lactobacillus plantarum 299v

Strains tested in selected populations, or an effect covering only a part of symptoms:
– Bacillus coagulans GBI-30, 6086
– Bifidobacterium animalis
– Saccharomyces boulardii CNCM I-745

Blends:
– Combined preparation: Lactobacillus rhamnosus NCIMB 30174, L. plantarum NCIMB 30173, L. acidophilus NCIMB and Enterococcus faecium NCIMB 30176
– Combined preparation: Lactobacillus animalis subsp. lactis BB-12, L. acidophilus LA-5, L. delbrueckii subsp. bulgaricus LBY-27 and Streptococcus thermophilus STY-31; Bifidobacterium animalis DN-173 010 in fermented milk (together with Streptococcus thermophilus and Lactobacillus bulgaricus)
– Combined preparation: Lactobacillus rhamnosus GG, L. rhamnosus LC705, Propionibacterium freudenreichii subsp. shermanii JS DSM 7067 and Bifidobacterium animalis subsp. lactis Bb12 DSM 15954
– Combined preparation Pediococcus acidilactici CECT 7483, Lactobacillus plantarum CECT 7484 and L. plantarum CECT 7485
– Combined preparation: Streptococcus thermophilus DSM24731, Bifidobacterium longum DSM24736, Bifidobacterium breve DSM24732, Bifidobacterium infantis DSM24737, Lactobacillus acidophilus DSM24735, Lactobacillus plantarum DSM24730, Lactobacillus paracasei DSM24733 and Lactobacillus delbrueckii ssp. bulgaricus DSM24734

 Weak quality of evidence Very Low
Romanian Society of Neurogastroenterology/Romania/ 2021 (12) “In patients with IBS, we recommend the use of probiotics as an alternative therapy in trials of limited duration.” Weak B (Several studies available, at least one of high quality, others with limitations; trustworthy)
World Gastroenterology Organisation (WGO)/Global Guidelines/2017 (13) “A reduction in abdominal bloating and flatulence as a result of probiotic treatments is a consistent finding in published studies; some strains may ameliorate pain and provide global relief. The literature suggests that certain probiotics may alleviate symptoms and improve the quality of life in patients with functional abdominal pain.”

Recommended strains and Blends:
-Bifidobacterium bifidum MIMBb75 (3)
-Lactobacillus plantarum 299v (DSM 9843) (2)
-Escherichia coli DSM17252 (2)
-Lactobacillus rhamnosus NCIMB 30174, L. plantarum NCIMB 30173, L. acidophilus NCIMB 30175, and Enterococcus faecium NCIMB 30176. (2)
-Lactobacillus animalis subsp. lactis BB-12®, L. acidophilus LA5®, L. delbrueckii subsp. bulgaricus LBY-27, Streptococcus thermophilus STY-31 (3)
-Saccharomyces boulardii CNCM I-745 (2)
-Bifidobacterium infantis 35624 (2)
-Bifidobacterium animalis DN-173 010 in fermented milk (with Streptococcus thermophilus and Lactobacillus bulgaricus) (2)
– Lactobacillus acidophilus SDC 2012, 2013 (3)
-Lactobacillus rhamnosus GG, L. rhamnosus LC705, Propionibacterium freudenreichii subsp. shermanii JS DSM 7067, Bifidobacterium animalis subsp. lactis Bb12 DSM 15954 (2)
-Bacillus coagulans GBI-30, 6086 (3)
-Pediococcus acidilactici CECT 7483, Lactobacillus plantarum CECT 7484, L. plantarum CECT 7485 (3)

 N/A Numerical evidence quality rankings were ascribed to each strain. All rankings for IBS probiotics were either a 2 or a 3 (see parenthesis next to strains in statement summary section).

Evidence level of 2:
Randomized trial or observational study with dramatic effect

Evidence level of 3:
Nonrandomized controlled cohort / follow-up study

References

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  9. Fukudo S, Okumura T, Inamori M, et al. Evidence-based clinical practice guidelines for irritable bowel syndrome 2020. J Gastroenterol. 2021;56:193-217. doi:10.1007/s00535-020-01746-z.
  10. Song KH, Jung HK, Kim HJ, et al. Clinical Practice Guidelines for Irritable Bowel Syndrome in Korea, 2017 Revised Edition. J Neurogastroenterol Motil. 2018;24(2):197-215. doi:10.5056/jnm17145.
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  12. Dumitrascu DL, Baban A, Bancila I, et al. Romanian Guidelines for Nonpharmacological Therapy of IBS. J Gastrointestin Liver Dis. 2021;30(2):291-306.
  13. Guarner F, Sanders ME, Eliakim R, et al. World Gastroenterology Organisation Global Guidelines: Probiotics and Prebiotics. February 2017. © World Gastroenterology Organisation; 2017.