A Gastroenterologist's Guide to Probiotics

  • Matthew A. Ciorba
    Reprint requests Address requests for reprints to: Matthew A. Ciorba, MD, Department of Medicine, Division of Gastroenterology, Washington University, St Louis School of Medicine, 660 South Euclid Avenue, Box 8124, St Louis, Missouri 63110. fax: (314) 362-8959
    Department of Medicine, Division of Gastroenterology, Washington University, St Louis School of Medicine, St Louis, Missouri
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Published:April 12, 2012DOI:
      The enteric microbiota contribute to gastrointestinal health, and their disruption has been associated with many disease states. Some patients consume probiotic products in attempts to manipulate the intestinal microbiota for health benefit. It is important for gastroenterologists to improve their understanding of the mechanisms of probiotics and the evidence that support their use in practice. Clinical trials have assessed the therapeutic effects of probiotic agents for several disorders, including antibiotic- or Clostridium difficile–associated diarrhea, irritable bowel syndrome, and the inflammatory bowel diseases. Although probiotic research is a rapidly evolving field, there are sufficient data to justify a trial of probiotics for treatment or prevention of some of these conditions. However, the capacity of probiotics to modify disease symptoms is likely to be modest and varies among probiotic strains—not all probiotics are right for all diseases. The current review provides condition-specific rationale for using probiotic therapy and literature-based recommendations.


      Abbreviations used in this paper:

      AAD (antibiotic-associated diarrhea), CD (Crohn's disease), CDAD (Clostridium difficile–associated diarrhea), ECN (Escherichia coli Nissle 1917), GI (gastrointestinal), IBS (irritable bowel syndrome), LGG (Lactobacillus rhamnosus GG), NNT (number needed-to-treat), RCT (randomized controlled trial), UC (ulcerative colitis)
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