Davidson’s Principles and Practice of Medicine, 22^nd Ed, Page-908, Fig 22.57

·       For reducing IBS pain & bloating as spasmolytics and also as Probiotics, in capsule form, can be effective if taken for several months, although the optimum combination of bacterial strains and dose have yet to be clarified.

A range of complementary and alternative therapies exist such as probiotics; most lack a good evidence base but are popular and help some patients in IBS.

Harrison’s principles of internal medicine, 19^th Ed, P-263, 797, 1970

·       For IBS patients with predominant gas and bloating, some patients may benefit from probiotics and rifaximin treatment.

·       Therapies to modify gut flora (non-absorbable antibiotics, probiotics) reduce gaseous symptoms in some IBS patients.

·       Because altered colonic flora may contribute to the pathogenesis of IBS, this has led to great interest in using probiotics to naturally alter the flora.

·       A meta-analysis of probiotic studies in IBS patients found significant relief of pain and bloating with the use of Bifidobacterium Breve, B. longum and Lactobacillus acidophilus species compared to placebo.

However, there was no change in stool frequency or consistency.

Note: Large-scale studies of well-phenotyped IBS patients, Probiotics have been only -20% effective as prophylaxis

Harrison’s principles of internal medicine, 19^th Ed, P-797, 857, 917, 1880, 1922

Traveler’s diarrhea

·       A meta-analysis suggests that probiotics may lessen the likelihood of traveler’s diarrhea by - 15%.

C. difficile associated diarrhea

·       Preliminary data suggest a role for probiotics in the prevention of C. difficile associated diarrhea in patients in whom systemic antibiotic therapy is being initiated.

Infectious diarrhea and irritable bowel syndrome

·       Probiotics containing active bacterial cultures are used as adjuncts in some cases of infectious diarrhea and irritable bowel syndrome. Probiotics that selectively nourish benign commensal bacteria may ultimately show benefit in functional disorders as well.

Antibiotic-associated diarrhea

·       Amoxicillin can also lead to antibiotic-associated diarrhea, nausea, vomiting, skin rash, and allergic reaction. Concomitant use of probiotics may ameliorate some of the antibiotic side effects.

Kumar & Klark’s Clinical Medicine, 8^th Ed, P-280-81

• Probiotics are live microorganisms which when ingested can modify the composition of enteric microflora.
• Commonly used probiotics are lactobacilli, bifidobacteria, non-pathogenic E. coli.

Pouchitis

Kumar & Klark’s Clinical Medicine, 8^th Ed, P-280-81

·       Pouchitis is inflammation of the ileal pouch (an artificial rectum surgically created out of ileal gut tissue in patients who have undergone a colectomy), which is created in the management of patients with ulcerative colitis, indeterminate colitis, familial adenomatous polyposis (FAP), or, rarely, other colitides.

·       The probiotic has been shown to be effective to prevent the onset of pouchitis and to maintain remission in pouchitis patients with antibiotic induced mucosal healing.

·       Pouchitis– Probiotics can prevent onset and maintain a remission.

CMDT, Current Medical Diagnosis & treatment 2015, P-644, 646

·       Probiotics containing nonpathogenic strains of lactobacilli, bifidobacteria, and streptococci (VSL#3) are effective in the maintenance of remission in patients with recurrent pouchitis.

Ulcerative colitis

Kumar & Klark’s Clinical Medicine, 8^th Ed, P-280-81

·       E. coli Nissle 1914 may be useful in maintaining remissions in ulcerative colitis.

CMDT, Current Medical Diagnosis & treatment 2015, P-644, 646

·       Probiotics—VSL#3 (two packets twice daily), a probiotic compound containing eight different nonpathogenic strains of lactobacilli, bifidobacteria, and streptococci, has demonstrated significant benefit versus placebo in the treatment of mild to moderate ulcerative colitis in two randomized, controlled multicenter trials.

Although its efficacy relative to other agents is unclear, it may be considered as an adjunctive therapy for mild to moderate disease.

Diverticular disease

Harrison’s principles of internal medicine, 19^th Ed, P-1972

·       Probiotics are being increasingly used by gastroenterologists for multiple bowel disorders and have been shown to prevent recurrence of diverticulitis. Specifically probiotics containing Lactobacillus acidophilus and Bifidobacterium strains have been shown to be beneficial. 

CMDT, Current Medical Diagnosis & treatment 2015, P-632

·       C difficile is acquired in approximately 20% of hospitalized patients, most of whom have received antibiotics that disrupt the normal bowel flora and thus allow the bacterium to flourish.

·       C difficile colitis will develop in approximately one-third of infected patients. In clinical trials, prophylactic administration of the probiotics containing Lactobacillus casei, Lactobacillus bulgaricus, and Streptococcus thermophilus, to hospitalized patients who are receiving antibiotics reduced the incidence of C difficile–associated diarrhea.