JLE

Hépato-Gastro & Oncologie Digestive

MENU

Probiotics in practice in Irritable Bowel Syndrome: Scientific answers to practical questions Volume 27, issue 6, Juin 2020

Authors
1 Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Service de gastroentérologie ; Aix-Marseille Université
2 Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d’explorations fonctionnelles digestives, 69437 Lyon
* Correspondance

Irritable Bowel Syndrome (IBS) is a multifactorial disease including the involvement of dysbiosis in a significant number of patients. This mechanism would explain the possible efficacy of probiotics in the treatment of IBS. Current data in the literature, including randomized trials, confirm the interest in using probiotics to restore the intestinal microbiota and relieve symptoms, with a moderate level of evidence. Given the very large number of probiotics currently available on the French and European markets, the heterogeneity of their status (food supplement, medical device, drug) and the regulations that govern them, the French and European health authorities have enacted eligibility criteria for probiotic status. These criteria ensure the choice of a “safe” probiotic. In addition, there are currently eligibility criteria for a probiotic in the treatment of IBS. Nevertheless, among these probiotics, the available data are not always equivalent. Thus, in practice, it is not possible to identify a probiotic that is more effective than another in the treatment of IBS. Nevertheless, it seems reasonable, when a practitioner decides to prescribe a probiotic, to start with one of those for which a clinical study with proven efficacy is available. Several probiotics may be tested successively. On the other hand, it is possible, if a patient is improved by a probiotic without a clinical study, not to modify it and to encourage the patient to continue it. In all cases, probiotics are generally well-tolerated treatments with few side effects in practice. It therefore seems reasonable to offer them to patients suffering from IBS by evaluating their individual efficacy. In the future, it should be possible to identify which patients or subgroups of patients with IBS are most likely to benefit from probiotic treatments and in which modalities.