A Gastroenterologist's Guide to Probiotics

Matthew a. Ciorba, MD


Clin Gastroenterol Hepatol. 2012;10(9):960-968. 

In This Article

Abstract and Introduction


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.


For more than a hundred years it has been recognized that certain microorganisms may impart health benefits to the host when administered in adequate amounts. These microorganisms, termed probiotics, have recently become a topic of significant focus in basic and clinical investigation. Relevant to the practice of gastroenterology, probiotics are commonly used by patients with gastrointestinal (GI) complaints or diseases. Increasingly, probiotics are also being recommended by the clinicians who treat these conditions.[1]

The goal of this review is to provide clinicians with an overview of the rationale and data which support or refute the role of probiotics for treating commonly encountered GI disorders. The information provided is based on review of primary literature from randomized controlled trials (RCTs), meta-analyses, expert consensus panel recommendations, and society-based practice recommendations. References are provided for more in-depth reading and tables or figures summarize key information.