2019 Top Stories in Gastroenterology: Probiotics in Irritable Bowel Syndrome
My choice for top story of 2019 is the mini-review, “Probiotics in Irritable Bowel Syndrome: Where Are We?”1 This article was published by Giovanni Barbara and colleagues from Italy and Spain. I selected this mini-review because of its importance and interest to the practicing gastroenterologist and to primary care providers. These providers will attest to the numerous and repeated visits by individuals looking for ways to cure or improve their IBS symptoms. To date, there are no specific treatments for this compilation of symptoms. Instead, clinic visits are spent attempting to discern the major symptoms from a complex of symptoms, identifying any triggers that induce or worsen the symptoms, and searching for treatment strategies, including medications and lifestyle changes, that will help to relieve the discomfort and associated anxiety that often accompanies IBS.
With the recent focus on the role of the gut microbiome and its associated metabolites that contribute so significantly to various aspects of our health and disease, many investigators have sought to understand whether specific probiotic consortia will alleviate IBS symptoms in specific subsets of IBS patients. Although some studies report benefit from probiotics, others show no difference from placebo. In any case, for those studies that show positive benefit, the mechanisms by which the administration of probiotics to IBS patients reduce symptoms are unknown. Likely, much of the difficulty in identifying specific combinations of probiotics that will reliably help in the management of IBS symptoms lies in the fact that IBS itself is not well-understood and symptoms stem from a number of different factors that may be relatively unique to each patient.
This mini-review offers insight into potential mechanisms through which probiotics may provide benefit to IBS patients, and the authors discuss clinical factors that may help to predict patients who will respond to such therapies. Clearly, much more work is needed in this area and we look forward to continued enlightenment that will emerge from such future studies.
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