A Practitioner's Guide to Probiotics: Gastrointestinal Conditions

Probiotic supplements contain beneficial microorganisms, similar to those found in the human gastrointestinal tract (271). When ingested, these live microorganisms confer a number of health benefits to the host (71). Probiotics, particularly Lactobacillus, Bifidobacterium, and Saccharomyces species, have been studied for their effectiveness in numerous gastrointestinal conditions (271). 

Imbalances in the intestinal microbiota are believed to be involved in the development of certain gastrointestinal disorders. Probiotic supplements may support a healthy composition of bacteria in the gastrointestinal tract and improve GI function by a number of mechanisms, such as:

  • Alteration of intestinal flora via acidification of the colon by fermentation of nutrients
  • Inhibition of pathogenic bacteria through displacement of gas-producing, bile salt-deconjugating bacterial species
  • Modulation of gastrointestinal immune function via action on inflammatory cytokines and inflammatory mechanisms
  • Improvement of epithelial barrier function
  • Induction of intestinal epithelial cell receptors (e.g., µ-opioid, cannabinoid)
  • Attenuation of stress response, spinal afferent traffic, and visceral hypersensitivity (263)

While the therapeutic use of probiotics is becoming increasingly common, especially within the field of gastroenterology (41), clear guidelines for clinical application have yet to be established. This is particularly important as the effectiveness of probiotic supplementation may be dependent on the condition, strain, dosing, and duration of therapy (271). This guide provides an overview of the available research for the clinical application of probiotics in gastrointestinal conditions, including dosing and administration for single-strain and multi-strain probiotics.

Safety Considerations & Contraindications

While probiotics are considered safe, rare short term side effects may occur such as gas and bloating (41). Isolated cases of bacteremia or fungemia have been associated with probiotics, though population data also indicates that there is no widespread risk of these complications (232). 

There is some limited evidence that probiotics should not be administered in critically ill patients, as demonstrated by an increased risk of mesenteric ischemia and mortality in a trial of patients with predicted severe acute pancreatitis (18).

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