The Potential for use of Probiotics in Pediatric Irritable Bowel Syndrome and Inflammatory Bowel Disease

Abstract

Controlled trials of probiotics in irritable bowel syndrome are promising, but most are limited by suboptimal design and small sample size. A recent report from the Rome foundation group included 32 randomized clinical trials of probiotics. Seventy-five percent of these studies (including the 4 pediatric ones) did show an improvement in symptoms, but the therapeutic gain over placebo was generally modest. The patients most benefitting from probiotics appear to be those with predominant diarrhea and those who have developed irritable bowel syndrome after an episode of gastroenteritis. A review focusing only on children with functional gastrointestinal disorders concluded that probiotics are more effective than placebo in the treatment of patients with abdominal pain-related functional disorders, but no effect on constipation was evident for any strain. In spite of a solid conceptual and experimental basis for successful use of probiotics in inflammatory bowel diseases (Crohn’s disease and ulcerative colitis), research in humans has been overall quite limited and overall disappointing. To summarize current evidence, no probiotic has proven successful in Crohn’s disease, while in ulcerative colitis data are more promising. In fact, a recent meta-analysis, that included 23 randomized controlled trials, concluded that there is evidence of efficacy for the probiotic mixture VSL#3 in helping inducing and maintaining remission. In summary, for both irritable bowel syndrome and inflammatory bowel diseases, there is a definite need for well-designed, randomized clinical trials.