Michael R. Page, PharmD, RPh
Probiotics may play a role in treating patients with acute diarrhea and irritable bowel syndrome and in preventing traveler’s diarrhea.
In an article
published in the September/October 2013 issue of Advances in Clinical and Experimental Medicine
, researchers provided an overview of probiotic use among patients with acute diarrhea, traveler’s diarrhea, and irritable bowel syndrome (IBS). Probiotic use may reduce the duration of acute diarrhea, the risk of developing traveler’s diarrhea, and the severity of symptoms of IBS.
Probiotic bacteria have the common feature of digesting saccharides into lactic acid through an anaerobic process. To be useful as a supplement, probiotic bacteria must be able to survive passage through the low-pH conditions of the stomach.
Some evidence supports use of probiotics in patients with acute diarrhea. Acute diarrhea typically lasts 10 to 14 days and may be caused by viruses, bacteria, or parasites. Of children with acute diarrhea in 2 different treatment centers, those who received milk containing probiotic yeast (Saccharomyces boulardii
) regained lost weight faster than children who received milk that did not contain probiotics.
Of preparations for acute diarrhea available over the counter in the United States, supplements containing Lactobacillus
GG have the best evidence for shortening the duration of diarrhea in children. However, the benefits may be minimal, with a reduction of diarrhea duration by an average of 17 to 30 hours, and then only if the probiotic treatment begins within 72 hours of acute diarrhea onset.
Probiotic bacteria may also play a role in reducing the risk of traveler's diarrhea, having demonstrated efficacy in 57% of patients who used a supplement containing Lactobacillus acidophilus
, Lactobacillus bulgaricus
, and Streptococcus thermophiles
for 2 weeks. In the control group, 29% of patients did not experience diarrhea.
In patients with IBS, bacteria of the genera Lactobacillus
may reduce the amount of bile acids that reach the large bowel, thereby reducing the severity of diarrhea and associated discomfort. In particular, Lactobacillus plantarum
may reduce the risk of flatulence, and Lactobacillus
GG may reduce the risk of diarrhea. However, patients with IBS should not expect complete remission of symptoms. Typically, probiotics may reduce the severity of symptoms, but generally do not completely eliminate symptoms and only reach full effect after several weeks of use.
Probiotics have a role in preventing traveler’s diarrhea, having been shown to reduce the severity and duration of diarrhea associated with acute viral infection, as well as the flatulence and bowel discomfort symptoms of patients with IBS. Knowing the specific role of each bacteria and the evidence supporting the use of each type of bacteria is useful for pharmacists providing advice on OTC supplements to patients seeking treatment, prevention, or symptom reduction with probiotic supplements.
To access a pdf with the full text of the article, click here