Symbiotics in irritable bowel syndrome - better than probiotics alone?

Purpose of review: Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder associated with significant physical and psychological co-morbidity. The aetiology of the condition is uncertain but recent research suggests the gut bacterial flora may play a role in its development. Therefore, manipulation of the intestinal microbiome by using probiotics and symbiotics has the potential to improve patient outcomes in IBS. Recent findings: Numerous randomised controlled trials (RCTs) suggest a benefit of probiotics in the management of IBS, with a significant reduction in the likelihood of symptoms persisting after therapy, and improvements in abdominal pain, bloating, and flatulence when probiotics are compared with placebo. Evidence for the effect of probiotics on quality of life is conflicting. Relatively few RCTs have examined the effect of symbiotics on outcomes in IBS, but results thus far are promising. Summary: Probiotics appear to be beneficial in IBS. Data supporting the use of symbiotics is sparse. Whether symbiotics are superior to probiotics is unclear.