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Healthcare professionals should ask patients about probiotic use

A team from King’s is advising that healthcare professionals should receive education on probiotic use by the public and should be encouraged to enquire about their patients’ probiotic use to self-medicate for constipation.

Constipation is a common, bothersome disorder that exerts a considerable impact on a person’s quality of life, and although several strategies exist for its management, many patients remain dissatisfied with the available treatment options.

In the past decade there has been increasing research investigating the effect of probiotics in constipation, with potential beneficial effects. There is evidence to suggest that probiotics affect constipation and gut motility via different mechanisms. Effects on the central and enteric nervous systems, the immune system and gut microbiota and fermentation have all been studied, with some probiotics appearing to increase stool bifidobacteria and lactobacilli concentrations, both of which are known to be reduced in patients with constipation compared to healthy people.

However, there is currently no published data on their use by people with constipation or their recommendation by doctors for its treatment. 

In a large national survey undertaken by Dr Eirini Dimidi and Prof Kevin Whelan (King’s College London) and Dr Mark Scott (Queen Mary University of London), it has been shown that significantly more people with self-reported constipation currently use probiotics compared to those without, which suggests that people with constipation believe that probiotics are effective in its management.

Sixty four percent of the public believes that probiotics have been tested in research studies for their effectiveness in constipation (with most citing TV adverts as the most common sources of information for probiotic use), and the strongest predictor for probiotic use for gut health in the general population was having constipation.

However, the same survey - which also included 411 general practitioners and 365 gastroenterology specialists - showed that the majority of the doctors did not recommend probiotics for symptoms of constipation in clinical practice and did not believe their effect on constipation has been tested in research studies.

This disparity highlighted an urgent need for a systematic review and meta-analysis (a statistical approach to combine the results from multiple studies) to summarise the evidence.

Research Associate, Dr Eirini Dimidi, from King’s carried out a systematic-review and meta-analysis on 14 randomised controlled trials. The results suggest that probiotics significantly reduce gut transit time by 12 hours, increase stool frequency by 1.3 bowel movements per week, and improve the cardinal symptoms of constipation; symptoms such as bloating. This review also emphasized that the effects of probiotics in constipation are strain and species specific.

Presenting her work at July’s Nutrition Society conference hosted by King’s Faculty of Life Sciences and Medicine, Dr Dimidi concludes that doctors should be encouraged to enquire about their patients’ probiotic use and patients should be given up-to-date information on the current evidence regarding the effectiveness of probiotics enabling them to make an informed choice.

She said:

“Healthcare professionals should support patients who decide to try probiotics as a treatment and advise them on choosing the right probiotic product, but also clearly communicate the uncertainty on the evidence that exists so far”.