Guidance for substantiating the evidence for beneficial effects of probiotics: Probiotics in chronic inflammatory bowel disease and the functional disorder irritable bowel syndrome

Ulcerative colitis and Crohn's disease, the 2 distinct idiopathic pathologies of inflammatory bowel diseases, are spontaneously relapsing, immunologicallymediated disorders of the gastrointestinal tract. Selected probiotics strains have been proven to be clinically effective in maintaining remission in patients with ulcerative colitis. None of the probiotics thus far tested has been shown to be effective in induction of remission or in maintenance of remission in patients with Crohn's disease. The multispecies probiotics mixture of 8 strains seems effective in the maintenance of remission in pouchitis. Irritable bowel syndrome is a functional bowel disorder manifested by chronic, recurring abdominal pain or discomfort associated with disturbed bowel habit in the absence of structural abnormalities likely to account for these symptoms. Recently conducted appropriately powered studies with different (combinations of) probiotics show positive results on reduction of symptoms, although a considerable placebo effect is also found. Mechanistic studies aimed at pathophysiological mechanisms of inflammatory bowel diseases can identify new targets for probiotic bacteria.