One particular strain, clinically trialled 2 to reduce the effects of stomach upsets, is Saccharomyces boulardii. It is unique from other bacterial strains, such as Lactobacillus acidophilus, because it is actually a probiotic yeast. Originally found in lychee fruit, this probiotic strain is known for its transient qualities, meaning that it doesn't colonise in the intestines.

Interestingly, it is thought to have a sticky outer membrane which it uses to adhere itself to harmful bacteria, including E. coli and Salmonella. This process is thought to help remove any pathogens from the gut.

Saccharomyces boulardii is the only probiotic that functions in this way, making it a valuable therapeutic tool to tackle most stomach upsets. It has even been found helpful in limiting Clostridium difficile 3 infection in the gut.

difficile is a notoriously difficult pathogen to eradicate, as it is becoming more and more resistant to antibiotics. Although food poisoning typically resolves in a couple of days, it can cause lasting damage to the natural balance in the gut microbiome, and sometimes results in ongoing digestive disorders.

You can read more about post-infectious irritable bowel syndrome on the Probiotics Learning Lab. You can find out more about the research using Saccharomyces boulardii on the Probiotics Database. In the previous section we learnt that Saccharomyces boulardii can be used to cleanse the pathogens involved in food poisoning from the gut.

However, this amazing probiotic strain has even proven to be effective against certain viruses including rotavirus 4 , one of the viruses often implicated in stomach flu. So it seems that whether symptoms were bought on by eating contaminated food, or simply through contact with a person suffering with a stomach virus, Saccharomyces boulardii is the best probiotic for upset stomach.

Another probiotic strain which could be of note here is Lactobacillus paracasei CASEI ®. The antibody IgG protects against both viral and bacterial infections in the host.

Lactobacillus paracasei CASEI ® has not been researched specifically for gastric flu but has been researched and shown to be help with diarrhea in children 6 , and is well-documented for immune support so may be another option to consider for those who often suffer from viral upset stomachs.

Lactobacillus paracasei CASEI ® is found in Optibac Probiotics Immune Support. Whether you're going away to a familiar destination, returning home to see family or backpacking to distant lands to explore uncharted territory, holidays are invariably a memorable experience.

However, sometimes these new experiences can also produce some nasty and uncomfortable stomach-related side effects. boulardii, as mentioned above, works differently from other probiotics specifically because of its unique transient qualities.

This means that it can pass through the system without binding to the gut wall. It works by adhering itself to harmful bacteria and gently removing those unwelcome pathogens from the system.

When travelling abroad, it is a good idea to also take other types of probiotics alongside Saccharomyces boulardii to give an extra level of protection to the gut, and to battle bad bacteria and other nasties in two ways.

Summary evidence from three Cochrane systematic reviews of randomized clinical trials about the effectiveness of dietary , pharmacological and psychological interventions in children concludes that probiotics, cognitive behavioral therapy and hypnotherapy may be effective in treating recurrent abdominal pain.

In the short and medium term, probiotics, cognitive behavioral therapy and hypnotherapy were found to reduce abdominal pain.

Based on 15 studies, probiotics led to a reduction in pain frequency and intensity in the short term 0 to 3 months with limited evidence for sustained effect up to 3 to 6 months post treatment, when compared with placebo. As not all species and strains had the same effects, however, the authors call for caution before systematically recommending probiotics in children with functional abdominal pain.

No major adverse events were reported. However, the quality of evidence assessed by the GRADE system was low or moderate, due to significant heterogeneity and small numbers of study participants.

On the other hand, fiber-based interventions did not lead to improved pain in the short term when compared with placebo. Furthermore, the quality of this evidence was low. The evidence for other dietary interventions like FODMAP diet and psychosocial therapies e.

hypno- and yoga therapy was found low-quality. For instance, only two small and short-duration studies showed reductions in pain frequency or pain secondary to a diet restricted in FODMAPs and fructose, respectively. In addition, the authors reported a lack of effectiveness when using drugs to treat recurrent abdominal pain.

On the whole, available data from randomized clinical trials suggest that probiotics, cognitive behavioral therapy and hypnotherapy might be considered when managing children with functional abdominal pain disorders.

Although these strategies might be considered part of the overall management of functional abdominal pain in children, it is still too early to recommend the optimum strain, dosage and length of treatment for probiotics and the best format of behavioral therapies.

Abbott RA, Martin AE, Newlove-Delgado TV, et al. Recurrent abdominal pain in children: summary evidence from 3 systematic reviews of treatment effectiveness.

J Pediatr Gastroenterol Nutr. doi: Alterations in the gut microbiome composition and functions are emerging as a potential target for managing IBS. Discover how microbiota-modifying treatments, including prebiotics, probiotics, antibiotics, and fecal microbiota transplantation, hold promise in alleviating symptoms of this vexing condition.

The gut microbiome has been involved in reducing adiposity in patients with obesity after gastric bypass. New research suggests that food intake, tryptophan metabolism, and gut microbiota composition can explain the glycemic improvement observed in patients after Roux-en-Y gastric bypass.

Celiac disease is a chronic immune-mediated enteropathy that may be unleashed by enteric viral infections. However, new findings in mice identified a commensal protist, Tritrichomonas arnold, that protects against reovirus-induced intolerance to gluten by counteracting virus-induced proinflammatory dendritic cell activation.

In addition, a significantly greater percentage of patients receiving the probiotic also reported adequate relief of symptoms compared to placebo. Finally, individual symptoms including bloating, bowel movement satisfaction, and quality of life were also significantly improved with Bifidobacterium bifidum MIMBb75 compared to placebo.

Previously, general consensus held that only active, living bacteria may have beneficial effects. But these results suggest that heat-inactivated Bifidobacterium can play a significant role in relieving symptoms of IBS, a syndrome with typically limited options for relief. This is important because inactive probiotics have several potential advantages over active probiotics.

For example, they are more likely to be stable, particularly if exposed to excessive heat. Inactive probiotics are also easier to standardize than active probiotics. Active probiotics also raise concerns for patients who may be susceptible to infection; inactive probiotics should relieve these concerns.

Whether other strains of heat-inactivated probiotics will also improve IBS symptoms remains unknown. Anthony Lembo, MD , Contributor.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

IBS is a gastrointestinal disorder in which your gut becomes more sensitive and the muscles of your digestive system have abnormal contractions that affect your bowel movements.

IBS cannot be cured, but the good news is it can be managed to minimize the effect on your overall health and quality of life. This report explores how your digestive system works and what science knows about this mysterious disorder.

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Sign up now and get a FREE copy of the Best Diets for Cognitive Fitness. Stay on top of latest health news from Harvard Medical School. Furthermore, exposure to selective serotonin reuptake inhibitor SSRIs in some cases have been shown to ameliorate IBS symptoms, such as enhanced orocecal transit and increased colonic motility [ 11 , 72 ].

Moreover, the antagonism of specific 5-HT receptors abundantly expressed in the gut, such as 5-HT 3, has been shown to reduce visceral pain, slow colonic transit, and enhance small intestinal absorption [ 6 ]. Despite this evidence, the role of 5-HT signaling in the gut remains confusing and controversial, therefore further research is warranted [ 48 ].

In addition to 5-HT, the neurotransmitters γ-aminobutyric acid GABA , dopamine DA and acetylcholine ACh are also synthesized in the lumen of the intestine by the microbiota and these neurotransmitters are believed to communicate with the brain via the vagus nerve [ 47 ].

It is also believed that the microbiota communicates with the CNS through the enteric nervous system ENS via vagal parasympathetic and sympathetic tracts [ 55 ]. A schematic representing the pathways of interaction between the microbiota and host is shown in Fig.

In recent years, preclinical studies have shed light on the role played by the microbiota in visceral pain. Studies using germ free mice GF; mice raised without any exposure to microorganisms , have shown the commensal microbiota is necessary for development of an adequate pain sensitivity [ 2 ], which is blunted in response to several stimuli including bacterial LPS and interleukin IL -1β in GF mice [ 12 ].

Reestablishment of a normal microbiota through microbial transfer from conventional to GF mice has demonstrated that the microbiota is necessary for the restoration of normal excitability of gut sensory neurons [ 49 ].

Of note, fecal transplant from IBS patients reproduced certain features characteristics of IBS in GF mice, including hypersensitivity to colorectal distension, [ 14 ].

In another study, GF rats inoculated with the microbiota from patients with IBS developed abnormal gut fermentation mostly characterized by increased H2 excretion and sulfide production, [ 14 ] which have been reported in IBS [ 41 , 69 ].

GF rodents represent a valuable tool for the investigation of visceral pain and related pathologies arising from intestinal dysbiosis.

As an alternative to a GF state, chronic antibiotic administration is also used as a model to deplete the gut microbiota.

Antibiotics can alter the innate mucosal immune system and attenuate visceral pain-related responses provoked by intracolonic capsaicin and intraperitoneal acetic acid administration in mice [ 1 ]. However, exposure to antibiotics during early life can also increase visceral sensitivity in adult rats, suggesting that alterations of the microbiota induced in specific time windows of life are crucial to the development of a sensitivity to pain [ 53 ].

Probiotics, bacteria that can confer beneficial effects onto the host following consumptionhave demonstrated improvements in animal models of visceral hypersensitivity.

Despite these highly interesting findings, the mechanisms involved in mediating these benefits remain unkown [ 29 ] Table 1.

Lactobacillus acidophilus -mediated analgesic effects function in the gut similarly to the effects of morphine, inducing upregulation of both opioid and cannabinoid receptors in rodents [ 66 ]. Lactobacillus paracasei administration blunted antibiotic-induced visceral sensitivity to colorectal distension CRD and increased substance P levels in the mice colon [ 74 ].

Interestingly, exposure to chronic stress has been used as a valuable rodent model of IBS and visceral sensitivity, suggesting the MGB axis serves as an important regulator of visceral pain.

For instance, the neonatal maternal separation MS paradigm, which consists of separating murine pups from their mothers for 3 h per day for at least 10 days, induces several alterations related to visceral pain such as hypersensitivity to CRD, increased gut permeability, activation of the immune system, increased hypothalamic pituitary adrenal HPA axis activation and altered intestinal microbial composition [ 28 , 54 , 60 , 70 ].

In this regard, a specific probiotics cocktail made of L. helveticus and L. rhamnosus reduced both macromolecular and paracellular permeability in MS [ 27 ].

paracasei and VSL 3, composed of B. longum , B. infantis , B. breve , L. acidophilus , L. casei , L. bulgaricus , L. plantarum , and Streptococcus salivarius , were also able to reverse MS-induced hyperalgesia and allodynia during CRD and restored normal gut permeability [ 18 , 23 ].

Moreover, VSL 3 was found to modulate the serotonergic system, specifically TPH1 expression levels, which is typically altered in IBS.

Similarly, both L. rhamnosus administration were shown to restore the function of the intestinal barrier and increased the levels of tight junction proteins in two different animal models of colitis [ 44 , 64 ].

Intestinal dysbiosis has also been reported in individuals suffering from visceral pain, including IBS patients, making the microbiota itself a novel target for treatment [ 29 , 61 ]. A reduction in the levels of Bifidobacterium, Lactobacillus [ 68 ] as well as alterations in the Firmicutes:Bacteroidetes ratio, which represent the most abundant phylum bacteria found within the human gut microbiome [ 63 ], have been identified in IBS patients.

VSL 3 treatment has been shown to be effective in five small different randomized control trials RCT in IBS patients that fulfilled the Rome II or Rome III criteria. A larger study involving women with IBS demonstrated efficacy of B. infantis in reducing pain, bloating and improving bowel movements after 4 weeks of treatment compared to placebo [ 75 ].

Similarly, L. rhamnosus [ 30 ] and L. plantarum [ 20 ] both showed amelioration in abdominal pain and bloating together with reduced visceral pain in two different large RCT studies in IBS patients.

Escherichia coli DSM has also showed improvements in IBS patients compared to placebo. After 8 weeks of treatment, both abdominal pain and general pain scores were significantly ameliorated in the IBS group provided with probiotics [ 22 ].

One study showed beneficial effects of the prebiotic fructoligosaccharides FOS in patients affected by minor functional bowel disorders FBD; Rome II criteria. After 6 weeks of treatment, FBD patients showed reduced incidence and intensity of gastrointestinal symptoms over placebo [ 56 ].

Taken together, these studies highlight the potential for beneficial probiotics for the treatment of visceral pain. The paucity of information coming from the accumulated clinical evidence to date limits our understanding on the efficacy of both prebiotics and probiotics in visceral pain Table 2.

Limitations are mostly due to inconsistencies within the studies, types of probiotics provided, length of the treatment and different types of pain disorders being treated. Nonetheless, the data to date suggests potential benefits exerted by specific probiotics and prebiotics in patients with visceral pain.

Increasing evidence strongly indicates that the gut microbiota plays a pivotal role in the regulation of visceral pain. Its association with autonomic and emotional reactions and visceral function makes the gut microbiota an appealing target for novel pharmacological strategies against visceral pain in FGIDs, including IBS.

Despite this, whether the microbiota is driving the abnormalities found in visceral pain and related pathologies remains to be resolved.

Moreover, our knowledge on the crosstalk between the gut and brain and the mechanisms by which the microbiota could alleviate visceral pain is still in its early infancy. The provocative preclinical evidence on the influence of the microbiota in the regulation of visceral pain seems promising but still need to be confirmed clinically.

Even though growing clinical research has found alleviation in the symptomatology of visceral pain after microbial manipulation with both prebiotics and probiotics, many lack power.

Further studies with greater numbers of patients showing consistent results are warranted. Finally, whether fecal transplantation could be considered as a viable therapeutic option to modify the microbiota for benefit in visceral pain still needs to be confirmed.

Aguilera M, Cerda-Cuellar M, Martinez V. Antibiotic-induced dysbiosis alters host-bacterial interactions and leads to colonic sensory and motor changes in mice. Gut Microbes. Article CAS Google Scholar. Amaral FA, Sachs D, Costa VV, Fagundes CT, Cisalpino D, Cunha TM, Ferreira SH, Cunha FQ, Silva TA, Nicoli JR, Vieira LQ, Souza DG, Teixeira MM.

Commensal microbiota is fundamental for the development of inflammatory pain. Proc Natl Acad Sci U S A. Arentsen T, Qian Y, Gkotzis S, Femenia T, Wang T, Udekwu K, Forssberg H, Diaz Heijtz R. The bacterial peptidoglycan-sensing molecule Pglyrp2 modulates brain development and behavior.

Mol Psychiatry. Belkaid Y, Hand TW. Role of the microbiota in immunity and inflammation. Cain KC, Jarrett ME, Burr RL, Rosen S, Hertig VL, Heitkemper MM.

Gender differences in gastrointestinal, psychological, and somatic symptoms in irritable bowel syndrome. Dig Dis Sci. Article Google Scholar. Camilleri M. Serotonergic modulation of visceral sensation: lower gut.

Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clin Epidemiol. PubMed PubMed Central Google Scholar. Cani PD, Everard A, Duparc T. Gut microbiota, enteroendocrine functions and metabolism.

Curr Opin Pharmacol. Chang L. Brain responses to visceral and somatic stimuli in irritable bowel syndrome: a central nervous system disorder? Gastroenterol Clin N Am. Chang L, Heitkemper MM. Gender differences in irritable bowel syndrome. Chial HJ, Camilleri M, Burton D, Thomforde G, Olden KW, Stephens D.

Selective effects of serotonergic psychoactive agents on gastrointestinal functions in health. Am J Physiol Gastrointest Liver Physiol.

Chichlowski M, Rudolph C. Visceral pain and gastrointestinal microbiome. J Neurogastroenterol Motil. Coates MD, Mahoney CR, Linden DR, Sampson JE, Chen J, Blaszyk H, Crowell MD, Sharkey KA, Gershon MD, Mawe GM, Moses PL.

Molecular defects in mucosal serotonin content and decreased serotonin reuptake transporter in ulcerative colitis and irritable bowel syndrome.

Crouzet L, Gaultier E, Del'Homme C, Cartier C, Delmas E, Dapoigny M, Fioramonti J, Bernalier-Donadille A. The hypersensitivity to colonic distension of IBS patients can be transferred to rats through their fecal microbiota.

Neurogastroenterol Motil. Cussotto S, Sandhu KV, Dinan TG, Cryan JF. The neuroendocrinology of the microbiota-gut-brain Axis: a Behavioural perspective.

Front Neuroendocrinol. Dai C, Guandalini S, Zhao DH, Jiang M. Antinociceptive effect of VSL 3 on visceral hypersensitivity in a rat model of irritable bowel syndrome: a possible action through nitric oxide pathway and enhance barrier function.

Mol Cell Biochem. Dinan TG, Cryan JF. Gut-brain axis in brain-gut-microbiota axis - mood, metabolism and behaviour. Nat Rev Gastroenterol Hepatol. Distrutti E, Cipriani S, Mencarelli A, Renga B, Fiorucci S. Probiotics VSL 3 protect against development of visceral pain in murine model of irritable bowel syndrome.

PLoS One. Distrutti E, Monaldi L, Ricci P, Fiorucci S. Gut microbiota role in irritable bowel syndrome: new therapeutic strategies. World J Gastroenterol. Ducrotte P, Sawant P, Jayanthi V. Clinical trial: lactobacillus plantarum v DSM improves symptoms of irritable bowel syndrome.

Dupont HL. Review article: evidence for the role of gut microbiota in irritable bowel syndrome and its potential influence on therapeutic targets. Aliment Pharmacol Ther. Enck P, Zimmermann K, Menke G, Klosterhalfen S.

Randomized controlled treatment trial of irritable bowel syndrome with a probiotic E. Zeitschrift fur Gastroenterologie. Eutamene H, Lamine F, Chabo C, Theodorou V, Rochat F, Bergonzelli GE, Corthesy-Theulaz I, Fioramonti J, Bueno L.

Synergy between lactobacillus paracasei and its bacterial products to counteract stress-induced gut permeability and sensitivity increase in rats. J Nutr. Ferrante RJ, Kubilus JK, Lee J, Ryu H, Beesen A, Zucker B, Smith K, Kowall NW, Ratan RR, Luthi-Carter R, Hersch SM.

Histone deacetylase inhibition by sodium butyrate chemotherapy ameliorates the neurodegenerative phenotype in Huntington's disease mice. J Neurosci. Foley S, Garsed K, Singh G, Duroudier NP, Swan C, Hall IP, Zaitoun A, Bennett A, Marsden C, Holmes G, Walls A, Spiller RC.

Impaired uptake of serotonin by platelets from patients with irritable bowel syndrome correlates with duodenal immune activation. Ford AC, Quigley EM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, Soffer EE, Spiegel BM, Moayyedi P. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis.

Am J Gastroenterol. Gareau MG, Jury J, MacQueen G, Sherman PM, Perdue MH. Probiotic treatment of rat pups normalises corticosterone release and ameliorates colonic dysfunction induced by maternal separation. Gareau MG, Jury J, Yang PC, MacQueen G, Perdue MH. Neonatal maternal separation causes colonic dysfunction in rat pups including impaired host resistance.

Pediatr Res. Gareau MG, Sherman PM, Walker WA. Probiotics and the gut microbiota in intestinal health and disease. Gawronska A, Dziechciarz P, Horvath A, Szajewska H.

A randomized double-blind placebo-controlled trial of lactobacillus GG for abdominal pain disorders in children. Gensollen T, Iyer SS, Kasper DL, Blumberg RS. How colonization by microbiota in early life shapes the immune system. Greenwood-Van Meerveld B, Johnson AC.

Stress-induced chronic visceral pain of gastrointestinal origin. Front Syst Neurosci. Guandalini S, Magazzu G, Chiaro A, La Balestra V, Di Nardo G, Gopalan S, Sibal A, Romano C, Canani RB, Lionetti P, Setty M.

Another probiotic strain which could be of note here is Lactobacillus paracasei CASEI ®. The antibody IgG protects against both viral and bacterial infections in the host. Lactobacillus paracasei CASEI ® has not been researched specifically for gastric flu but has been researched and shown to be help with diarrhea in children 6 , and is well-documented for immune support so may be another option to consider for those who often suffer from viral upset stomachs.

Lactobacillus paracasei CASEI ® is found in Optibac Probiotics Immune Support. Whether you're going away to a familiar destination, returning home to see family or backpacking to distant lands to explore uncharted territory, holidays are invariably a memorable experience.

However, sometimes these new experiences can also produce some nasty and uncomfortable stomach-related side effects. boulardii, as mentioned above, works differently from other probiotics specifically because of its unique transient qualities. This means that it can pass through the system without binding to the gut wall.

It works by adhering itself to harmful bacteria and gently removing those unwelcome pathogens from the system. When travelling abroad, it is a good idea to also take other types of probiotics alongside Saccharomyces boulardii to give an extra level of protection to the gut, and to battle bad bacteria and other nasties in two ways.

Live cultures, like L. acidophilus and L. rhamnosus possess qualities that enable them to line the interior of the gut wall, creating a physical barrier and fortifying the gut's natural defences. They also create a gut environment which discourages the growth of pathogens so can be a particular aid against contracting upset stomachs in countries where tummy troubles are a common issue for travellers.

For this reason, Saccharomyces boulardii can still be used to excellent effect against the symptom of diarrhea in IBS-D sufferers. Read more about dysbiosis on the Probiotics Learning Lab.

The search included meta-analyses, randomized controlled trials, and practice guidelines within the previous 20 years. Also searched were the Cochrane databases and Essential Evidence Plus.

Search dates: June and July , and March Logan AC, Jacka FN, Prescott SL. Immune-microbiota interactions: dysbiosis as a global health issue. Curr Allergy Asthma Rep. Ricci A, Tagliacarne SC, Valsecchi C, et al. Probiotics and inflammatory bowel diseases. J Biol Regul Homeost Agents.

Food and Drug Administration. Accessed June 19, Department of Health and Human Services; U. Food and Drug Administration; Center for Drug Evaluation and Research; Center for Biologics Evaluation and Research; Office of Regulatory Affairs.

Guidance for industry: CGMP for phase 1 investigational drugs. July Probiotics rankings. Accessed June 29, Probiotics for adults, children and pets [login required].

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Evidence-based guidelines for use of probiotics in preterm neonates. BMC Med. Goldenberg JZ, Ma SS, Saxton JD, et al. Probiotics for the prevention of Clostridium difficile -associated diarrhea in adults and children.

Johnston BC, Ma SS, Goldenberg JZ, et al. Probiotics for the prevention of Clostridium difficile -associated diarrhea: a systematic review and meta-analysis. Ann Intern Med. Zheng X, Lyu L, Mei Z.

Lactobacillus -containing probiotic supplementation increases Helicobacter pylori eradication rate: evidence from a meta-analysis. Rev Esp Enferm Dig. Lu C, Sang J, He H, et al. Probiotic supplementation does not improve eradication rate of Helicobacter pylori infection compared to placebo based on standard therapy: a meta-analysis.

Sci Rep. Xu J, et al. Effects of probiotic therapy on hepatic encephalopathy in patients with liver cirrhosis: an updated meta-analysis of six randomized controlled trials. Hepatobiliary Pancreat Dis Int. Dalal R, et al. Probiotics for people with hepatic encephalopathy.

Shen J, Zuo ZX, Mao AP. Effect of probiotics on inducing remission and maintaining therapy in ulcerative colitis, Crohn's disease, and pouchitis: meta-analysis of randomized controlled trials [published correction appears in Inflamm Bowel Dis.

Inflamm Bowel Dis. Naidoo K, et al. Probiotics for maintenance of remission in ulcerative colitis. Ford AC, Moayyedi P, Lacy BE, et al. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation.

Am J Gastroenterol. Zhang Y, Li L, Guo C, et al. Effects of probiotic type, dose and treatment duration on irritable bowel syndrome diagnosed by Rome III criteria: a meta-analysis.

BMC Gastroenterol. Korterink JJ, et al. Probiotics for childhood functional gastrointestinal disorders: a systematic review and meta-analysis. Acta Paediatr. Sung V, Collett S, de Gooyer T, Hiscock H, Tang M, Wake M. Probiotics to prevent or treat excessive infant crying: systematic review and meta-analysis.

JAMA Pediatr. Anabrees J, Indrio F, Paes B, AlFaleh K. Probiotics for infantile colic: a systematic review. BMC Pediatr. AlFaleh K, Anabrees J. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Olsen R, Greisen G, Schrøder M, Brok J. Prophylactic probiotics for pre-term infants: a systematic review and meta-analysis of observational studies.

Allen SJ, et al. Probiotics for treating acute infectious diarrhoea. McFarland LV. Meta-analysis of probiotics for the prevention of traveler's diarrhea. Travel Med Infect Dis. Feizizadeh S, Salehi-Abargouei A, Akbari V.

Efficacy and safety of Saccharomyces boulardii for acute diarrhea. Urbańska M, Gieruszczak-Białek D, Szajewska H. Systematic review with meta-analysis: Lactobacillus reuteri DSM for diarrhoeal diseases in children. Aliment Pharmacol Ther. Basu S, Chatterjee M, Ganguly S, Chandra PK.

Efficacy of Lactobacillus rhamnosus GG in acute watery diarrhoea of Indian children: a randomised controlled trial. J Paediatr Child Health. Szajewska H, et al. Meta-analysis: Lactobacillus GG for treating acute gastroenteritis in children—updated analysis of randomised controlled trials.

Shan LS, Hou P, Wang ZJ, et al. Prevention and treatment of diarrhoea with Saccharomyces boulardii in children with acute lower respiratory tract infections. Benef Microbes. Hempel S, Newberry SJ, Maher AR, et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis.

boulardii, as mentioned above, works differently from other probiotics specifically because of its unique transient qualities. This means that it can pass through the system without binding to the gut wall.

It works by adhering itself to harmful bacteria and gently removing those unwelcome pathogens from the system. When travelling abroad, it is a good idea to also take other types of probiotics alongside Saccharomyces boulardii to give an extra level of protection to the gut, and to battle bad bacteria and other nasties in two ways.

Live cultures, like L. acidophilus and L. rhamnosus possess qualities that enable them to line the interior of the gut wall, creating a physical barrier and fortifying the gut's natural defences. They also create a gut environment which discourages the growth of pathogens so can be a particular aid against contracting upset stomachs in countries where tummy troubles are a common issue for travellers.

For this reason, Saccharomyces boulardii can still be used to excellent effect against the symptom of diarrhea in IBS-D sufferers. Read more about dysbiosis on the Probiotics Learning Lab. Another probiotic strain: Lactobacillus acidophilus NCFM ® may be useful to use in combination with S.

boulardii to provide good all round gut support. One trial 8 using this particular strain found that study participants that took this probiotic strain in combination with 2 other strains, over a 14 week period, saw a statistically significant reduction in episodes and severity of loose stools, compared to those in the placebo group.

To read more about IBS-D visit the Probiotics Learning Lab. Healthcare professionals can read more about the strains included in this article on the Probiotics Database.

This transient probiotic strain effectively cleanses pathogens from the digestive tract, and helps to restore the gut flora back to a healthy balance.

We found 18 studies with a total of children, which compared probiotics or synbiotics with placebo. We found that probiotics may provide better pain relief and relief from other stomach problems than placebo for children with functional abdominal pain. In particular, in children taking probiotics, treatment was judged a success more often than in those taking a placebo.

Synbiotics also showed a difference from placebo but this was based on a smaller number of studies. There was not enough information to consider changes in the frequency of pain when comparing synbiotics to placebo. We cannot reach any conclusions about safety as the evidence we found on any unwanted or harmful effects was of very low certainty.

The evidence for synbiotics in this review is limited by the fact that the results are from fewer studies. In terms of safety, there were not enough cases of unwanted or harmful effects to give a clear picture about the safety of probiotics and synbiotics.

The results from this review demonstrate that probiotics and synbiotics may be more efficacious than placebo in achieving treatment success, but the evidence is of low certainty.

The evidence demonstrates little to no difference between probiotics or synbiotics and placebo in complete resolution of pain.

We were unable to draw meaningful conclusions about the impact of probiotics or synbiotics on the frequency and severity of pain as the evidence was all of very low certainty due to significant unexplained heterogeneity or imprecision.

There were no reported cases of serious adverse events when using probiotics or synbiotics amongst the included studies, although a review of RCTs may not be the best context to assess long-term safety.

The available evidence on adverse effects was of very low certainty and no conclusions could be made in this review. Safety will always be a priority in paediatric populations when considering any treatment.

Reporting of all adverse events, adverse events needing withdrawal, serious adverse events and, particularly, long-term safety outcomes are vital to meaningfully move forward the evidence base in this field.

Further targeted and appropriately designed RCTs are needed to address the gaps in the evidence base. In particular, appropriate powering of studies to confirm the safety of specific strains not yet investigated and studies to investigate long-term follow-up of patients are both warranted.

Functional abdominal pain is pain occurring in the abdomen that cannot be fully explained by another medical condition and is common in children. It has been hypothesised that the use of micro-organisms, such as probiotics and synbiotics a mixture of probiotics and prebiotics , might change the composition of bacterial colonies in the bowel and reduce inflammation, as well as promote normal gut physiology and reduce functional symptoms.

To assess the efficacy and safety of probiotics in the treatment of functional abdominal pain disorders in children. We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials CENTRAL and two clinical trials registers from inception to October Randomised controlled trials RCTs that compare probiotic preparations including synbiotics to placebo, no treatment or any other interventional preparation in patients aged between 4 and 18 years of age with a diagnosis of functional abdominal pain disorder according to the Rome II, Rome III or Rome IV criteria.