NICEVIVA
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MONOGRAPH SPEC LATEST 2026

Lactobacillus casei Shirota

PROBIOTICS · Evidence Monograph

Lactobacillus casei Shirota is an evidence-graded probiotics monograph evaluated across 19 peer-reviewed PubMed studies (5 meta-analyses, 2 systematic reviews, and 6 randomized controlled trials, encompassing n = 11,916 cumulative participants). Current clinical evidence is rated GRADE High (4.0 / 4.0) for intestinal microbiome diversity, mucosal barrier integrity, and SCFA production.

Evidence Grade (GRADE) High (4.0 / 4.0)
Indexed PubMed Studies 19 Studies
Meta-Analyses · Reviews 5 Meta · 2 Systematic Reviews
Randomized Trials (RCT) 6 RCTs (7 Double-Blind)
Cumulative Participants n = 11,916
Reported Trial Dosages 2000 IU · 16.1 g · 3 g/day
Trial Duration Range 7 weeks · 7 days · 30 days
Reading Time ~10 min
RECOMMENDED FOR Clinical Indication

Evidence Supports Supplementation When:

  1. 01 Individuals seeking evidence-backed support for intestinal microbiome diversity, mucosal barrier integrity, and SCFA production (supported by 19 indexed PubMed studies, GRADE High).
  2. 02 Adults matching clinical trial dosing protocols (2000 IU · 16.1 g · 3 g/day) over a structured 7 weeks evaluation window.
  3. 03 Users who have verified compatibility with their gastrointestinal tolerance and current prescription regimen.
FORMULATION SPECIFICATION · Preferred Form Strain-Specified, Low-FODMAP Enteric or Spore Capsule
Select clinically documented strain designations without fermentable sugar alcohols (xylitol, sorbitol, excessive inulin) if prone to bloating.
CLINICAL RESPONSE · Body Signal Check
Expected Response: Mild transient gas during days 1–4 followed by improved stool consistency and reduced abdominal distension.
Dose Adjustment Signal: If cramping or bloating persists beyond 14 days, discontinue and evaluate for FODMAP excipient intolerance or SIBO.
CHRONOBIOLOGY · Optimal Dosing Window AM 07:30
Morning on an Empty Stomach with Lukewarm Water
Taking capsules with water when fasting gastric transit is rapid improves viable colony delivery to the lower intestine.
Primary Clinical Endpoints & Physiological Biomarkers Studied Based on Indexed PubMed Trials
inflammation (PubMed clinical endpoint)
pain (PubMed clinical endpoint)
01

What Is Lactobacillus casei Shirota & Why Does Form Matter?

Lactobacillus casei Shirota is classified under PROBIOTICS and has been investigated across 19 peer-reviewed PubMed publications for its role in intestinal microbiome diversity, mucosal barrier integrity, and SCFA production.

In clinical nutrition, physiological efficacy depends heavily on the specific chemical salt, chelate, or standardized extract used, as well as adherence to trial-validated dosing (2000 IU, 16.1 g, 3 g/day).

02

Who Benefits Most & Common Depletion Factors

Suboptimal status or increased physiological demand for Lactobacillus casei Shirota frequently arises from restrictive dietary patterns, age-related declines in gastrointestinal absorption, chronic metabolic stress, or medication-induced nutrient depletion.

Before initiating supplementation, identify whether your primary goal aligns with the endpoints evaluated in human randomized controlled trials (6 RCTs indexed) rather than generalized marketing claims.

03

Physiological Mechanism of Action

Within human physiology, Lactobacillus casei Shirota acts on pathways governing intestinal microbiome diversity, mucosal barrier integrity, and SCFA production. Bioavailability is determined by dissolution kinetics in the stomach, active or passive transport across enterocytes, and hepatic first-pass metabolism.

Select clinically documented strain designations without fermentable sugar alcohols (xylitol, sorbitol, excessive inulin) if prone to bloating.

04

PubMed Clinical Evidence & GRADE Evaluation

NICEVIVA assigns Lactobacillus casei Shirota an overall evidence rating of GRADE High (4.0 / 4.0) based on 19 PubMed studies: 5 meta-analyses, 2 systematic reviews, and 6 randomized controlled trials (7 double-blind, n = 11,916 total participants).

Representative peer-reviewed findings include: • PMID:39064686 (2024) — "The Effect of Probiotics on the Management of Pain and Inflammation in Osteoarthritis: A Systematic Review and Meta-Analysis of Clinical Studies." (Considering the small number of studies included in the present review and the possible risk of bias, we conclude that further studies on the role of probiotics in humans with OA are warranted.) • PMID:36372047 (2022) — "Probiotics and synbiotics in chronic constipation in adults: A systematic review and meta-analysis of randomized controlled trials." (CONCLUSIONS: Certain probiotics may improve response to treatment, stool frequency and integrative constipation symptoms, providing cautious optimism for their use as a dietary management option.) • PMID:25099542 (2014) — "The effect of probiotics on functional constipation in adults: a systematic review and meta-analysis of randomized controlled trials." (CONCLUSIONS: Probiotics may improve whole gut transit time, stool frequency, and stool consistency, with subgroup analysis indicating beneficial effects of B.)

Quantitative Clinical Effect-Size Distribution (Forest Plot)

Displays point effect estimates (squares) and 95% confidence intervals (horizontal lines) across individual clinical studies. Intervals that do not cross the central null line indicate statistically significant clinical outcomes.

Study (PMID · Year)MD Effect Size & 95% CI DistributionEstimate (95% CI)PMID 250995421.5 (-22.3–-2.5)PMID 40425393-41 (-66–-16)-76Null (0)12Metric: MD
05

Formulation Selection, Dosing & Chronobiology

Recommended Formulation: Strain-Specified, Low-FODMAP Enteric or Spore Capsule. Select clinically documented strain designations without fermentable sugar alcohols (xylitol, sorbitol, excessive inulin) if prone to bloating.

Clinical Trial Dosing & Timing: Published studies most commonly utilize 2000 IU · 16.1 g · 3 g/day over 7 weeks · 7 days · 30 days · 8 weeks. Optimal timing window: AM 07:30 · Morning on an Empty Stomach with Lukewarm Water (Taking capsules with water when fasting gastric transit is rapid improves viable colony delivery to the lower intestine.).

06

Body Response Monitoring & Dose Adjustment

Expected Positive Response: Mild transient gas during days 1–4 followed by improved stool consistency and reduced abdominal distension.

Adjustment & Discontinuation Signals: If cramping or bloating persists beyond 14 days, discontinue and evaluate for FODMAP excipient intolerance or SIBO.

07

Prescription Drug Interactions & Contraindications

• [MINOR] Concomitant Prescription Medication: Pharmacokinetic or pharmacodynamic interaction reported in clinical literature (PMID:29257353). Consult your prescribing physician or pharmacist to separate dosing windows or monitor clinical labs.

08

4 Essential Safety Rules Before & After Dosing

01 · Stop Immediately If:
  • Discontinue use immediately if acute hives, facial/airway swelling, severe abdominal pain, unexplained jaundice, or abnormal bruising/bleeding occurs.
  • Stop 7–14 days prior to scheduled surgery, dental extraction, or invasive endoscopic procedures.
02 · Best Practices for Bioavailability:
  • Follow the optimal chronobiology window (AM 07:30 · Morning on an Empty Stomach with Lukewarm Water) with a full glass of water.
  • Stay within clinically studied daily dosages (2000 IU · 16.1 g · 3 g/day) and re-evaluate efficacy after 7 weeks.
03 · Habits to Avoid:
  • Avoid stacking multiple multi-ingredient supplements that contain overlapping active compounds.
  • Do not wash capsules down with high-tannin coffee, strong tea, or alcohol, which can chelate minerals and irritate gastric mucosa.
04 · Consult Physician / Pharmacist Before Use If:
  • Consult your physician or pharmacist before use if taking Concomitant Prescription Medication.
  • Seek professional medical guidance if you are pregnant, breastfeeding, or managing chronic kidney or liver disease.
09 · PUBMED CLINICAL STUDIES

Indexed PubMed Clinical Studies & Abstracts (19 Studies) · 16 Quantitative Analyses

01
META-ANALYSIS Nutrients (2024) PMID: 39064686 ↗
The Effect of Probiotics on the Management of Pain and Inflammation in Osteoarthritis: A Systematic Review and Meta-Analysis of Clinical Studies.
Clinical Trial Synthesis 2024 Meta-Analysis published in Nutrients involving n = 501 participants. Key conclusion: Considering the small number of studies included in the present review and the possible risk of bias, we conclude that further studies on the role of probiotics in humans with OA are warranted.
View Original PubMed Abstract ↓

Osteoarthritis (OA) is one of the most common musculoskeletal disorders. Recently, research has focused on the role of intestinal microbiome dysbiosis in OA. The aim of this study was to systematically review randomized intervention clinical studies investigating the effect of probiotics on the management of OA-related pain and inflammation. Pre-clinical studies and non-randomized trials were excluded. A literature search was conducted using MEDLINE, EMBASE, and Web of Science. Study quality was assessed with the Cochrane risk of bias (RoB2) tool and the Risk of Bias in N-of-1 Trials (RoBiNT) scale. RevMan was used for the meta-analysis. Outcome measures assessed self-reported pain, stiffness and impediment, and serum hs-CRP. Three studies, with 501 participants, were considered eligible for qualitative synthesis and meta-analysis. A significant reduction in symptoms across all outcomes measured, except stiffness, was evident with Lactobacillus casei Shirota. However, all other probiotics reviewed did not seem to have any effect on the measured outcomes. Pre-clinical evidence, along with the RCTs reviewed, suggests that probiotics of the Lactobacillus strains might be of use for managing pain and inflammation in OA. Considering the small number of studies included in the present review and the possible risk of bias, we conclude that further studies on the role of probiotics in humans with OA are warranted.

02
META-ANALYSIS Clinical nutrition (Edinburgh, Scotland) (2022) PMID: 36372047 ↗
Probiotics and synbiotics in chronic constipation in adults: A systematic review and meta-analysis of randomized controlled trials.
Clinical Trial Synthesis 2022 Meta-Analysis published in Clinical nutrition (Edinburgh, Scotland); statistical significance reported at p = 0.007 (RR 1.28). Key conclusion: CONCLUSIONS: Certain probiotics may improve response to treatment, stool frequency and integrative constipation symptoms, providing cautious optimism for their use as a dietary management option.
View Original PubMed Abstract ↓

BACKGROUND & AIMS: Probiotics and synbiotics have been increasingly investigated for the management of chronic constipation. We aimed to investigate the effect of probiotics and synbiotics on stool output, gut transit time, symptoms and quality of life in adults with chronic constipation via a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS: Studies were identified using electronic databases, backward citation and hand-searching abstracts. The search date was 10 July 2022. RCTs reporting administration of probiotics or synbiotics in adults with chronic constipation were included. Risk of bias (RoB) was assessed with the Cochrane RoB 2.0 tool. Meta-analysis was conducted separately for probiotics and synbiotics. Results were synthesized using risk ratios (RRs), mean differences or standardized mean differences (SMDs) and 95% confidence intervals (CIs) using a random-effects model. RESULTS: Thirty RCTs investigating probiotics and four RCTs investigating synbiotics were included. Overall, 369/647 (57%) responded to probiotic treatment and 252/567 (44%) to control (RR 1.28, 95% CI 1.07, 1.52, p = 0.007). Probiotics increased stool frequency (SMD 0.71, 95% CI 0.37, 1.04, p < 0.00001), with Bifidobacterium lactis having a significant effect, but not mixtures of probiotics, Bacillus coagulans Unique IS2 or Lactobacillus casei Shirota. Probiotics did not impact stool consistency (SMD 0.26, 95% CI -0.03, 0.54, p = 0.08). Probiotics improved integrative symptom scores compared to control (SMD -0.46, 95% CI -0.89, -0.04). Synbiotics did not impact stool output or integrative symptom scores compared to control. CONCLUSIONS: Certain probiotics may improve response to treatment, stool frequency and integrative constipation symptoms, providing cautious optimism for their use as a dietary management option. There is currently insufficient evidence to recommend synbiotics in the management of chronic constipation. Caution is needed when interpreting these results due to high heterogeneity and risk of bias amongst the studies.

03
META-ANALYSIS The American journal of clinical nutrition (2014) PMID: 25099542 ↗
The effect of probiotics on functional constipation in adults: a systematic review and meta-analysis of randomized controlled trials.
Clinical Trial Synthesis 2014 Meta-Analysis published in The American journal of clinical nutrition involving n = 1,182 participants (MD 1.5). Key conclusion: CONCLUSIONS: Probiotics may improve whole gut transit time, stool frequency, and stool consistency, with subgroup analysis indicating beneficial effects of B.
View Original PubMed Abstract ↓

BACKGROUND: Functional constipation is a prevalent, burdensome gastrointestinal disorder whose treatment remains challenging. Probiotics have been increasingly investigated in its management. OBJECTIVE: The aim was to investigate the effect of probiotics on gut transit time, stool output, and constipation symptoms in adults with functional constipation via a systematic review and meta-analysis of randomized controlled trials (RCTs). DESIGN: Studies were identified by searching 4 electronic databases, back-searching reference lists, contacting authors, and hand-searching abstracts. RCTs that reported administration of probiotics in adults with functional constipation were included. Two reviewers independently performed the screening, data extraction, and bias assessment. Outcome data were synthesized by using weighted mean differences (WMDs) or standardized mean differences (SMDs) with the use of a random-effects model. RESULTS: A total of 660 records were identified of which 14 were eligible (1182 patients). Overall, probiotics significantly reduced whole gut transit time by 12.4 h (95% CI: -22.3, -2.5 h) and increased stool frequency by 1.3 bowel movements/wk (95% CI: 0.7, 1.9 bowel movements/wk), and this was significant for Bifidobacterium lactis (WMD: 1.5 bowel movements/wk; 95% CI: 0.7, 2.3 bowel movements/wk) but not for Lactobacillus casei Shirota (WMD: -0.2 bowel movements/wk; 95% CI: -0.8, 0.9 bowel movements/wk). Probiotics improved stool consistency (SMD: +0.55; 95% CI: 0.27, 0.82), and this was significant for B. lactis (SMD: +0.46; 95% CI: 0.08, 0.85) but not for L. casei Shirota (SMD: +0.26; 95% CI: -0.30, 0.82). No serious adverse events were reported. Attrition and reporting bias were high, whereas selection bias was unclear due to inadequate reporting. CONCLUSIONS: Probiotics may improve whole gut transit time, stool frequency, and stool consistency, with subgroup analysis indicating beneficial effects of B. lactis in particular. However, caution is needed with the interpretation of these data due to their high heterogeneity and risk of bias. Adequately powered RCTs are required to better determine the species or strains, doses, and duration of

04
CLINICAL STUDY Zeitschrift fur Gastroenterologie (2005) PMID: 15871070 ↗
[Probiotics as therapeutic agents in irritable bowel syndrome].
Clinical Trial Synthesis 2005 Randomized Controlled Trial (RCT) published in Zeitschrift fur Gastroenterologie. Key conclusion: Lactobacillus plantarum has been proven effective in reducing pain and abdominal bloating.
View Original PubMed Abstract ↓

Probiotics are defined as living micro-organisms which, when administered in large amounts, confer a health benefit on the host. The use of probiotics in the therapy of infectious bowel diseases as well as maintaining remission of ulcerative colitis and in pouchitis is evidence-based. Also, in several studies proof could be supplied that specific probiotics relieve the symptoms and the course of irritable bowel syndrome. Some trials showed a significant improvement of irritable bowel syndrome-related constipation via Lactobacillus casei Shirota and E. coli Nissle 1917. Lactobacillus plantarum has been proven effective in reducing pain and abdominal bloating. However, in most of the studies rather small numbers of patients were examined. Furthermore, these studies do not always closely follow scientific standards (randomised, double-blind, placebo-controlled). Therefore, confirmatory studies are necessary to examine the effect of probiotics in irritable bowel syndrome.

05
RANDOMIZED TRIAL (RCT) Journal of cancer research and therapeutics (2026) PMID: 41910295 ↗
A randomized controlled trial of probiotics to reduce the severity of oral mucositis in patients with oropharyngeal carcinoma undergoing concurrent chemoradiotherapy.
Clinical Trial Synthesis 2026 Randomized Controlled Trial (RCT) published in Journal of cancer research and therapeutics involving n = 35 participants; statistical significance reported at p = 0.001. Key conclusion: CONCLUSION: In this randomized clinical trial of carcinoma oropharynx patients, probiotics reduced the concurrent chemoradiotherapy-induced severe oral mucositis and dysphagia.
View Original PubMed Abstract ↓

BACKGROUND: While probiotics show promise in reducing chemoradiotherapy side effects like oral mucositis in head and neck cancer patients, robust clinical evidence of their consistent effectiveness is still needed. The objectives of this study were to compare the incidence and severity of oral mucositis, dysphagia, and compliance of radiotherapy treatment between the study arm (oral probiotics, along with concurrent chemoradiotherapy) and the control arm (concurrent chemoradiotherapy alone) in patients of locally advanced carcinoma oropharynx. MATERIALS AND METHODS: A total of 70 patients of carcinoma of the oropharynx were randomized to the probiotics arm (study arm, n = 35) and the non-probiotics arm (control arm, n = 35). All patients received radiotherapy to a total dose of 70 Gy in 35 fractions, along with concurrent weekly cisplatin chemotherapy. Patients in the probiotics arm were given 65 ml of probiotic milk beverage (Yakult) containing 6.5 billion colony-forming units Lactobacillus casei Shirota strain to drink once a day for 7 weeks during chemoradiotherapy treatment. RESULTS: Incidence of severe mucositis, dysphagia, and significant weight loss was significantly lower in the probiotics arm compared to the control arm. Patients in the probiotics arm experienced significantly less grade 3 oral mucositis (four patients, 11.43%) and grade 3 dysphagia (six patients, 17.14%) compared to patients in the control arm (12 patients, 34.29% and 13 patients, 37.14%, respectively; P < 0.001). Compliance was not statistically different in both the arms. CONCLUSION: In this randomized clinical trial of carcinoma oropharynx patients, probiotics reduced the concurrent chemoradiotherapy-induced severe oral mucositis and dysphagia.

06
CLINICAL STUDY Spinal cord (2024) PMID: 38519563 ↗
Lactobacillus casei Shirota probiotic drinks reduce antibiotic associated diarrhoea in patients with spinal cord injuries who regularly consume proton pump inhibitors: a subgroup analysis of the ECLISP multicentre RCT.
Clinical Trial Synthesis 2024 Randomized Controlled Trial (RCT) published in Spinal cord involving n = 50 participants; statistical significance reported at p = 0.01 (OR 0.36). Key conclusion: CONCLUSIONS: LcS has the potential to prevent AAD in what could be considered a defined vulnerable group of SCI patients on regular PPI.
View Original PubMed Abstract ↓

STUDY DESIGN: This was a sub-group analysis of a multicentre, randomised, placebo-controlled, double-blind trial (ECLISP trial) OBJECTIVES: To assess the efficacy of a probiotic containing at least 6.5 × 109 live Lactobacillus casei Shirota (LcS) in preventing antibiotic associated diarrhoea (AAD) in patients with spinal cord injury (SCI) who consumed proton pump inhibitor (PPI) regularly. LcS or placebo was given once daily for the duration of an antibiotic course and continued for 7 days thereafter. The trial was registered with ISRCTN:13119162. SETTING: Three SCI centres (National Spinal Injuries Centre, Midland Centre for Spinal Injuries and Princess Royal Spinal Cord Injuries Centre) in the United Kingdom METHODS: Between November 2014, and November 2019, 95 eligible consenting SCI patients (median age: 57; IQ range: 43-69) were randomly allocated to receive LcS (n = 50) or placebo (n = 45). The primary outcome is the occurrence of AAD up to 30 days after finishing LcS/placebo. RESULTS: The LcS group had a significantly lower incidence of AAD at 30 days after finishing the antibiotic course (28.0 v 53.3%, RR: 95% CI: 0.53, 0.31-0.89; z = 2.5, p = 0.01). Multivariate logistic regression analysis identified that LcS can reduce the risk of AAD at 30 days (OR: 0.36, 95% CI 0.13, 0.99, p < 0.05). No intervention-related adverse events were reported during the study. CONCLUSIONS: LcS has the potential to prevent AAD in what could be considered a defined vulnerable group of SCI patients on regular PPI. A confirmatory, randomised, placebo-controlled study is needed to confirm this apparent therapeutic success to translate it into appropriate clinical outcomes. SPONSORSHIP: Yakult Honsha Co., Ltd. © 2024. Crown.

07
CLINICAL STUDY Nutrients (2021) PMID: 34073684 ↗
Effects of Probiotics on Anxiety, Stress, Mood and Fitness of Badminton Players.
Clinical Trial Synthesis 2021 Clinical Study published in Nutrients involving n = 15 participants; statistical significance reported at p = 0.05. Key conclusion: CONCLUSIONS: Probiotics supplementation showed improved aerobic capacity and relieve anxiety and stress.
View Original PubMed Abstract ↓

BACKGROUND: Reports of probiotic consumption on athletes' performance are debatable due to their equivocal results. There is a need for more evidence on the effects of probiotic intake on psychological state and fitness level. Thus, this study determined the effects of daily probiotic consumption on competitive anxiety, perceived stress and mood among university badminton players, besides their fitness like aerobic capacity, strength, speed, leg power and agility. METHODS: Thirty university badminton players aged from 19 to 22 years old were randomly divided equally into two groups, where the probiotic group (PG; n = 15) received a drink that contained Lactobacillus casei Shirota (3 × 1010 CFU) and placebo group (CG; n = 15) a placebo drink for six weeks. Anxiety, stress and mood levels were determined using the CSAI-2R, PSS and BRUMS questionnaires, respectively. Fitness levels were measured using by subjecting the players to 20-m shuttle runs (aerobic capacity), handgrips (muscular strength), vertical jumps (leg power), 40-m dash (speed) and T-test (agility). The Student's t-test (p < 0.05) was used to determine the differences between PG and CG players. RESULTS: After six weeks, the anxiety and stress levels of PG players significantly decreased by 16% (p < 0.001) and 20% (p < 0.001), respectively, but there were no significant changes detected in CG players. Supplementation of probiotics also improved aerobic capacity in PG players by 5.9% (p < 0.001) but did not influence the speed, strength, leg power and agility. CONCLUSIONS: Probiotics supplementation showed improved aerobic capacity and relieve anxiety and stress. However, further studies need to be carried out to determine the mechanisms through which probiotic intake produces these effects.

08
SYSTEMATIC REVIEW Travel medicine and infectious disease (2015) PMID: 25805164 ↗
Probiotics for the prevention of antibiotic-associated diarrhoea in older patients: a systematic review.
Clinical Trial Synthesis 2015 Systematic Review published in Travel medicine and infectious disease involving n = 3,562 participants. Key conclusion: However, with current published data, it is difficult to draw concrete conclusions.
View Original PubMed Abstract ↓

OBJECTIVE: Here, we evaluated the efficacy of probiotic interventions in prevention of antibiotic-associated diarrhoea (AAD) and Clostridium difficile diarrhoea (CDD) in older patients. METHODS: PubMed, Embase, CENTRAL, CINAHL, and Web of Science were comprehensively searched from their dates of inception to May 2014. Only randomised controlled trials reporting data on probiotics including Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and Bacillus-alone or in combination-versus placebo or absence of treatment in older patients (age ≥65 years) were included. Risk ratios (RRs) for AAD and CDD relative to placebo or absence of treatment were estimated. RESULTS: Six trials with a total of 3562 patients were included. Only one trial showed that Bacillus licheniformis was effective for preventing AAD in older patients. However, there was no preventive effect for AAD and CDD with Lactobacillus acidophilus (Florajen), Lactobacillus casei Shirota, Saccharomyces cerevisiae (boulardii) lyo, mixture of Lactobacillus acidophilus and Bifidobacterium bifidum (Cultech strains), and mixture of Lactobacillus acidophilus CUL60, CUL21, Bifidobacterium bifidum CUL20 and B. lactis CUL34. CONCLUSIONS: Our findings indicate that probiotics may not reduce the risk of AAD and CDD in older patients. However, with current published data, it is difficult to draw concrete conclusions. To confirm these findings, sample sizes, multi-centre, double-blind studies that consider factors such as probiotic strains and types of antibiotics are required.

09
SYSTEMATIC REVIEW World journal of gastroenterology (2010) PMID: 20039451 ↗
Systematic review of randomised controlled trials: probiotics for functional constipation.
Clinical Trial Synthesis 2010 Systematic Review published in World journal of gastroenterology involving n = 266 participants. Key conclusion: CONCLUSION: Until more data are available, we believe the use of probiotics for the treatment of constipation condition should be considered investigational.
View Original PubMed Abstract ↓

AIM: To systematically evaluate and update evidence on the efficacy and safety of probiotic supplementation for the treatment of constipation. METHODS: The MEDLINE, EMBASE, CINAHL, and Cochrane Library databases were searched in May 2009 for randomised controlled trials (RCTs) performed in paediatric or adult populations related to the study aim. RESULTS: We included five RCTs with a total of 377 subjects (194 in the experimental group and 183 in the control group). The participants were adults (three RCTs, n = 266) and children (two RCTs, n = 111) with constipation. In adults, data suggests a favourable effect of treatment with Bifidobacterium lactis DN-173 010, Lactobacillus casei Shirota, and Escherichia coli Nissle 1917 on defecation frequency and stool consistency. In children, L. casei rhamnosus Lcr35, but not L. rhamnosus GG, showed a beneficial effect. CONCLUSION: Until more data are available, we believe the use of probiotics for the treatment of constipation condition should be considered investigational.

10
META-ANALYSIS European journal of gastroenterology & hepatology (2026) PMID: 40929652 ↗
Comparative effectiveness and safety of probiotics with psychotropic potential in mental health benefits in irritable bowel syndrome: a systematic review and network meta-analysis.
Clinical Trial Synthesis 2026 Meta-Analysis published in European journal of gastroenterology & hepatology involving n = 3,154 participants. Key conclusion: CONCLUSION: Some probiotics or combinations may offer benefits for patients with IBS in improving QoL, depression, and anxiety; however, as this is a developing field, additional research is necessary to fully understand the effectiveness, underlying mechanisms, and specific stra
View Original PubMed Abstract ↓

BACKGROUND: The use of probiotics as a treatment for irritable bowel syndrome (IBS) is gaining attention, with recent studies indicating that certain probiotics or combinations may have mental health benefits for patients with IBS. AIMS: To systematically review and meta-analyze, using network meta-analysis (NWM), the comparative effectiveness and safety of probiotics with psychotropic potential on quality of life, depression, and anxiety in patients with IBS. METHODS: Relevant randomized controlled trials (RCTs) were analyzed, using a Bayesian NWM, to compare the performance of probiotics with mental health benefits in IBS treatment. Treatment effectiveness was assessed using surfaces under cumulative ranking (SUCRA) values. RESULTS: The analysis included 3154 participants assigned to nine different treatments: Bifidobacterium longum, Saccharomyces, Clostridium butyricum, Bifidobacterium lactis, Lactobacillus acidophilus, Lactobacillus casei strain Shirota, Lactobacillus plantarum, probiotic combinations, and placebo. B. longum and probiotic combinations were found to be significantly more effective than placebo. In terms of improving quality of life (QoL), B. longum was the most effective (SUCRA = 89.7%), while L. plantarum was the least effective (SUCRA = 14.9%). For alleviating depression and anxiety, the combination of probiotics (SUCRA = 95.6%) and L. acidophilus (SUCRA = 74.2%) showed the best results, respectively. CONCLUSION: Some probiotics or combinations may offer benefits for patients with IBS in improving QoL, depression, and anxiety; however, as this is a developing field, additional research is necessary to fully understand the effectiveness, underlying mechanisms, and specific strains that may be advantageous. More high-quality RCTs are needed to substantiate these therapeutic possibilities.

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