Irritable bowel syndrome and probiotics: from rationale to clinical use
Bibliographic record
Abstract
PURPOSE OF REVIEW: Few therapies are of proven efficacy in irritable bowel syndrome. Thus, there is great interest in the development of a natural therapy that can be both safe and effective. An understanding that probiotics are heterogeneous, with multiple targets and mechanisms of action, is fundamental to the development of clinical trials. RECENT FINDINGS: A bidirectional model for the pathogenesis of irritable bowel syndrome is proposed in which gut-driven and brain-driven mechanisms contribute to the genesis of gut dysfunction and symptoms. In-vitro and animal studies have generated most of the mechanistic rationale for the use of probiotics in functional bowel disorders. A MEDLINE search of publications from 1989 to date revealed only eight placebo-controlled clinical trials on the subject of probiotics and irritable bowel syndrome. All these studies suffer from methodologic problems. By contrast, numerous reviews have been published in the past 2 years on this subject. SUMMARY: Animal research will continue to identify novel targets and elucidate the mechanisms of action of probiotics, thus providing a rational basis for their use in irritable bowel syndrome. The notion of treating irritable bowel syndrome with probiotics is particularly attractive to patients and generates great interest, although clinical evidence is not yet sufficient to enable clear guidelines to be designed. Large, well-designed, controlled clinical trials using specific probiotics are warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.001 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.000 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".