Evidence supporting the use of: Lactobacillus (mixed)
For the health condition: Small Intestinal Bacterial Overgrowth

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Synopsis

Source of validity: Scientific
Rating (out of 5): 2

Lactobacillus (mixed species) probiotics are sometimes used as adjunctive therapy for Small Intestinal Bacterial Overgrowth (SIBO), but the scientific validation for their effectiveness is currently limited and inconclusive. A handful of small clinical trials and case series have explored the use of probiotics, including mixed strains of Lactobacillus, in patients with SIBO. Some studies have reported symptomatic improvement and reductions in breath hydrogen/methane levels following probiotic use, but these studies are often limited by small sample sizes, lack of blinding, and heterogeneous patient populations.

For example, a 2009 randomized controlled trial (Furnari et al.) found that probiotics containing Lactobacillus improved symptoms in some SIBO patients, but the effect size was modest and not all studies have replicated these findings. Some evidence suggests that probiotics may help restore the balance of intestinal flora, competitively inhibit pathogenic bacteria, and modulate immune responses, which could theoretically benefit SIBO patients. However, there is also concern that introducing more bacteria—including Lactobacillus species—into the small intestine could, in some cases, exacerbate symptoms or lead to unwanted colonization.

Professional guidelines generally do not recommend probiotics as primary therapy for SIBO, instead favoring antibiotics as first-line treatment. The current evidence base rates at about 2/5 for efficacy, reflecting preliminary findings and the need for larger, well-designed trials. In summary, while there is some scientific rationale and early clinical data, robust evidence supporting the use of mixed Lactobacillus probiotics for SIBO is lacking.

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