The clear delineation of a postinfective variety of IBS, and the description in numerous studies of evidence of low-grade inflammation and immune activation in IBS, suggest a role for a dysfunctional relationship between the indigenous flora and the host in IBS. Accordingly, this provides a clear rationale for the use of probiotics in this disorder. Other modes of action, including bacterial displacement and alterations in luminal contents, are also plausible. Clinical evidence of efficacy remains scanty, and a review of available trials, while providing some hints of efficacy and therapeutic promise, emphasizes the importance of clear definition of strain selection, dose, and viability. This is clearly an area of great potential in IBS and deserves further study at all levels.
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