ArticleFrontiers in medicine2026
Initiating multi-strain probiotics is associated with clinically meaningful symptom relief, better quality of life, and fewer treatment escalations in IBS-D/IBS-M: a Chinese real-world propensity-matched cohort study.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Inroduction: Evidence for probiotics in irritable bowel syndrome remains heterogeneous, although real-world use is common in Chinese gastroenterology practice. This study evaluated whether initiation of multi-strain probiotics, compared with contemporary standard care without probiotics, was associated with clinically meaningful symptom and quality-of-life improvement in adults with diarrhoea-predominant or mixed irritable bowel syndrome. Methods: This single-centre retrospective real-world cohort study identified adults with Rome IV IBS-D or IBS-M managed between January 2022 and December 2024 from electronic health records. A new-user design with a symmetrical 14-day landmark was used. After prespecified exclusions, 287 patients comprised the full analytic set, including 122 probiotic initiators and 165 non-users. One-to-one nearest-neighbour propensity score matching yielded 75 matched pairs. Outcomes were assessed at 4-6 and 8-12 weeks, with change in IBS Symptom Severity Score from baseline to 8-12 weeks as the primary endpoint. Results: In the matched cohort, probiotic initiation was associated with a greater reduction in IBS-SSS than standard care at 8-12 weeks, with mean changes of -95 versus -60 points and a mean difference of -35 points (95% CI: -50 to -20; p = 0.001). IBS-SSS response occurred more frequently with probiotics than with non-use (62.7% versus 44.0%), as did pain response (58.7% versus 40.0%) and adequate relief (54.7% versus 38.7%). IBS-QOL improved by 16.0 versus 8.0 points, and IBS-QOL minimal clinically important difference response was more frequent with probiotics (53.3% versus 34.7%). Adverse events were infrequent and similar between groups (16.0% versus 13.3%). Treatment escalation occurred less often with probiotics (24.0% versus 40.0%). Discussion: In routine Chinese hospital care, initiation of multi-strain probiotics was associated with earlier and clinically meaningful symptom improvement, better disease-specific quality of life, and fewer treatment escalations among adults with IBS-D or IBS-M, without an apparent excess of adverse events.
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