Ewha Med J.
2026 Apr;49(2):e10. 10.12771/emj.2026.01256.
Clinical guidance and practical recommendations for probiotic use in patients with irritable bowel syndrome, functional constipation, and Clostridioides difficile infection considering sex-based differences: a Korean translation
- Kim YS
1,2 - Park SY3
- Kang SJ4
- Lee MW5
- Choi Y6
- Kim BY7
- Choi M8
- Shin CM6
- Kim YS4
- Kim N5,6
- Park MI9
- Gut Microbiota and Therapy Research Group of the Korean Society for Neurogastroenterology and Motility1
- Affiliations
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- 1Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan, Korea
- 2Kim’s GutEase Internal Medicine, Gunpo, Korea
- 3Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- 4Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
- 5Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- 6Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- 7Department of Food Science and Biotechnology, Konyang University, Nonsan, Korea
- 8Division of Healthcare Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
- 9Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
- KMID: 2580772
- DOI: http://doi.org/10.12771/emj.2026.01256
Abstract
- Probiotics have gained increasing clinical attention as adjunctive treatment for lower gastrointestinal disorders. However, evidence supporting their therapeutic efficacy remains limited, particularly with regard to sex-related differences. This expert review provides evidence-based insights and practical recommendations for the use of probiotics in patients with irritable bowel syndrome (IBS), functional constipation (FC), and Clostridioides difficile infection (CDI), considering possible sex-related differences. Evidence from randomized controlled trials and meta-analyses indicates that probiotics can modestly improve global symptoms, abdominal pain, and bloating in IBS and enhance bowel movement frequency and stool consistency in FC. However, these effects are strain-specific and heterogeneous. Although clinical studies on probiotics in IBS have not confirmed significant sex-related differences, experimental animal studies using stress-induced IBS models have demonstrated sex-dependent responses to specific probiotic strains, supporting the biological plausibility of such differences. For CDI, the efficacy of probiotics in preventing primary or recurrent infections remains inconsistent across large trials, and current guidelines usually do not recommend their routine use. However, sex- and age-related immunologic differences support the clinical differences of CDI. Probiotics are generally considered safe for healthy individuals, although caution is advised in patients who are immunocompromised or critically ill. Clinicians should select probiotic products based on strain-specific clinical evidence, adequate viable doses, patient characteristics and sex. In conclusion, probiotics might play a role as adjunctive therapy for IBS and FC, with variability in responses influenced by microbial, host, and potential sex-related factors. Further research is needed to establish optimized personalized probiotic strategies.
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