Gut 62:787-796 doi:10.1136/gutjnl-2012-302504
  • Recent advances in clinical practice

An update on the use and investigation of probiotics in health and disease

Open AccessEditor's Choice
  1. Emeran A Mayer9
  1. 1Dairy & Food Culture Technologies, Centennial, Colorado, USA
  2. 2Digestive System Research Unit, University Hospital Vall d'Hebron, CIBEREHD, Barcelona, Spain
  3. 3Center for Global Health, University of Virginia School of Medicine, Charlottesville, Virginia, USA
  4. 4Laboratory of Biochemical Genetics & Metabolism, The Rockefeller University, New York City, New York, USA
  5. 5Department of Medicine, Alimentary Pharmabiotic Centre, University College Cork, Ireland
  6. 6Division of Gastroenterology and Hepatology, The Methodist Hospital and Weill Cornell School of Medicine, Houston, Texas, USA
  7. 7Departments of Medicine, Microbiology and Immunology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
  8. 8The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
  9. 9Division of Digestive Diseases, University of California, Los Angeles, California, USA
  1. Correspondence to Emeran A Mayer, Oppenheimer Center for Neurobiology of Stress, Division of Digestive Diseases, UCLA CHS 47-122, 10833 Le Conte Ave, Los Angeles, CA 90095-7378, USA;emayer{at}
  • Received 16 May 2012
  • Revised 5 February 2013
  • Accepted 7 February 2013
  • Published Online First 8 March 2013


Probiotics are derived from traditional fermented foods, from beneficial commensals or from the environment. They act through diverse mechanisms affecting the composition or function of the commensal microbiota and by altering host epithelial and immunological responses. Certain probiotic interventions have shown promise in selected clinical conditions where aberrant microbiota have been reported, such as atopic dermatitis, necrotising enterocolitis, pouchitis and possibly irritable bowel syndrome. However, no studies have been conducted that can causally link clinical improvements to probiotic-induced microbiota changes. Whether a disease-prone microbiota pattern can be remodelled to a more robust, resilient and disease-free state by probiotic administration remains a key unanswered question. Progress in this area will be facilitated by: optimising strain, dose and product formulations, including protective commensal species; matching these formulations with selectively responsive subpopulations; and identifying ways to manipulate diet to modify bacterial profiles and metabolism.

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