Management of Abdominal Bloating

Evidence on S. boulardii for Bloating

The American Gastroenterological Association (AGA) makes no recommendations for the use of probiotics in patients with irritable bowel syndrome due to significant heterogeneity in study designs and outcomes 3
The AGA suggests using probiotics only in the context of clinical trials for patients with IBS symptoms, including bloating 3
Three studies testing S. boulardii among 232 adults with IBS found no difference between S. boulardii and placebo for abdominal pain scores (standardized MD, 0.26; 95% CI, −0.09 to 0.61) 1

Regular exercise is strongly recommended for all patients with IBS and bloating symptoms 4
First-line dietary advice should be offered to all patients 4
Soluble fiber (e.g., ispaghula) can be effective for global symptoms and abdominal pain in IBS, starting at a low dose (3-4 g/day) and gradually increasing to avoid worsening bloating 4
A low FODMAP diet may be considered as a second-line dietary therapy for global symptoms and abdominal pain, but should be supervised by a trained dietitian 4, 5

The AGA specifically states that "treatment with probiotics and medical foods is not recommended for bloating or distention" 5
Probiotics may actually be associated with developing new onset of brain fogginess, bloating, and lactic acidosis in some patients 5
Brain-gut behavioral therapies and diaphragmatic breathing may be beneficial regardless of the underlying cause of bloating 7

Evaluate for potential underlying causes of bloating such as carbohydrate intolerances (lactose, fructose, sucrose) 7
Evaluate for potential underlying causes of bloating such as small intestinal bacterial overgrowth (SIBO) 7
Evaluate for potential underlying causes of bloating such as constipation or pelvic floor dyssynergia 7
Evaluate for potential underlying causes of bloating such as celiac disease or non-celiac gluten sensitivity 7

Avoid recommending probiotics based solely on manufacturer claims without supporting evidence 5
Do not rely on probiotics as a primary treatment for bloating when other evidence-based approaches are available 5
Be cautious about potential adverse effects of probiotics, especially in immunocompromised patients 5
Avoid prolonged dietary restrictions without evidence of benefit, as they may lead to nutritional deficiencies 5