Probiotics in gastrointestinal disorders.

A new era in medical science has dawned with the realization of the critical role of the "forgotten organ," the enteric flora, in health and disease. Central to this beneficial interaction between the flora and humans is the manner in which the bacteria contained within the gut "talk" to the immune system and, in particular, the immune system that is widespread within the gut itself, the gut- (or mucosa-) associated lymphoid tissue (GALT or MALT). Into this landscape comes a new player: the probiotic. While many products have masqueraded as probiotics, only those that truly and reproducibly contain live organisms and have been shown, in high-quality human studies, to confer a health benefit can actually claim this title. Several human disease states have benefited from the use of probiotics, most notably diarrheal illnesses, some inflammatory bowel diseases, and certain infectious disorders. Irritable bowel syndrome can now be added to this list. Although this area holds much promise, more high-quality trials of probiotics in digestive disorders, as well as laboratory investigations of their mechanisms of action, are required.