Reduction of chronic constipation and IBS symptoms: Both IBS andnon IBS related constipation are commonly occurring health issues inAustralia, however, non IBS related constipation is twice as commonin Australia as IBS.^12,13 Lactobacillus plantarum 299v is extensivelyresearched and shown to reduce a range of IBS symptoms.¹⁴ PHGG isa selective prebiotic, used as a fuel by butyrate producing bacteria.¹⁵ Ameta-analysis of seven randomised trials¹⁶ of PHGG found a reductionin chronic constipation (Figure 1) while several randomised trials,^17,18found a significant decrease in IBS symptoms.

SIBO, methane and butyrate regulation; PHGG is fermented bylarge intestinal commensal bacteria increasing SCFA productionparticularly butyrate¹⁹ (Figure 2), as well as assisting colonic bloodflow and epithelial repair.²⁰ PHGG influences gut motility, secretionsand vagal modulation of contraction,²¹ and has been shown to reducemethane levels. Methane production is implicated in the reduction in5HT (gut serotonin) levels and reduced intestinal motility.²² Excessiveproduction of methane has been linked to gastrointestinal issues suchas SIBO, chronic constipation, IBS and slow transit time.^23,24 PHGG maytherefore assist in reducing severity of these conditions and symptoms. Research of PHGG has also shown other benefits, including:

• Reduced methane excretion²⁵
• Improved effectiveness of antibiotic SIBO treatment (when usedwith PHGG)²⁵
• Improvements in chronic constipation²⁶

Visceral hypersensitivity, abdominal pain and inflammation;Probiotics can help modulate visceral hypersensitivity (increasedpain sensitivity) to reduce abdominal pain²⁷ and improve patientcomfort. Both L. plantarum 299v and PHGG have been shown toreduce abdominal pain by 50%,²⁸ which can be a key symptom drivingpatients to seek health advice. Gut inflammation can also contributeto pain and associated symptoms that may benefit from probioticstrains, such as L. plantarum 299v, shown to exert a modulatory effecton the inflammatory response of epithelium,²⁹ helping to improvegastrointestinal comfort and health.