Probiotics may help prevent chemoradiotherapy-induced diarrhoea in people with abdominal and pelvic cancer


Scientific evidence shows probiotics may have a role in treating acute infectious diarrhoea and preventing antibiotic-associated diarrhoea. However, little is known regarding their role in the treatment of diarrhoea generated as a result of radiotherapy or chemotherapy treatments.

A recent systematic review and meta-analysis, led by Dr. C-X Pei from The First Clinical Medical College and Evidence Based Medical Centre of Lanzhou University in Lanzhou (China), has shown that probiotics may have a role in prevention of chemoradiotherapy-induced diarrhoea in people with abdominal and pelvic cancer, and are rarely associated with adverse events.

In order to determine whether probiotics are effective in reducing incidence of chemoradiotherapy-induced diarrhoea, the researchers performed a systematic review of 9 studies (chosen for low risk of bias) on the use of probiotic supplements during abdominal or pelvic cancer treatment with radiotherapy or chemotherapy. The efficacy of probiotics was assessed through randomized controlled trials (RCTs), while both RCTs and non-RCTs were considered for assessing the safety of probiotics. The authors excluded trials on animals, non-placebo-controlled studies, and studies of patients having primary tumours other than abdominal or pelvic cancer. The primary outcomes included incidence of diarrhoea induced by chemotherapy or radiotherapy (defined as the frequency of Grade ≥ 3 or ≥ 2 diarrhoea—grades assigned according to the Common Terminology Criteria for Adverse Events) and incidence of adverse events (AEs) such as infection and bacteremia. Secondary outcomes were incidence of diarrhoea Grade ≤ 2, and Grade ≥ 2 and Grade ≥ 3 induced by chemotherapy or radiotherapy.

Nine randomized and placebo-controlled studies (n = 1265 participants) were included for assessing efficacy, of which 7 (n = 1071) were concerned with radiotherapy and 2 (n = 194) with chemotherapy. Supplementing with probiotics reduced the incidence of radiotherapy-diarrhoea, as well as the incidence of CTC Grade ≥ 2 and Grade ≥ 3 diarrhoea induced by radiotherapy. However, probiotics did not appear to reduce the frequency of CTC Grade ≤ 2 diarrhoea induced by both chemotherapy and radiotherapy. For chemotherapy-induced diarrhoea, neither incidence of diarrhoea nor incidence of CTC Grade ≥ 3 diarrhoea was reduced.

Eleven studies, including 1612 people, were used for the analysis of safety of probiotics. Of the 11 studies, 7 studies had no AEs caused by probiotics, whereas 4 studies reported varying degrees of AEs (neutropenia, anorexia and mild-to-moderate gastrointestinal problems) in their treatment.

In conclusion, probiotics may have a beneficial effect in prevention of chemoradiotherapy-induced diarrhoea, especially for Grade ≥ 2 diarrhoea, and appear to be safe for this kind of intervention.




Wang YH, Yao N, Wei KK, et al. The efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer: a systematic review and meta-analysis. Eur J Clin Nutr. 2016; 70(11):1246-53. doi: 10.1038/ejcn.2016.102.



Paul Enck
Paul Enck
Prof. Dr. Paul Enck, Director of Research, Dept. of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany. His main interests are gut functions in health and disease, including functional and inflammatory bowel disorders, the role of the gut microbiota, regulation of eating and food intake and its disorders, of nausea, vomiting and motion sickness, and the psychophysiology and neurobiology of the placebo response, with specific emphasis on age and gender contributions. He has published more than 170 original data paper in scientific, peer-reviewed journals, and more than 250 book chapters and review articles. He is board member/treasurer of the European Society of Neurogastroenterology and Motility and of the German Society of Neurogastroenterology and Motility, and has served as reviewer for many international journals and grant agencies.