Probiotic therapy: celebrating the 50th anniversary with a change in the concept of synbiotics | Ukrainian Medical Journal

The article provides brief historical information on the use of probiotics in medicine and modern views on synbiotics. The updated definitions of WGO, ISAPP on the definition of complementary and synergistic synbiotics are presented, and the differences between synbiotics and symbiotics are emphasised. The main properties of the most researched and effective probiotic strains Lacticaseibacillus rhamnosus GG, S. cerevisiae var. boulardii, and the prebiotic inulin are considered. The provisions of the updated WGO and AGA guidelines for the clinical use of probiotics, prebiotics, and synbiotics are quoted.

References

1. The Prolongation of Life: Optimistic Studies by Elie Metchnikoff (2016) http://www.gutenberg.org/ebooks/51521.
2. Marteau P., Pochart P., Bouhnik Y. et al. (1992) Survival of Lactobacillus acidophilus and Bifidobacterium sp. in the small intestine following ingestion in fermented milk. A rational basis for the use of probiotics in man. Gastroenterol. Clin. Biol., 16(1): 25–28.
3. FAO/WHO Working Group (2002) Report of a joint FAO/WHO expert consultation on evaluation of health and nutrition properties of probiotics in food including powder milk with live lactic acid bacteria. Cordoba, Argentina. http://www.fao.org/3/a-a0512e.pdf.
4. Hill C., Guarner F., Reid G. et al. (2014) Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat. Rev. Gastroenterol. Hepatol., 11(8): 506–514. doi: 10.1038/nrgastro.2014.66.
5. Reid G., Sanders M.E., Gaskins H. et al. (2003). New scientific paradigms for probiotics and prebioticS. J. Clin. Gastroenterol., 37(2): 105–118. doi: 10.1097/00004836-200308000-00004.
6. Su G.L., Ko C.W., Bercik P. et al. (2020) AGA Clinical Practice Guidelines on the Role of Probiotics in the Management of Gastrointestinal DisorderS. Gastroenterology, 159(2): 697–705. doi: 10.1053/j.gastro.2020.05.059.
7. Guarner F., Sanders M., Szajewska H. et al. (2024) World Gastroenterology Organisation Global Guidelines: Probiotics and PrebioticS. J. Clin. Gastroenterol., 58(6): 533–553. doi: 10.1097/MCG.0000000000002002.
8. ISAPP (2020) SynbioticS. isappscience.org/wp-content/uploads/2020/08/Synbiotics-infographic.pdf.
9. Zheng J., Wittouck S., Salvetti E. et al. (2020) A taxonomic note on the genus Lactobacillus: Description of 23 novel genera, emended description of the genus Lactobacillus Beijerinck 1901, and union of Lactobacillaceae and Leuconostocaceae. Int. J. Syst. Evol. Microbiol., 70(4): 2782–2858. doi: 10.1099/ijsem.0.004107.
10. Dronkers T., Ouwehand A., Rijkers G. (2020) Global analysis of clinical trials with probiotics. Heliyon, 6(7): e04467. doi: 10.1016/j.heliyon.2020.e04467.
11. Tannis A. (2021) IPA. 7 Things Lacticaseibacillus rhamnosus Is Good For. internationalprobiotics.org/home/7-things-lacticaseibacillus-rhamnosus-is-good-for.
12. Liu Y., Chen Y., Liao H. et al. (2025) Research progress on the application of Lacticaseibacillus rhamnosus GG in pediatric respiratory diseases. Front. Nutr., 12: 1553674. doi: 10.3389/fnut.2025.1553674
13. Leser T., Baker A. (2024) Molecular Mechanisms of Lacticaseibacillus rhamnosus, LGG® Probiotic Function. Microorganisms, 12(4): 794. doi: 10.3390/microorganisms12040794.
14. Полезно знать всем! Дрожжи — опасное биологическое оружие. renewal.od.ua/ru/stati/polezno-znat-vsem-drozhzhi-opasnoe-biologicheskoe-oruzhie/.
15. van der Aa K.A., Jespersen L. (2003) The taxonomic position of Saccharomyces boulardii as evaluated by sequence analysis of the D1/D2 domain of 26S rDNA, the ITS1-5.8S rDNA-ITS2 region and the mitochondrial cytochrome-C oxidase II gene. Syst. Appl. Microbiol., 26: 564–571.
16. Crowch M. (2024) Classification of Saccharomyces boulardii. http://www.optibacprobiotics.com/professionals/latest-research/general-health/classification-of-saccharomyces-boulardii.
17. Offei B., Vandecruys P., De Graeve S. et al. (2019) Unique genetic basis of the distinct antibiotic potency of high acetic acid production in the probiotic yeast Saccharomyces cerevisiae var. boulardii. Genome Res., 29(9): 1478–1494. doi: 10.1101/gr.243147.118.
18. Fu J., Liu J., Wen X. et al. (2023) Unique Probiotic Properties and Bioactive Metabolites of Saccharomyces boulardii. Probiotics Antimicrob Proteins, 15(4): 967–982. doi: 10.1007/s12602-022-09953-1.
19. Pais P., Oliveira J., Almeida V. et al. (2021) Transcriptome-wide differences between Saccharomyces cerevisiae and Saccharomyces cerevisiae var. boulardii: Clues on host survival and probiotic activity based on promoter sequence variability. Genomics, 113(2): 530–539. doi: 10.1016/j.ygeno.2020.11.034.
20. Gopalan S., Ganapathy S., Mitra M. et al. (2023) Unique Properties of Yeast Probiotic Saccharomyces boulardii CNCM I-745: A Narrative Review. Cureus, 15(10): e46314. doi: 10.7759/cureus.46314.
21. Tannis A. (2021) Saccharomyces boulardii. internationalprobiotics.org/home/saccharomyces-boulardii.
22. McFarland L.V. (2010) Systematic review and meta-analysis of Saccharomyces boulardii in adult patientS. World J. Gastroenterol., 16(18): 2202–2222. doi: 10.3748/wjg.v16.i18.2202.
23. Qin Y., Wang L., Yang X. (2023) Inulin: properties and health benefitS. Food Funct., 14(7): 2948–2968. doi: 10.1039/d2fo01096h.
24. Sheng W., Ji G., Zhang L. (2023) Immunomodulatory effects of inulin and its intestinal metaboliteS. Front. Immunol., 14: 1224092. doi: 10.3389/fimmu.2023.1224092.
25. Hughes R., Alvarado D., Swanson K.S. (2022) The Prebiotic Potential of Inulin-Type Fructans: A Systematic Review. Adv. Nutr., 13(2): 492–529. doi: 10.1093/advances/nmab119.
26. Bakirhan H., Karabudak E. (2023) Effects of inulin on calcium metabolism and bone health. Int. J. Vitam. Nutr. ReS, 93(1): 85–96. doi: 10.1024/0300-9831/a000700.
27. Amadieu C., Ahmed H., Leclercq S. et al. (2025) Effect of inulin supplementation on fecal and blood metabolome in alcohol use disorder patients: A randomised, controlled dietary intervention. Clin. Nutr. ESPEN, 66: 361–371. doi: 10.1016/j.clnesp.2025.01.046.
28. Citarrella R., Chianetta R., Amodeo S. et al. (2024) Effectiveness of a Food Supplement Based on Glucomannan, D-Chiro-Inositol, Cinnamomum zeylanicum Blume and Inulin in Patients with Metabolic Syndrome. Nutrients, 16(2): 249. doi: 10.3390/nu16020249.
29. Hindle V.K., Veasley N.M., Holscher H.D. (2025) Microbiota-Focused Dietary Approaches to Support Health: A Systematic Review. J. Nutr., 155(2): 381–401. doi: 10.1016/j.tjnut.2024.10.043.
30. Reimer R.A., Theis S., Zanzer Y.C. (2024) The effects of chicory inulin-type fructans supplementation on weight management outcomes: systematic review, meta-analysis, and meta-regression of randomized controlled trials. Am. J. Clin. Nutr., 120(5): 1245–1258. doi: 10.1016/j.ajcnut.2024.09.019.
31. Zhang T., Li X., Li J. et al. (2025) Gut microbiome-targeted therapies as adjuvant treatments in inflammatory bowel diseases: a systematic review and network meta-analysis. J. Gastroenterol. Hepatol., 40(1): 78–88. doi: 10.1111/jgh.16795.
32. Інструкція з застосування Актив Флора Дуо Плюс (2025) Режим доступу: https://compendium.com.ua/dec/556638/740121.