STRAIN-SPECIFIC EFFECTS OF PROBIOTICS IN GASTROESOPHAGEAL REFLUX DISEASE: A COMPREHENSIVE REVIEW
Abstract
Gastroesophageal reflux disease (GERD) is one of the most prevalent gastrointestinal disorders worldwide and represents a significant burden on healthcare systems due to its high prevalence, chronic course, and impact on patients’ quality of life. Although proton pump inhibitors (PPIs) remain the cornerstone of GERD treatment, a considerable proportion of patients continue to experience persistent symptoms, and concerns regarding the long-term use of acid-suppressive therapy have increased interest in complementary therapeutic approaches. Recent advances in microbiome research have highlighted the potential role of gut and esophageal microbiota in the pathogenesis of GERD, suggesting that probiotics may offer therapeutic benefits beyond conventional treatment. This review summarizes current evidence regarding the strain-specific effects of probiotics in GERD, focusing on commonly investigated strains, including Lactobacillus reuteri, Lactobacillus rhamnosus GG, Lactobacillus acidophilus, and Bifidobacterium species. Available studies indicate that these probiotics may improve upper gastrointestinal symptoms through modulation of the intestinal microbiota, enhancement of epithelial barrier function, regulation of inflammatory responses, and improvement of gastrointestinal motility. Emerging evidence also suggests that certain Bifidobacterium strains may indirectly influence glucagon-like peptide-1 (GLP-1) secretion via the production of short-chain fatty acids, although the clinical significance of this mechanism in GERD has not yet been established. Overall, current findings support the use of probiotics as a promising adjunct to standard GERD therapy; however, their effects remain highly strain-specific, and the available evidence is limited by heterogeneous study designs and relatively small patient populations. Further well-designed randomized controlled trials are required to determine the most effective probiotic strains, optimal treatment regimens, and their long-term role in the management of GERD.