Research suggests that probiotics may help ease symptoms of acid reflux — and some side effects of acid reflux medications.

While the evidence is promising, further large, placebo-controlled trials are necessary to confirm these effects.

Probiotics are living bacteria or yeasts that may benefit health, particularly digestive health. This article investigates how probiotics may benefit people with acid reflux and notes which bacterial strains may be best.

It also looks at important considerations when choosing probiotics and explores the risks. Finally, this article lists some alternative acid reflux treatments.

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Acid reflux involves stomach acid leaking upward, into the esophagus. Depending on how frequent it is, this may be uncomfortable, painful, or even debilitating.

Emerging research suggests that probiotics may be a viable complementary treatment, whether a person has occasional bouts of acid reflux or more prolonged gastroesophageal reflux disease (GERD).

There is also evidence that probiotics may ease side effects of medications that help manage the condition.

Which acid reflux symptoms could they ease?

A 2020 systematic review investigated the effects of probiotics on GERD. The authors looked at 13 studies of varying quality, 11 of which found that probiotics had some benefit for acid reflux. The specific benefits are below:

  • One study noted improvements in reflux or heartburn.
  • Five studies noted improvements in shortness of breath.
  • Three studies noted a reduction in regurgitation.
  • Nine studies noted improvements in other gastrointestinal symptoms, such as:

While these findings are promising, the review did not include more rigorous, placebo-controlled trials, which will be necessary to confirm the effects of probiotics.

Do they help with side effects?

Another potential benefit of probiotics is that they may ease some side effects of proton pump inhibitors (PPIs). These prescription medications reduce the production of stomach acid and help heal the lining of the esophagus.

Taking PPIs can cause small intestine bacterial overgrowth (SIBO). Symptoms of SIBO include:

A 2019 study investigated the effect of probiotic supplements in adults taking the PPI esomeprazole for reflux esophagitis. Over 8 weeks, one group of participants took esomeprazole with a probiotic, while a second group took esomeprazole with a placebo.

At 12 weeks, the researchers assessed the participants with cured esophagitis. The group that had received the probiotic had lower rates of SIBO and decreased diarrhea.

A 2018 study looked at the effects of probiotics on SIBO in children with GERD. The 12-week study included 128 participants with GERD and 120 without it. The researchers divided the children with GERD into two groups. One received a PPI with probiotics, and the other received the same PPI with a placebo.

At the end of the trial, the children who took probiotics had lower rates of SIBO, compared with those who took a placebo. These lower rates were similar to those of children without GERD.

Most studies of probiotics for GERD have investigated Lactobacillus bacterial strains. Some have looked at other strains, such as Bacillus subtilis and Enterococcus faecium. Any of these may help with acid reflux.

The American Gastroenterological Association offers the following advice about choosing probiotic supplements:

  • Opt for probiotics that list their strains of bacteria.
  • Buy them from an established company.
  • Ask a doctor for a recommendation.
  • Beware of buying fake probiotics online.

Antacids are medications that neutralize stomach acid and alleviate acid reflux and heartburn. It is safe to take probiotics and antacids together, though each can interact with other medications. For this reason, a person should speak with a doctor before taking any kind of supplement.

Probiotics may increase the effectiveness of antacids and may even be a viable replacement.

A large 2021 study investigated different approaches for people with indigestion and acid reflux. Each participant received one of the following treatments:

  • probiotics with antacids
  • probiotics with PPI drugs
  • probiotics with prokinetics
  • probiotics alone

All groups experienced improvements in their indigestion symptoms. However, the group that received the probiotics alone had the greatest improvements.

Most people can safely take probiotics. However, as with other medications and supplements, there is always a risk of side effects. And people who are unwell or have weakened immune systems may be more vulnerable to the side effects of probiotics.

Some risks of taking probiotics include:

  • bloating and discomfort
  • allergic reactions, which are serious in rare cases
  • exposure to microorganisms not listed on the label
  • bacterial or fungal infections
  • harmful interactions with other medications
  • harm from counterfeit products

In addition, research into the effects of probiotics on SIBO has had mixed results. Some studies show a benefit, while others have found that probiotics may make SIBO worse.

It is important to use probiotics as a complementary treatment, not a substitute for standard treatment.

There are many options for treating acid reflux. Examples include:

  • Self-care strategies: These can help ease mild-to-moderate cases. A person can try:
    • avoiding fatty, spicy, or acidic foods
    • eating more frequent small meals, rather than fewer large meals
    • not eating before bed
    • elevating the head higher when sleeping
  • Medications: A doctor may prescribe:
    • Antacids, to reduce the production of stomach acid and alleviate mild symptoms.
    • H2 blockers, which also help reduce stomach acid production.
    • PPIs, which have the same effect and can also heal the lining of the esophagus. A doctor may prescribe these when chronic acid reflux does not respond to antacids.
  • Surgery: A doctor may recommend surgery for people with severe GERD that does not respond to other treatment. Options include:
    • bariatric surgery to help with weight loss
    • fundoplication, which involves sewing around the top of the stomach to prevent stomach acid leaking into the esophagus

Acid reflux involves stomach acid traveling upward into the esophagus.

Probiotics cannot cure it, but they may help ease some symptoms and reduce side effects of prescription treatments called PPIs. Confirming these benefits requires more research.

People can safely take probiotics and antacids together, but either approach can interact with other medications. Also, probiotics can cause side effects. Always speak with a doctor before taking a new supplement or medication.