Quatroflora® is a multi-strain probiotic formula proven to relieve general symptoms of IBS (Irritable Bowel Syndrome). In a study conducted in 2014: therapeutic effects, tolerability and safety of a multi-strain probiotic in Iranian adults with irritable bowel syndrome and bloating2  89% of participants in the multi-strain probiotic group reported satisfactory relief of IBS.


Irritable bowel syndrome (IBS) is the most common functional gastrointestinal (GI) disorder with estimated worldwide prevalence rates ranging between 10 to 15%. According to the International Foundation of Functional Gastrointestinal Disorders40% of people have mild IBS, 35% moderate IBS, and 25% severe IBS. The cost to society in terms of direct medical expenses and indirect costs associated with loss of productivity and work absenteeism is considerable – estimated to range from $21bn or more annually.

The aetiology of IBS is unknown. Recurrent abdominal pain, bloating, constipation, and diarrhoea are the most common symptoms. Criteria for its diagnosis is having recurrent abdominal pain or discomfort at least three days a month for a duration of three months associated with at least two of the following symptoms:

  • Relieved by defaecation
  • Onset associated with a change in stool frequency
  • Onset associated with a change in stool form or appearance.

Supporting symptoms include:

  • Altered stool frequency
  • Altered stool form
  • Altered stool passage (straining and/or urgency)
  • Mucorrhea
  • Abdominal bloating or subjective distention.

Currently, there is no cure for IBS, and treatment options are aimed at relieving and controlling the symptoms.

Probiotics are among the recent and favourable treatment approaches and have not been associated with any severe drug reactions. Probiotics are defined as ‘viable micro-organisms that confer potential health benefits by preventing or treating specific pathological conditions’. Mechanisms associated with probiotic action include normalising intestinal flora, preventing the overgrowth of pathogenic bacteria and reducing inflammation in the gastrointestinal tract. More recently it has also been associated with the microbiota-gut-brain axis which refers to a broad set of functions and interactions between the gut microbiome, endocrine, immune and nervous systems and the brain.


The most commonly evaluated probiotics in previous trials were the lactic producing bacteria, particularly Lactobacillus and Bifidobacterium species which have shown to be associated with alleviation of abdominal bloating and general symptoms.

Quatroflora® contains a combination ofBifidobacterium animalis subsp. LactisBB-12® Lactobacillus acidophilus LA-5, Lactobacillus delibrueckii subsp bulgaricus LBY-27 and Streptococcus thermophilesSTY-31. In clinical trials the first two have been associated with improved gastrointestinal function, faecal properties and microbiotica, while the other two help with the digestion of lactose and milk protein in dairy products.

The formula is available in capsules. The suggested dosage is one capsule three times a day to prevent bacterial overgrowth after treatment with antibiotics or after procedures like colonoscopy or bowel surgery to restore intestinal flora.

Quatroflora® should not be taken at the same time as antibiotics. It will be most beneficial to take it at least three hours after the antibiotic dose. For long-acting antibiotics e.g. once or twice a day doses, it is preferable to start on day 3 of treatment and use for 7 days.

To assist with symptoms of IBS or imbalance of gut flora, the suggested dose is one capsule three times a day until relief is experienced. The dosage can be decreased to a maintenance dose which keeps symptoms under control.


  • Diarrhoea
  • Constipation
  • Helicobacter Pylori infections – with conventional treatment
  • Burping
  • Gas
  • Lactose intolerance
  • Bloating after a meal
  • Nutritional deficiencies due to malabsorption


A study conducted among IBS patients with bloating in Iran evaluated the efficacy,safety and tolerability of a multi-strain probiotic combination (Quatroflora®).


The randomised placebo-controlled study was conducted in a clinical centre in Teheran and included 108 eligible IBS patients who met the Rome III criteria for IBS. They were randomised into equal groups of 54, with one group receiving the multi-strain probiotic combination and the other placebo twice daily for a period of four weeks. The mean age was 36.7 years and 60% of the participants were female.

Efficacy in this study was defined as a significant reduction in mean of abdominal bloating score at four weeks of treatment. Secondary endpoints included description of changes in abdominal pain or discomfort score; reduction in feeling of incomplete defaecation per passage, determining the proportion of participants reporting symptom relief for at least 50% of the time, and description of possible adverse drug effects.

After two weeks of treatment 11 of the randomised patients (3 in the intervention and 7 in the placebo group) withdrew from the study due to dissatisfaction, while the remaining one could not continue with the study due to knee surgery.


After completing the treatment, 89% of participants in the multi-strain probiotic group reported satisfactory relief of general symptoms compared to 47% in the placebo group.

According to the researchers they observed a superior reduction in abdominal bloating, pain and the feeling of incomplete defaecation per each passage in the probiotics group compared to placebo. They noted that the only other study they could find to compare their results was a meta-analysis by Ortiz-Lucas et al that showed the beneficial effects of the multi-strain probiotic, Quatroflora® on abdominal symptoms to be greater than that of each of the strains alone.


The researchers note that despite the high response rate for satisfactory relief of general symptoms in the placebo group, the difference between proportions of satisfactory relief with the multi-strain probiotic remained significant, showing that the sample size was large enough to detect the difference.

‘Although no data are available to compare, we know that IBS is an intermittent and chronic disease and probiotics are used for improving, not curing, it; so, this result was not unexpected, and since there is no report of adverse drug reactions with probiotics in IBS patients, they seem to be a good choice for treatment of IBS in the long term. Still, further studies are warranted to determine the optimal dosage and duration of use in order to yield the greatest effectiveness,’ the authors concluded.

Because the gut represents over 70% of the immune system, it will be beneficial to keep the colon healthy by taking Quatroflora® capsules. There are no reported side effects and it keeps the microbiome intact by colonizing in the colon and therefore bad bacteria under control.


  1. International Foundation of Functional Gastrointestinal Disorders. https://www.aboutibs.org/facts-about-ibs/statistics.html
  2. Jafari E, Vahedi H, Merat S, Momtahen S, Riahi A. Therapeutic effects, tolerability and safety of a multi-strain probiotic in Iranian adults with irritable bowel syndrome and bloating. Arch Iran Med. 2014; 17(7):466-470.


  1. Schoeman AL, Greef OBW. Evidence-based therapeutics: the irritable bowel syndrome. African Journal of Clinical and Outcomes Research.2017; 1(1): 2-3

This unregistered medicine has not been evaluated by the SAHPRA for its quality, safety or intended use.

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