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Systematic review with meta-analysis: Saccharomyces boulardii for treating acute gastroenteritis in children-a 2020
Hania Szajewska1, Maciej Kołodziej1, Bartłomiej M Zalewski1
1Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland.
Insights
Saccharomyces boulardii (S. boulardii) may help reduce diarrhea duration in children with acute gastroenteritis. Evidence quality is low to very low, but it shows potential benefits for diarrheal outcomes.
Area of Science:
- Gastroenterology
- Microbiology
- Pediatrics
Background:
- Efficacy of probiotics for acute gastroenteritis remains debated.
- Saccharomyces boulardii (S. boulardii) is a probiotic yeast used for gastrointestinal issues.
Purpose of the Study:
- To update evidence on the efficacy of S. boulardii for treating acute gastroenteritis in children.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing S. boulardii with placebo or no treatment.
- Searched Cochrane Library, MEDLINE, EMBASE, and grey literature up to December 2019.
- Contacted authors and manufacturers for additional data.
Main Results:
- Included 29 RCTs (20 newly identified); many trials had limitations in randomization, allocation concealment, and blinding.
- S. boulardii significantly reduced diarrhea duration (mean difference -1.06 days) with high heterogeneity (very low quality evidence).
- Associated with reduced hospitalization duration (mean difference -0.85 days) and decreased risk of diarrhea on days 2-7 (low quality evidence).
Conclusions:
- Low- to very low-quality evidence suggests S. boulardii provides benefits for several diarrheal outcomes in children with acute gastroenteritis.
- Further high-quality trials are needed to confirm these findings.
- S. boulardii may be a beneficial adjunct therapy for pediatric acute gastroenteritis.
Background:
There is still controversy with regard to the efficacy of individual probiotic strains for the management of acute gastroenteritis.
Aim:
To update evidence on use of Saccharomyces boulardii for treating acute gastroenteritis in children.
Methods:
The Cochrane Library, MEDLINE and EMBASE databases were searched from inception to December 2019 for randomised controlled trials (RCTs) that compared use of S boulardii with no S boulardii (defined as placebo or no treatment). The grey literature was searched through Google search. Authors of the original papers and S boulardii manufacturers were contacted for additional data.
Results:
Twenty-nine RCTs (among them, 20 newly identified trials) were included. Only 38% of trials adequately generated their randomisation sequence, only 17% adequately concealed allocation and only one trial adequately blinded participants, study personnel and outcome assessors. However, 83% provided complete outcome data. None of the trials evaluated the effect of S boulardii on stool volume. Compared with placebo or no treatment, S boulardii use reduced the duration of diarrhoea (23 RCTs, n = 3450, mean difference -1.06 day, 95% CI -1.32 to -0.79; high heterogeneity [I2 = 90%]) (very low quality of evidence). S boulardii use was also associated with a reduced duration of hospitalisation (8 RCTs, n = 999, mean difference -0.85 day, 95% CI -1.35 to -0.34; I2 = 91%) (very low quality of evidence). S boulardii reduced the risk of diarrhoea on day 2 to day 7 (low quality of evidence).
Conclusions:
In children with acute gastroenteritis, low- to very low-quality evidence suggests that S boulardii confers a benefit for several diarrhoeal outcomes.
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