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Published on: July 27, 2022
Efficacy of Probiotics in Irritable Bowel Syndrome: Systematic Review and Meta-analysis
Vivek C Goodoory1, Mais Khasawneh1, Christopher J Black1
1Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom.
Background & Aims:
Some probiotics may be beneficial in irritable bowel syndrome (IBS), but differences in species and strains used, as well as endpoints reported, have hampered attempts to make specific recommendations as to which should be preferred. We updated our previous meta-analysis examining this issue.
Methods:
MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (up to March 2023). Randomized controlled trials (RCTs) recruiting adults with IBS, comparing probiotics with placebo were eligible. Dichotomous symptom data were pooled to obtain a relative risk of global symptoms, abdominal pain, or abdominal bloating or distension persisting after therapy, with a 95% confidence interval (CI). Continuous data were pooled using a standardized mean difference with a 95% CI. Adverse events data were also pooled.
Results:
We identified 82 eligible trials, containing 10,332 patients. Only 24 RCTs were at low risk of bias across all domains. For global symptoms, there was moderate certainty in the evidence for a benefit of Escherichia strains, low certainty for Lactobacillus strains and Lactobacillus plantarum 299V, and very low certainty for combination probiotics, LacClean Gold S, Duolac 7s, and Bacillus strains. For abdominal pain, there was low certainty in the evidence for a benefit of Saccharomyces cerevisae I-3856 and Bifidobacterium strains, and very low certainty for combination probiotics, Lactobacillus, Saccharomyces, and Bacillus strains. For abdominal bloating or distension there was very low certainty in the evidence for a benefit of combination probiotics and Bacillus strains. The relative risk of experiencing any adverse event, in 55 trials, including more than 7000 patients, was not significantly higher with probiotics.
Conclusions:
Some combinations of probiotics or strains may be beneficial in IBS. However, certainty in the evidence for efficacy by GRADE criteria was low to very low across almost all of our analyses.
Insights
Probiotics may offer some benefits for irritable bowel syndrome (IBS) symptoms, but evidence certainty is low. Researchers found limited support for specific strains or combinations, with no increased risk of adverse events.
Area of Science:
- Gastroenterology
- Microbiology
- Clinical Trials
Background:
- Irritable bowel syndrome (IBS) management remains challenging, with probiotics showing potential benefits.
- Specific probiotic strains and species vary in efficacy, hindering clear recommendations for IBS treatment.
- This meta-analysis updates previous findings on probiotic efficacy in IBS.
Approach:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) up to March 2023.
- Inclusion of 82 RCTs with 10,332 adult IBS patients comparing probiotics to placebo.
- Pooled dichotomous and continuous symptom data, alongside adverse event reporting.
Key Points:
- Moderate evidence supports *Escherichia* strains for global IBS symptoms; low to very low certainty for other strains/combinations.
- Low certainty evidence for *Saccharomyces cerevisae* I-3856 and *Bifidobacterium* strains in reducing abdominal pain.
- Very low certainty evidence for combination probiotics and *Bacillus* strains in reducing bloating/distension.
- No significant increase in adverse events was observed with probiotic use.
Conclusions:
- Certain probiotic strains or combinations may benefit IBS symptoms.
- However, the GRADE certainty of evidence for efficacy remains low to very low across most analyses.
- Further high-quality research is needed to establish definitive probiotic recommendations for IBS.
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