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Efficacy of Probiotics Compared With Pharmacological Treatments for Maintenance Therapy for Functional Constipation

Rebecca G Harris1,2, Elizabeth P Neale1,2, Marijka Batterham2,3

  • 1School of Medical Indigenous and Health Science, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong, New South Wales 2522, Australia.

Nutrition Reviews
|September 30, 2024
PubMed

Insights

Probiotics do not effectively treat functional constipation in children as a standalone therapy. Mineral oil and polyethylene glycol are more effective for improving bowel movements and treatment success.

Area of Science:

  • Pediatric Gastroenterology
  • Evidence-Based Medicine
  • Pharmacological Interventions

Background:

  • Increasing randomized controlled trials (RCTs) compare probiotics with conventional therapies for pediatric functional constipation.
  • Existing research lacks a comprehensive comparison and ranking of these treatments.

Purpose of the Study:

  • To conduct a network meta-analysis comparing probiotics against other oral maintenance therapies for functional constipation in children.
  • To rank all treatments based on their effectiveness.

Main Methods:

  • Systematic literature search across major databases (MEDLINE, Scopus, EMBASE, Cochrane Library) and trial registries.
  • Risk of bias assessed using Cochrane Risk of Bias 2 tool; confidence in estimates evaluated with the CINeMA framework.
  • Random-effects network meta-analyses performed for defecation frequency and treatment success.

Main Results:

  • Probiotics showed no significant increase in bowel movements compared to conventional treatments or placebo.
  • Mineral oil and a polyethylene glycol-lactulose combination were most effective for treatment success.
  • Mineral oil combined with probiotics was most effective for increasing defecation frequency.

Conclusions:

  • Current evidence does not support probiotics as a standalone treatment for pediatric functional constipation.
  • Mineral oil and polyethylene glycol are recommended as first-line treatments.
  • Further high-quality studies are needed to explore probiotics as adjunctive therapy.

Keywords:
childrenfunctional constipationlaxativesmaintenance therapynetwork meta-analysisprobioticsrandomized controlled trialssystematic review

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