Probiotics for Irritable Bowel Syndrome: An Updated Systematic Review and Meta-Analysis With Trial Sequential...

Area of Science:

• Gastroenterology
• Microbiology
• Clinical Trials

Background:

• Growing interest in probiotics for Irritable Bowel Syndrome (IBS) treatment.
• Traditional meta-analysis faces limitations due to the multiplicity problem.
• Need for robust evaluation of probiotic efficacy in IBS.

Purpose of the Study:

• To evaluate probiotic efficacy in alleviating IBS symptoms.
• To assess the impact of probiotics on IBS Quality of Life (IBS-QOL).
• To utilize Trial Sequential Analysis (TSA) for robust evidence assessment.

Main Methods:

• Screened Medline, Embase, Web of Science, and Cochrane for RCTs.
• Compared probiotics versus placebo in adult IBS patients.
• Employed pairwise meta-analysis, followed by TSA, ROB-2, and GRADE evaluations.

Main Results:

• Probiotics significantly improved IBS Symptom Severity Score (IBS-SSS).
• No significant improvements were observed in IBS-QOL.
• TSA indicated insufficient evidence size for IBS-SSS; no futility or benefit confirmed.
• Low certainty of evidence due to inconsistency, despite low risk of bias in most studies.

Conclusions:

• Further high-powered trials are recommended based on TSA findings.
• Standardization and identification of heterogeneity sources are crucial for future IBS probiotic research.
• Current evidence suggests potential symptom benefit but lacks conclusive quality of life improvement.