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Comparative efficacy of probiotic, prebiotic, and synbiotic interventions in children with functional abdominal pain
Yongrui Yang1, Yunsong Li1, Xiyu Yan2
1The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China.
Insights
Probiotics significantly improve symptoms in children with functional abdominal pain disorders (FAPDs). Specific strains like L. reuteri DSM 17938 and L. rhamnosus GG show the most consistent efficacy for pediatric FAPD.
Area of Science:
- Pediatric Gastroenterology
- Gut-Brain Interaction Disorders
- Microbiome Research
Background:
- Functional abdominal pain disorders (FAPDs) are common in children, significantly impacting their quality of life.
- Current treatments for pediatric FAPDs lack consistent efficacy.
- Probiotics are explored as a potential therapy due to biological plausibility, but evidence is inconsistent.
Purpose of the Study:
- To evaluate the efficacy of probiotic interventions for functional abdominal pain disorders (FAPDs) in children.
- To identify specific probiotic strains with the most significant therapeutic effects.
- To synthesize evidence from randomized controlled trials (RCTs) using network meta-analysis.
Main Methods:
- A comprehensive search of eight databases identified 21 RCTs (n=1,807) involving children aged 4-18 years with FAPDs.
- Frequentist random-effects network meta-analysis was employed to synthesize data on global improvement, pain resolution, severity, and frequency.
- Risk of bias and evidence certainty were assessed using Cochrane RoB 2.0 and CINeMA, respectively.
Main Results:
- Probiotics significantly improved global improvement (RR=1.33), complete pain resolution (RR=1.85), pain severity (MD=-0.72), and pain frequency (MD=-1.04) compared to placebo.
- Specific strains including L. reuteri DSM 17938, L. rhamnosus GG, Bifidobacterium mix, and B. longum DM8504 demonstrated the highest efficacy.
- Prebiotics and synbiotics did not show significant benefits, and B. clausii was consistently ineffective.
Conclusions:
- Probiotic therapy offers significant symptom improvement for children with functional abdominal pain disorders.
- A shift towards strain-specific, mechanism-based probiotic selection is recommended for pediatric FAPDs.
- L. reuteri DSM 17938, L. rhamnosus GG, Bifidobacterium mixtures, and B. longum are identified as the most effective strains.
Background:
Functional abdominal pain disorders (FAPDs) are common pediatric gut-brain interaction disorders that substantially impair quality of life and lack effective pharmacologic or behavioral treatments. Given their biological plausibility, probiotics have emerged as a promising therapy, yet evidence remains inconsistent due to strain-specific effects and heterogeneous study designs.
Methods:
Eight databases (PubMed, Embase, Web of Science, CENTRAL, CNKI, VIP, Wanfang, and CBM) were searched up to October 2025 for randomized controlled trials (RCTs) evaluating probiotic interventions in children (4-18 years) with FAPDs. Eligible comparators included placebo, no treatment, or other probiotics. Primary outcomes were global improvement, complete pain resolution, pain severity, and pain frequency. Data were synthesized using a frequentist random-effects network meta-analysis (Stata 17.0, mvmeta command), and treatment efficacy was ranked by SUCRA. Risk of bias was assessed with the Cochrane RoB 2.0 tool, and evidence certainty with CINeMA. Sensitivity and meta-regression analyses evaluated the robustness of findings and the influence of dosage, duration, strain composition, age, and country.
Results:
21 RCTs (n = 1,807; published 2003-2023) were included, involving children aged 4-18 years with FAPDs diagnosed mainly by Rome III criteria. Interventions included various probiotic strains (e.g., L. reuteri DSM 17938, L. rhamnosus GG, B. longum DM8504, Bacillus clausii), synbiotics, and prebiotics. In the primary network meta-analysis, probiotics significantly improved all major outcomes versus placebo-global improvement (RR = 1.33, 95% CI 1.03-1.73), complete pain resolution (RR = 1.85, 1.07-3.21), pain severity (MD = -0.72, -1.16 to -0.28), and pain frequency (MD = -1.04, -1.98 to -0.11)-while prebiotics and synbiotics showed no significant benefit. Strain-level analyses identified L. reuteri DSM 17938, L. rhamnosus GG, Bifidobacterium mix, and B. longum (DM8504) as the most effective, with B. clausii consistently ineffective. Sensitivity and meta-regression analyses confirmed result robustness and found no effect modification by dose, duration, strain composition, or demographic factors.
Conclusion:
This network meta-analysis shows that probiotics significantly improve symptoms in children with functional abdominal pain disorders. Specific strains-Lactobacillus reuteri DSM 17938, Lactobacillus rhamnosus GG, Bifidobacterium mixtures, and B. longum-demonstrated the most consistent efficacy, supporting a shift toward strain-specific, mechanism-based probiotic therapy in pediatric FAPD.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD420251218779, identifier CRD420251218779.
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