The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review
Top Cited Papers
- 17 December 2008
- Vol. 59 (3), 325-332
- https://doi.org/10.1136/gut.2008.167270
Abstract
Introduction Probiotics may benefit irritable bowel syndrome (IBS) symptoms, but randomised controlled trials (RCTs) have been conflicting; therefore a systematic review was conducted. Methods MEDLINE (1966 to May 2008), EMBASE (1988 to May 2008) and the Cochrane Controlled Trials Register (2008) electronic databases were searched, as were abstracts from DDW (Digestive Diseases Week) and UEGW (United European Gastroenterology Week), and authors were contacted for extra information. Only parallel group RCTs with at least 1 week of treatment comparing probiotics with placebo or no treatment in adults with IBS according to any acceptable definition were included. Studies had to provide improvement in abdominal pain or global IBS symptoms as an outcome. Eligibility assessment and data extraction were performed by two independent researchers. Data were synthesised using relative risk (RR) of symptoms not improving for dichotomous data and standardised mean difference (SMD) for continuous data using random effects models. Results 19 RCTs (18 papers) in 1650 patients with IBS were identified. Trial quality was generally good, with nine reporting adequate methods of randomisation and six a method of concealment of allocation. There were 10 RCTs involving 918 patients providing outcomes as a dichotomous variable. Probiotics were statistically significantly better than placebo (RR of IBS not improving=0.71; 95% CI 0.57 to 0.88) with a number needed to treat (NNT)=4 (95% CI 3 to 12.5). There was significant heterogeneity (χ2=28.3, p=0.001, I2=68%) and possible funnel plot asymmetry. Fifteen trials assessing 1351 patients reported on improvement in IBS score as a continuous outcome (SMD=−0.34; 95% CI −0.60 to −0.07). There was statistically significant heterogeneity (χ2=67.04, p2=79%), but this was explained by one outlying trial. Conclusion Probiotics appear to be efficacious in IBS, but the magnitude of benefit and the most effective species and strain are uncertain.Keywords
This publication has 23 references indexed in Scilit:
- A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndromeGastroentérologie Clinique et Biologique, 2008
- Therapeutic Effect of Lactobacillus acidophilus-SDC 2012, 2013 in Patients with Irritable Bowel SyndromeDigestive Diseases and Sciences, 2008
- Probiotics and irritable bowel syndrome: a rationale for their use and an assessment of the evidence to dateNeurogastroenterology & Motility, 2006
- Incidence and Epidemiology of Irritable Bowel Syndrome After a Large Waterborne Outbreak of Bacterial DysenteryGastroenterology, 2006
- Inhibitory effects of Lactobacillus reuteri on visceral pain induced by colorectal distension in Sprague-Dawley ratsGut, 2006
- The efficacy of Lactobacillus reuteri ATCC 55730 in the treatment of patients with irritable bowel syndrome—a double blind, placebo-controlled, randomized studyClinical Nutrition, 2005
- A probiotic mixture alleviates symptoms in irritable bowel syndrome patients: a controlled 6‐month interventionAlimentary Pharmacology & Therapeutics, 2005
- Disturbances of Motility and Visceral Hypersensitivity in Irritable Bowel Syndrome: Biological Markers or EpiphenomenonGastroenterology Clinics of North America, 2005
- A randomized controlled trial of a probiotic combination VSL# 3 and placebo in irritable bowel syndrome with bloatingNeurogastroenterology & Motility, 2005
- Measuring inconsistency in meta-analysesBMJ, 2003