Abstract
Background: Probiotic and low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) diet are two commonly used management approaches for patients with irritable bowel syndrome (IBS). We aimed to evaluate the most effective combinations and components among different probiotics or low FODMAP diet through component network meta-analysis (NMA). Methods: We searched Embase, Ovid Medline, and Web of Science from inception to 21 January 2021. Randomized controlled trials (RCTs) examining the efficacy of probiotics and low FODMAP diet for IBS were included, with placebo, sham diet, or conventional treatments as controls. Binary outcomes were compared among treatments using the relative ratio (RR). A minimally contextualized framework recommended by the GRADE group was used to evaluate the certainty of evidence. The primary efficacy outcome was the relief of global IBS symptoms, and the secondary efficacy outcome was the reduction in IBS symptom scores or abdominal pain scores. Key Results: We included 76 RCTs (n = 8058) after screening 1940 articles. Eight RCTs were classified as low risk of bias. Standard network meta-analysis (NMA) showed that Lactobacillus (RR 1.74, 95% CI 1.22–2.48) and Bifidobacterium (RR 1.76, 95% CI 1.01–3.07) were the most effective for the primary efficacy outcome (high certainty evidence); component NMA showed that Bacillus (RR 5.67, 95% CI 1.88 to 17.08, p = 0.002) and Lactobacillus (RR 1.42, 95% CI 1.07 to 1.91, p = 0.017) were among the most effective components. The results of standard NMA and CNMA analysis of the improvement of overall IBS symptom scores or abdominal pain scores were consistent with this finding. Conclusion: Lactobacillus was the most effective component for the relief of IBS symptoms; Bifidobacterium and Bacillus were possibly effective and need further verification. Systematic Review Registration: website, identifier registration number.
Highlights
Irritable bowel syndrome (IBS) is a chronic, often debilitating bowel disease because of the disorder of the brain–gut axis (Drossman and Hasler, 2016; Ford et al, 2017)
We aimed to evaluate the most effective combinations and components among different probiotics or low FODMAP diet through component network meta-analysis (NMA)
The included Randomized controlled trials (RCTs) were conducted in 26 countries, with the sample sizes ranging from 19 to 443 participants (33–123 participants in the RCTs of low FODMAP diet group and 19 to 443 participants in the RCTs of the probiotics group)
Summary
Irritable bowel syndrome (IBS) is a chronic, often debilitating bowel disease because of the disorder of the brain–gut axis (Drossman and Hasler, 2016; Ford et al, 2017). Management therapies with diet and probiotics were of great interest in patients with IBS since they are safe and welltolerated. The mainstream dietary management includes dietary fiber, with low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) diet, which is a gluten-free diet (Ford et al, 2020). There is little evidence supporting the use of a gluten-free diet in IBS, and it is still ambiguous whether patients should increase their dietary fiber intake to mitigate IBS symptoms (Dionne et al, 2018). In the 2020 ACG guidelines (Lacy et al, 2021), probiotics and a low FODMAP diet are recommended to alleviate IBS symptoms before escalating to medical therapies or as adjuncts to medical therapies. Probiotic and low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) diet are two commonly used management approaches for patients with irritable bowel syndrome (IBS). We aimed to evaluate the most effective combinations and components among different probiotics or low FODMAP diet through component network meta-analysis (NMA)
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