Strain-specific and outcome-specific efficacy of probiotics for the treatment of irritable bowel syndrome: A systematic review and meta-analysis.

Lynne V Mcfarland,Ali Karatas,Tarkan Karakan

doi:10.1016/j.eclinm.2021.101154

Lynne V Mcfarland, Ali Karatas + Show 1 more

Open Access

https://doi.org/10.1016/j.eclinm.2021.101154

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Journal: eClinicalMedicine	Publication Date: Oct 18, 2021
Citations: 35	License type: cc-by

Affiliation: University of Washington, Gazi University

Abstract

BackgroundConsistent guidance for choosing an appropriate probiotic for the treatment of irritable bowel syndrome is lacking.MethodsLiterature databases searched included: PubMed, Google Scholar and NIH registry of clinical trials from inception to June 2021. Inclusion criteria: randomized controlled trials (RCTs) enrolling adult or pediatric IBS patients comparing probiotics against controls and ≥ 2 RCTs with common IBS outcome measures within each type of probiotic. Five common measures of IBS symptoms (changes in global Irritable Bowel Syndrome Severity Scoring System or IBS-SSS scores, frequency of global responders, changes in bloating or abdominal pain scores and frequency of abdominal pain relief) were used. This study was registered at Prospero (#CRD42018109169).FindingsWe screened 521 studies and included 42 randomized controlled trials (45 treatment arms, N = 3856). Four probiotics demonstrated significant reduction in abdominal pain relief: B. coagulans MTCC5260 (RR= 4.9, 95% C.I. 3.3, 7.3), L. plantarum 299v (RR= 4.6, 95% CI 1.9, 11.0), S. boulardii CNCM I-745 (RR= 1.5, 95% C.I. 1.1, 2.1) and S. cerevisiae CNCM I-3856 (RR= 1.3, 95% C.I. 1.04, 1.6). Mild-moderate adverse events were reported in 51% of the trials, none were more associated with the probiotic compared to controls.InterpretationAlthough the analysis of probiotic efficacy was limited by the diversity of IBS outcomes used in trials and lack of confirmatory trials for some strains, six single-strain probiotics and three different types of probiotic mixtures showed significant efficacy for at least one IBS outcome measure. These results might be relevant to clinical practice and policy.

Highlights

Irritable bowel syndrome (IBS) is included in the spectrum of disorders of gut-brain interactions and is characterized by recurrent abdominal pain, bloating and changes in bowel habits, which may include diarrhea or constipation
To the best of our knowledge, this is the first meta-analysis that accounted for probiotic strain-specificity when assessing efficacy for the treatment of IBS
This study showed six single-strain probiotics (Bac. coagulans MTCC5260, Bif. infantis 35624, L. plantarum 299v, L. rhamnosus GG, S. boulardii CNCM I-745 and S. cerevisiae CNCM I-3856) and three mixtures (a 4-strain mixture, a 7-strain mixture and an 8-strain mixture) showed significant improvement in at least one IBS outcome measure

Summary

Introduction

Irritable bowel syndrome (IBS) is included in the spectrum of disorders of gut-brain interactions and is characterized by recurrent abdominal pain, bloating and changes in bowel habits, which may include diarrhea or constipation. To assess the efficacy and safety of probiotics for the treatment of irritable bowel syndrome (IBS) within specific strain sub-groups, inclusion criteria required 2 trials with common IBS outcome measures within each type of probiotic. Interpretation: the analysis of probiotic efficacy was limited by the diversity of IBS outcomes used in trials and lack of confirmatory trials for some strains, six single-strain probiotics and three different types of probiotic mixtures showed significant efficacy for at least one IBS outcome measure. These results might be relevant to clinical practice and policy

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