Efficacy and Safety of Probiotics in Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis

IntroductionIrritable bowel syndrome (IBS) is a common chronic functional gastrointestinal disorder affecting approximately 10% to 25% of the adult population. A large number of clinical trials have been conducted to evaluate the efficacy of probiotics for IBS but the results were inconsistent. Previous meta-analyses have shown that probiotics are effective for IBS, but the comparative efficacy of individual species is unclear. In addition, evidence regarding the superiority of combination over single probiotic is still lacking. We, therefore, perform this study to evaluate the comparative efficacy and safety of various species of probiotics, and combination regimens for the treatment of IBS.Methods and analysisThis study is a systematic review with network meta-analysis. We will search PubMed, Scopus, The Cochrane Central Register of Controlled Trials and CINAHL for randomised controlled trials comparing probiotics with placebo or comparing different probiotics for IBS, with no language restrictions. The primary outcomes will be treatment response and global IBS-symptom score. We will initially combine included studies with traditional pairwise meta-analysis and then with random-effects network meta-analysis. We will quantify the effect of potential effect modifiers by meta-regression if appropriate. We will check the consistency assumption by testing the absolute difference between direct and indirect estimates for comparisons in closed loops. The quality of evidence will be evaluated according to the GRADE framework.Ethics and disseminationEthical approval is not required for literature-based studies. We will disseminate the findings through publications in peer-reviewed journals and relevant conferences.PROSPERO registration numberCRD42018102101

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Efficacy and Safety of Probiotics, Prebiotics and Synbiotics in the Treatment of Irritable Bowel Syndrome: A systematic review and meta-analysis

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.2020.20.01.003 ◽

2020 ◽

Vol 20 (1) ◽

pp. 13 ◽

Cited By ~ 3

Author(s):

Mohammad Z. Asha ◽

Sundos F. H. Khalil

Keyword(s):

Systematic Review ◽

Irritable Bowel Syndrome ◽

Adverse Events ◽

Meta Analysis ◽

Group Differences ◽

Significant Heterogeneity ◽

Efficacy And Safety ◽

Gastrointestinal Microbiome ◽

Irritable Bowel

Treatments that target alterations in gut microbiota may be beneficial for patients with irritable bowel syndrome (IBS). A systematic review and meta-analysis was conducted of randomised clinical trials (RCTs) evaluating the efficacy and safety of probiotics, prebiotics and synbiotics. Factors considered in the analysis included global IBS symptoms and/or abdominal pain, secondary symptoms and the frequency of adverse events. A total of 33 RCTs involving 4,321 patients were identified. Overall, probiotics significantly improved global IBS symptoms compared to placebos (standardised mean difference = −0.32, 95% confidence interval: −0.48 to −0.15; P <0.001), with significant heterogeneity between studies (I2 = 72%; P <0.001). This remained apparent in both single- and multi-strain probiotic interventions as well as synbiotic formulations. However, evidence regarding prebiotics was scarce. There were no significant inter-group differences in terms of the frequency of adverse events. Future RCTs should address methodological limitations, including short follow-up periods and patient adherence.Keywords: Irritable Bowel Syndrome; Gastrointestinal Microbiome; Dietary Supplements; Probiotics; Prebiotics; Synbiotics; Meta-Analysis; Systematic Review.

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