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The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review.

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 (chi(2)=28.3, p=0.001, I(2)=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 (chi(2)=67.04, p<0.001, I(2)=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.

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  • Authors+Show Affiliations

    ,

    Department of Medicine, Division of Gastroenterology, McMaster University Medical Centre, 1200 Main Street West, HSC 4W8E, Hamilton, ON L8N 3Z5, Canada. moayyep@mcmaster.ca

    , , , , ,

    Source

    Gut 59:3 2010 Mar pg 325-32

    MeSH

    Evidence-Based Medicine
    Humans
    Irritable Bowel Syndrome
    Probiotics
    Randomized Controlled Trials as Topic
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    19091823

    Citation

    Moayyedi, P, et al. "The Efficacy of Probiotics in the Treatment of Irritable Bowel Syndrome: a Systematic Review." Gut, vol. 59, no. 3, 2010, pp. 325-32.
    Moayyedi P, Ford AC, Talley NJ, et al. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut. 2010;59(3):325-32.
    Moayyedi, P., Ford, A. C., Talley, N. J., Cremonini, F., Foxx-Orenstein, A. E., Brandt, L. J., & Quigley, E. M. (2010). The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut, 59(3), pp. 325-32. doi:10.1136/gut.2008.167270.
    Moayyedi P, et al. The Efficacy of Probiotics in the Treatment of Irritable Bowel Syndrome: a Systematic Review. Gut. 2010;59(3):325-32. PubMed PMID: 19091823.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. AU - Moayyedi,P, AU - Ford,A C, AU - Talley,N J, AU - Cremonini,F, AU - Foxx-Orenstein,A E, AU - Brandt,L J, AU - Quigley,E M M, Y1 - 2008/12/17/ PY - 2008/12/19/entrez PY - 2008/12/19/pubmed PY - 2010/5/21/medline SP - 325 EP - 32 JF - Gut JO - Gut VL - 59 IS - 3 N2 - 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 (chi(2)=28.3, p=0.001, I(2)=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 (chi(2)=67.04, p<0.001, I(2)=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. SN - 1468-3288 UR - https://www.unboundmedicine.com/medline/citation/19091823/The_efficacy_of_probiotics_in_the_treatment_of_irritable_bowel_syndrome:_a_systematic_review_ L2 - http://gut.bmj.com/cgi/pmidlookup?view=long&amp;pmid=19091823 DB - PRIME DP - Unbound Medicine ER -