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Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis.

Abstract

OBJECTIVES

Irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC) are functional bowel disorders. Evidence suggests that disturbance in the gastrointestinal microbiota may be implicated in both conditions. We performed a systematic review and meta-analysis to examine the efficacy of prebiotics, probiotics, and synbiotics in IBS and CIC.

METHODS

MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (up to December 2013). Randomized controlled trials (RCTs) recruiting adults with IBS or CIC, which compared prebiotics, probiotics, or synbiotics with placebo or no therapy, were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI). Continuous data were pooled using a standardized or weighted mean difference with a 95% CI.

RESULTS

The search strategy identified 3,216 citations. Forty-three RCTs were eligible for inclusion. The RR of IBS symptoms persisting with probiotics vs. placebo was 0.79 (95% CI 0.70-0.89). Probiotics had beneficial effects on global IBS, abdominal pain, bloating, and flatulence scores. Data for prebiotics and synbiotics in IBS were sparse. Probiotics appeared to have beneficial effects in CIC (mean increase in number of stools per week=1.49; 95% CI=1.02-1.96), but there were only two RCTs. Synbiotics also appeared beneficial (RR of failure to respond to therapy=0.78; 95% CI 0.67-0.92). Again, trials for prebiotics were few in number, and no definite conclusions could be drawn.

CONCLUSIONS

Probiotics are effective treatments for IBS, although which individual species and strains are the most beneficial remains unclear. Further evidence is required before the role of prebiotics or synbiotics in IBS is known. The efficacy of all three therapies in CIC is also uncertain.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    1] Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK [2] Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.

    ,

    Division of Gastroenterology and Hepatology, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA.

    ,

    Dartmouth-Hitchcock Medical Center, Gastroenterology, One Medical Center Drive, Lebanon, New Hampshire, USA.

    ,

    The Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.

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    Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.

    ,

    Digestive Health Associates of Texas, Baylor University Medical Center, Dallas, Texas, USA.

    ,

    Division of Gastroenterology at Cedars-Sinai, University of Southern California, Los Angeles, California, USA.

    ,

    Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.

    Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, Ontario, Canada.

    Source

    The American journal of gastroenterology 109:10 2014 Oct pg 1547-61; quiz 1546, 1562

    MeSH

    Abdominal Pain
    Adult
    Constipation
    Dietary Supplements
    Humans
    Irritable Bowel Syndrome
    Prebiotics
    Probiotics
    Synbiotics
    Treatment Outcome

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    25070051

    Citation

    Ford, Alexander C., et al. "Efficacy of Prebiotics, Probiotics, and Synbiotics in Irritable Bowel Syndrome and Chronic Idiopathic Constipation: Systematic Review and Meta-analysis." The American Journal of Gastroenterology, vol. 109, no. 10, 2014, pp. 1547-61; quiz 1546, 1562.
    Ford AC, Quigley EM, Lacy BE, et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol. 2014;109(10):1547-61; quiz 1546, 1562.
    Ford, A. C., Quigley, E. M., Lacy, B. E., Lembo, A. J., Saito, Y. A., Schiller, L. R., ... Moayyedi, P. (2014). Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. The American Journal of Gastroenterology, 109(10), pp. 1547-61; quiz 1546, 1562. doi:10.1038/ajg.2014.202.
    Ford AC, et al. Efficacy of Prebiotics, Probiotics, and Synbiotics in Irritable Bowel Syndrome and Chronic Idiopathic Constipation: Systematic Review and Meta-analysis. Am J Gastroenterol. 2014;109(10):1547-61; quiz 1546, 1562. PubMed PMID: 25070051.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. AU - Ford,Alexander C, AU - Quigley,Eamonn M M, AU - Lacy,Brian E, AU - Lembo,Anthony J, AU - Saito,Yuri A, AU - Schiller,Lawrence R, AU - Soffer,Edy E, AU - Spiegel,Brennan M R, AU - Moayyedi,Paul, Y1 - 2014/07/29/ PY - 2014/02/25/received PY - 2014/04/30/accepted PY - 2014/7/30/entrez PY - 2014/7/30/pubmed PY - 2015/2/24/medline SP - 1547-61; quiz 1546, 1562 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 109 IS - 10 N2 - OBJECTIVES: Irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC) are functional bowel disorders. Evidence suggests that disturbance in the gastrointestinal microbiota may be implicated in both conditions. We performed a systematic review and meta-analysis to examine the efficacy of prebiotics, probiotics, and synbiotics in IBS and CIC. METHODS: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (up to December 2013). Randomized controlled trials (RCTs) recruiting adults with IBS or CIC, which compared prebiotics, probiotics, or synbiotics with placebo or no therapy, were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI). Continuous data were pooled using a standardized or weighted mean difference with a 95% CI. RESULTS: The search strategy identified 3,216 citations. Forty-three RCTs were eligible for inclusion. The RR of IBS symptoms persisting with probiotics vs. placebo was 0.79 (95% CI 0.70-0.89). Probiotics had beneficial effects on global IBS, abdominal pain, bloating, and flatulence scores. Data for prebiotics and synbiotics in IBS were sparse. Probiotics appeared to have beneficial effects in CIC (mean increase in number of stools per week=1.49; 95% CI=1.02-1.96), but there were only two RCTs. Synbiotics also appeared beneficial (RR of failure to respond to therapy=0.78; 95% CI 0.67-0.92). Again, trials for prebiotics were few in number, and no definite conclusions could be drawn. CONCLUSIONS: Probiotics are effective treatments for IBS, although which individual species and strains are the most beneficial remains unclear. Further evidence is required before the role of prebiotics or synbiotics in IBS is known. The efficacy of all three therapies in CIC is also uncertain. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/25070051/Efficacy_of_prebiotics_probiotics_and_synbiotics_in_irritable_bowel_syndrome_and_chronic_idiopathic_constipation:_systematic_review_and_meta_analysis_ L2 - http://Insights.ovid.com/pubmed?pmid=25070051 DB - PRIME DP - Unbound Medicine ER -