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Effectiveness of probiotics in irritable bowel syndrome: Updated systematic review with meta-analysis.

Abstract

AIM

To investigate the efficacy of probiotics in irritable bowel syndrome (IBS) patients.

METHODS

PubMed, Cochrane library, Scopus, Google Scholar, and Clinicaltrial.gov databases were searched for literature published between September 2007 and December 2013. The applied Mesh terms were "probiotics," "irritable bowel syndrome," and "irritable bowel syndrome treatment." The collected data contained24 clinical trials, of which 15 were eligible for meta-analysis and nine were reviewed systematically. All studies were randomized placebo-controlled trials in patients with IBS that investigated the efficacy of probiotics in IBS improvement. The Jadad score was used to assess the methodological quality of trials. The quality scale ranges from 0 to 5 points, with a score ≤ 2 indicating a low quality report, and a score of ≥ 3 indicating a high quality report. Relative risk (RR), standardized effect size, and 95%CI were calculated using the DerSimonian-Laird method. The Cochran Q test was used to test heterogeneity with P < 0.05. Funnel plots were constructed and Egger's and Begg-Mazumdar tests were performed to assess publication bias.

RESULTS

A total of 1793 patients were included in the meta-analysis. The RR of responders to therapies based on abdominal pain score in IBS patients for two included trials comparing probiotics to placebo was 1.96 (95%CI: 1.14-3.36; P = 0.01). RR of responders to therapies based on a global symptom score in IBS patients for two included trials comparing probiotics with placebo was 2.43 (95%CI: 1.13-5.21; P = 0.02). For adequate improvement of general symptoms in IBS patients, the RR of seven included trials (six studies) comparing probiotics with placebo was 2.14 (95%CI: 1.08-4.26; P = 0.03). Distension, bloating, and flatulence were evaluated using an IBS severity scoring system in three trials (two studies) to compare the effect of probiotic therapy in IBS patients with placebo, the standardized effect size of mean differences for probiotics therapy was -2.57 (95%CI: -13.05--7.92).

CONCLUSION

Probiotics reduce pain and symptom severity scores. The results demonstrate the beneficial effects of probiotics in IBS patients in comparison with placebo.

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  • Authors+Show Affiliations

    ,

    Tina Didari, Shilan Mozaffari, Mohammad Abdollahi, Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran 1417614411, Iran.

    ,

    Tina Didari, Shilan Mozaffari, Mohammad Abdollahi, Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran 1417614411, Iran.

    ,

    Tina Didari, Shilan Mozaffari, Mohammad Abdollahi, Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran 1417614411, Iran.

    Tina Didari, Shilan Mozaffari, Mohammad Abdollahi, Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran 1417614411, Iran.

    Source

    World journal of gastroenterology 21:10 2015 Mar 14 pg 3072-84

    MeSH

    Abdominal Pain
    Flatulence
    Humans
    Intestines
    Irritable Bowel Syndrome
    Odds Ratio
    Pain Measurement
    Probiotics
    Quality of Life
    Recovery of Function
    Severity of Illness Index
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    25780308

    Citation

    Didari, Tina, et al. "Effectiveness of Probiotics in Irritable Bowel Syndrome: Updated Systematic Review With Meta-analysis." World Journal of Gastroenterology, vol. 21, no. 10, 2015, pp. 3072-84.
    Didari T, Mozaffari S, Nikfar S, et al. Effectiveness of probiotics in irritable bowel syndrome: Updated systematic review with meta-analysis. World J Gastroenterol. 2015;21(10):3072-84.
    Didari, T., Mozaffari, S., Nikfar, S., & Abdollahi, M. (2015). Effectiveness of probiotics in irritable bowel syndrome: Updated systematic review with meta-analysis. World Journal of Gastroenterology, 21(10), pp. 3072-84. doi:10.3748/wjg.v21.i10.3072.
    Didari T, et al. Effectiveness of Probiotics in Irritable Bowel Syndrome: Updated Systematic Review With Meta-analysis. World J Gastroenterol. 2015 Mar 14;21(10):3072-84. PubMed PMID: 25780308.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Effectiveness of probiotics in irritable bowel syndrome: Updated systematic review with meta-analysis. AU - Didari,Tina, AU - Mozaffari,Shilan, AU - Nikfar,Shekoufeh, AU - Abdollahi,Mohammad, PY - 2014/06/03/received PY - 2014/07/24/revised PY - 2014/09/29/accepted PY - 2015/3/18/entrez PY - 2015/3/18/pubmed PY - 2015/10/16/medline KW - Clinical trial KW - Evidence-based medicine KW - Irritable bowel syndrome KW - Meta-analysis KW - Probiotics KW - Systematic review SP - 3072 EP - 84 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 21 IS - 10 N2 - AIM: To investigate the efficacy of probiotics in irritable bowel syndrome (IBS) patients. METHODS: PubMed, Cochrane library, Scopus, Google Scholar, and Clinicaltrial.gov databases were searched for literature published between September 2007 and December 2013. The applied Mesh terms were "probiotics," "irritable bowel syndrome," and "irritable bowel syndrome treatment." The collected data contained24 clinical trials, of which 15 were eligible for meta-analysis and nine were reviewed systematically. All studies were randomized placebo-controlled trials in patients with IBS that investigated the efficacy of probiotics in IBS improvement. The Jadad score was used to assess the methodological quality of trials. The quality scale ranges from 0 to 5 points, with a score ≤ 2 indicating a low quality report, and a score of ≥ 3 indicating a high quality report. Relative risk (RR), standardized effect size, and 95%CI were calculated using the DerSimonian-Laird method. The Cochran Q test was used to test heterogeneity with P < 0.05. Funnel plots were constructed and Egger's and Begg-Mazumdar tests were performed to assess publication bias. RESULTS: A total of 1793 patients were included in the meta-analysis. The RR of responders to therapies based on abdominal pain score in IBS patients for two included trials comparing probiotics to placebo was 1.96 (95%CI: 1.14-3.36; P = 0.01). RR of responders to therapies based on a global symptom score in IBS patients for two included trials comparing probiotics with placebo was 2.43 (95%CI: 1.13-5.21; P = 0.02). For adequate improvement of general symptoms in IBS patients, the RR of seven included trials (six studies) comparing probiotics with placebo was 2.14 (95%CI: 1.08-4.26; P = 0.03). Distension, bloating, and flatulence were evaluated using an IBS severity scoring system in three trials (two studies) to compare the effect of probiotic therapy in IBS patients with placebo, the standardized effect size of mean differences for probiotics therapy was -2.57 (95%CI: -13.05--7.92). CONCLUSION: Probiotics reduce pain and symptom severity scores. The results demonstrate the beneficial effects of probiotics in IBS patients in comparison with placebo. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/25780308/Effectiveness_of_probiotics_in_irritable_bowel_syndrome:_Updated_systematic_review_with_meta_analysis_ L2 - http://www.wjgnet.com/1007-9327/full/v21/i10/3072.htm DB - PRIME DP - Unbound Medicine ER -