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British Dietetic Association systematic review of systematic reviews and evidence-based practice guidelines for the use of probiotics in the management of irritable bowel syndrome in adults (2016 update).
J Hum Nutr Diet 2016; 29(5):576-92JH

Abstract

BACKGROUND

Probiotics are often taken by individuals with irritable bowel syndrome (IBS). Which products are effective is unclear, despite an increasing research base. This project will systematically review which strain- and dose- specific probiotics can be recommended to adults with IBS to improve symptoms and quality of life (QoL). It is part of a broader systematic review to update British Dietetic Association guidelines for the dietary management of IBS in adults.

METHODS

CINAHL, Cochrane, Embase, Medline, Scopus and Web of Science were searched for systematic reviews (SRs) of randomised controlled trial (RCT)s recruiting adults with IBS comparing probiotic intervention with placebo. AMSTAR, risk of bias and diet bias tools were used to appraise methodological quality. Symptom and QoL data were appraised to develop probiotic-specific evidence statements on clinically meaningful and marginal outcomes in various settings, graded clinical practice recommendations and practical considerations.

RESULTS

Nine systematic reviews and 35 RCTs were included (3406 participants) using 29 dose-specific probiotic formulations. None of the RCTs were at low risk of bias. Twelve out of 29 probiotics (41%) showed no symptom or QoL benefits. Evidence indicated that no strain or dose specific probiotic was consistently effective to improve any IBS symptoms or QoL. Two general clinical practice recommendations were made.

CONCLUSIONS

Symptom outcomes for dose-specific probiotics were heterogeneous. Specific probiotic recommendations for IBS management in adults were not possible at this time. More data from high-quality RCTs treating specific symptom profiles are needed to support probiotic therapy in the management of IBS.

Authors+Show Affiliations

Nuffield Health, The Manor Hospital, Oxford, UK. yvonne@digestiblenutrition.co.uk.Calm Gut Clinic, Todmorden, Lancashire, UK.Dr Ashok Ayurveda Clinic, Birmingham, UK.Diabetes and Nutritional Sciences Division, King's College London, London, UK. Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, UK.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Practice Guideline
Review
Systematic Review

Language

eng

PubMed ID

27265510

Citation

McKenzie, Y A., et al. "British Dietetic Association Systematic Review of Systematic Reviews and Evidence-based Practice Guidelines for the Use of Probiotics in the Management of Irritable Bowel Syndrome in Adults (2016 Update)." Journal of Human Nutrition and Dietetics : the Official Journal of the British Dietetic Association, vol. 29, no. 5, 2016, pp. 576-92.
McKenzie YA, Thompson J, Gulia P, et al. British Dietetic Association systematic review of systematic reviews and evidence-based practice guidelines for the use of probiotics in the management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet. 2016;29(5):576-92.
McKenzie, Y. A., Thompson, J., Gulia, P., & Lomer, M. C. (2016). British Dietetic Association systematic review of systematic reviews and evidence-based practice guidelines for the use of probiotics in the management of irritable bowel syndrome in adults (2016 update). Journal of Human Nutrition and Dietetics : the Official Journal of the British Dietetic Association, 29(5), pp. 576-92. doi:10.1111/jhn.12386.
McKenzie YA, et al. British Dietetic Association Systematic Review of Systematic Reviews and Evidence-based Practice Guidelines for the Use of Probiotics in the Management of Irritable Bowel Syndrome in Adults (2016 Update). J Hum Nutr Diet. 2016;29(5):576-92. PubMed PMID: 27265510.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - British Dietetic Association systematic review of systematic reviews and evidence-based practice guidelines for the use of probiotics in the management of irritable bowel syndrome in adults (2016 update). AU - McKenzie,Y A, AU - Thompson,J, AU - Gulia,P, AU - Lomer,M C E, AU - ,, Y1 - 2016/06/06/ PY - 2016/6/7/entrez PY - 2016/6/7/pubmed PY - 2018/1/25/medline KW - diet KW - guidelines KW - irritable bowel syndrome KW - probiotics KW - systematic review of systematic reviews SP - 576 EP - 92 JF - Journal of human nutrition and dietetics : the official journal of the British Dietetic Association JO - J Hum Nutr Diet VL - 29 IS - 5 N2 - BACKGROUND: Probiotics are often taken by individuals with irritable bowel syndrome (IBS). Which products are effective is unclear, despite an increasing research base. This project will systematically review which strain- and dose- specific probiotics can be recommended to adults with IBS to improve symptoms and quality of life (QoL). It is part of a broader systematic review to update British Dietetic Association guidelines for the dietary management of IBS in adults. METHODS: CINAHL, Cochrane, Embase, Medline, Scopus and Web of Science were searched for systematic reviews (SRs) of randomised controlled trial (RCT)s recruiting adults with IBS comparing probiotic intervention with placebo. AMSTAR, risk of bias and diet bias tools were used to appraise methodological quality. Symptom and QoL data were appraised to develop probiotic-specific evidence statements on clinically meaningful and marginal outcomes in various settings, graded clinical practice recommendations and practical considerations. RESULTS: Nine systematic reviews and 35 RCTs were included (3406 participants) using 29 dose-specific probiotic formulations. None of the RCTs were at low risk of bias. Twelve out of 29 probiotics (41%) showed no symptom or QoL benefits. Evidence indicated that no strain or dose specific probiotic was consistently effective to improve any IBS symptoms or QoL. Two general clinical practice recommendations were made. CONCLUSIONS: Symptom outcomes for dose-specific probiotics were heterogeneous. Specific probiotic recommendations for IBS management in adults were not possible at this time. More data from high-quality RCTs treating specific symptom profiles are needed to support probiotic therapy in the management of IBS. SN - 1365-277X UR - https://www.unboundmedicine.com/medline/citation/27265510/British_Dietetic_Association_systematic_review_of_systematic_reviews_and_evidence_based_practice_guidelines_for_the_use_of_probiotics_in_the_management_of_irritable_bowel_syndrome_in_adults__2016_update__ L2 - https://doi.org/10.1111/jhn.12386 DB - PRIME DP - Unbound Medicine ER -