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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).

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.

Links

  • Publisher Full Text
  • 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.

    Source

    MeSH

    Adult
    Dietetics
    Dysbiosis
    Evidence-Based Medicine
    Gastrointestinal Microbiome
    Humans
    Irritable Bowel Syndrome
    Precision Medicine
    Probiotics
    Quality of Life
    Randomized Controlled Trials as Topic
    Reproducibility of Results
    Review Literature as Topic
    Societies, Scientific
    United Kingdom

    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 -