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Prebiotics in irritable bowel syndrome and other functional bowel disorders in adults: a systematic review and meta-analysis of randomized controlled trials.
Am J Clin Nutr. 2019 04 01; 109(4):1098-1111.AJ

Abstract

BACKGROUND

Irritable bowel syndrome (IBS) and other functional bowel disorders (FBDs) are prevalent disorders with altered microbiota. Prebiotics positively augment gut microbiota and may offer therapeutic potential.

OBJECTIVES

The aim of this study was to investigate the effect of prebiotics compared with placebo on global response, gastrointestinal symptoms, quality of life (QoL), and gut microbiota, via systematic review and meta-analysis of randomized controlled trials (RCTs) in adults with IBS and other FBDs.

METHODS

Studies were identified using electronic databases, back-searching reference lists, and hand-searching abstracts. RCTs that compared prebiotics to placebo in adults with IBS or other FBDs were included. Two reviewers independently performed screening, data extraction, and bias assessment. Outcome data were synthesized as ORs, weighted mean differences (WMDs) or standardized mean differences (SMDs) with the use of a random-effects model. Subanalyses were performed for type of FBD and dose, type, and duration of prebiotic.

RESULTS

Searches identified 2332 records, and 11 RCTs were eligible (729 patients). The numbers responding were 52/97 (54%) for prebiotic and 59/94 (63%) for placebo, with no difference between groups (OR: 0.62; 95% CI: 0.07, 5.69; P = 0.67). Similarly, no differences were found for severity of abdominal pain, bloating and flatulence, and QoL score between prebiotics and placebo. However, flatulence severity was improved by prebiotics at doses ≤6 g/d (SMD: -0.35; 95% CI: -0.71, 0.00; P = 0.05) and by non-inulin-type fructan prebiotics (SMD: -0.34; 95% CI: -0.66, -0.01; P = 0.04), while inulin-type fructans worsened flatulence (SMD: 0.85; 95% CI: 0.23, 1.47; P = 0.007). Prebiotics increased absolute abundance of bifidobacteria (WMD: 1.16 log10 copies of the 16S ribosomal RNA gene; 95% CI: 0.06, 2.26; P = 0.04). No studies were at low risk of bias across all bias categories.

CONCLUSIONS

Prebiotics do not improve gastrointestinal symptoms or QoL in patients with IBS or other FBDs, but they do increase bifidobacteria. Variations in prebiotic type and dose impacted symptom improvement or exacerbation. This review was registered at PROSPERO as CRD42017074072.

Authors+Show Affiliations

Department of Nutritional Sciences, King's College London, London, United Kingdom.Department of Nutritional Sciences, King's College London, London, United Kingdom.Department of Nutritional Sciences, King's College London, London, United Kingdom.Department of Nutritional Sciences, King's College London, London, United Kingdom.

Pub Type(s)

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

Language

eng

PubMed ID

30949662

Citation

Wilson, Bridgette, et al. "Prebiotics in Irritable Bowel Syndrome and Other Functional Bowel Disorders in Adults: a Systematic Review and Meta-analysis of Randomized Controlled Trials." The American Journal of Clinical Nutrition, vol. 109, no. 4, 2019, pp. 1098-1111.
Wilson B, Rossi M, Dimidi E, et al. Prebiotics in irritable bowel syndrome and other functional bowel disorders in adults: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2019;109(4):1098-1111.
Wilson, B., Rossi, M., Dimidi, E., & Whelan, K. (2019). Prebiotics in irritable bowel syndrome and other functional bowel disorders in adults: a systematic review and meta-analysis of randomized controlled trials. The American Journal of Clinical Nutrition, 109(4), 1098-1111. https://doi.org/10.1093/ajcn/nqy376
Wilson B, et al. Prebiotics in Irritable Bowel Syndrome and Other Functional Bowel Disorders in Adults: a Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Clin Nutr. 2019 04 1;109(4):1098-1111. PubMed PMID: 30949662.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prebiotics in irritable bowel syndrome and other functional bowel disorders in adults: a systematic review and meta-analysis of randomized controlled trials. AU - Wilson,Bridgette, AU - Rossi,Megan, AU - Dimidi,Eirini, AU - Whelan,Kevin, PY - 2018/06/22/received PY - 2018/12/10/accepted PY - 2019/4/6/pubmed PY - 2020/1/31/medline PY - 2019/4/6/entrez KW - FBD KW - IBS KW - Prebiotics KW - galactooligosaccharides KW - inulin-type fructans SP - 1098 EP - 1111 JF - The American journal of clinical nutrition JO - Am. J. Clin. Nutr. VL - 109 IS - 4 N2 - BACKGROUND: Irritable bowel syndrome (IBS) and other functional bowel disorders (FBDs) are prevalent disorders with altered microbiota. Prebiotics positively augment gut microbiota and may offer therapeutic potential. OBJECTIVES: The aim of this study was to investigate the effect of prebiotics compared with placebo on global response, gastrointestinal symptoms, quality of life (QoL), and gut microbiota, via systematic review and meta-analysis of randomized controlled trials (RCTs) in adults with IBS and other FBDs. METHODS: Studies were identified using electronic databases, back-searching reference lists, and hand-searching abstracts. RCTs that compared prebiotics to placebo in adults with IBS or other FBDs were included. Two reviewers independently performed screening, data extraction, and bias assessment. Outcome data were synthesized as ORs, weighted mean differences (WMDs) or standardized mean differences (SMDs) with the use of a random-effects model. Subanalyses were performed for type of FBD and dose, type, and duration of prebiotic. RESULTS: Searches identified 2332 records, and 11 RCTs were eligible (729 patients). The numbers responding were 52/97 (54%) for prebiotic and 59/94 (63%) for placebo, with no difference between groups (OR: 0.62; 95% CI: 0.07, 5.69; P = 0.67). Similarly, no differences were found for severity of abdominal pain, bloating and flatulence, and QoL score between prebiotics and placebo. However, flatulence severity was improved by prebiotics at doses ≤6 g/d (SMD: -0.35; 95% CI: -0.71, 0.00; P = 0.05) and by non-inulin-type fructan prebiotics (SMD: -0.34; 95% CI: -0.66, -0.01; P = 0.04), while inulin-type fructans worsened flatulence (SMD: 0.85; 95% CI: 0.23, 1.47; P = 0.007). Prebiotics increased absolute abundance of bifidobacteria (WMD: 1.16 log10 copies of the 16S ribosomal RNA gene; 95% CI: 0.06, 2.26; P = 0.04). No studies were at low risk of bias across all bias categories. CONCLUSIONS: Prebiotics do not improve gastrointestinal symptoms or QoL in patients with IBS or other FBDs, but they do increase bifidobacteria. Variations in prebiotic type and dose impacted symptom improvement or exacerbation. This review was registered at PROSPERO as CRD42017074072. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/30949662/Prebiotics_in_irritable_bowel_syndrome_and_other_functional_bowel_disorders_in_adults:_a_systematic_review_and_meta_analysis_of_randomized_controlled_trials_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.1093/ajcn/nqy376 DB - PRIME DP - Unbound Medicine ER -