Strain-specific and outcome-specific efficacy of probiotics for the treatment of irritable bowel syndrome: A systematic review and meta-analysis

Strain-specific and outcome-specific efficacy of probiotics for the treatment of irritable bowel syndrome: A systematic review and meta-analysis

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Background: Consistent guidance for choosing an appropriate probiotic for the treatment of irritable bowel syndrome is lacking.Methods: Literature databases searched included: PubMed, Google Scholar and NIH registry of clinical trials from inception to June 2021.Inclusion criteria: randomized controlled trials (RCTs) enrolling adult or pediatric IBS patients comparing probiotics against controls and ≥ 2 RCTs with common IBS outcome measures within each type of read more probiotic.

Five common measures of IBS symptoms (changes in global Irritable Bowel Syndrome Severity Scoring System or IBS-SSS scores, frequency of global responders, changes in bloating or abdominal pain scores and frequency of abdominal pain relief) were used.This study was registered at Prospero (#CRD42018109169).Findings: We screened 521 studies and included 42 randomized controlled trials (45 treatment arms, N = 3856).

Four probiotics demonstrated significant reduction in abdominal pain relief: B.coagulans MTCC5260 (RR= 4.9, 95% C.

I.3.3, 7.

3), L.plantarum 299v (RR= 4.6, 95% CI 1.

9, 11.0), S.boulardii CNCM I-745 (RR= 1.

5, 95% C.I.1.

1, 2.1) and S.cerevisiae CNCM I-3856 (RR= 1.

3, 95% C.I.1.

04, 1.6).Mild-moderate adverse events were reported in 51% of the trials, none were more associated with the probiotic compared to controls.

Interpretation: Although the analysis of probiotic efficacy here was limited by the diversity of IBS outcomes used in trials and lack of confirmatory trials for some strains, six single-strain probiotics and three different types of probiotic mixtures showed significant efficacy for at least one IBS outcome measure.These results might be relevant to clinical practice and policy.