A double‐blind, placebo‐controlled study to assess the effect of a probiotic mixture on symptoms and inflammatory markers in women with diarrhea‐predominant <scp>IBS</scp>

Hod, Keren; Sperber, Ami D.; Ron, Yishai; Boaz, Mona; Dickman, Ram; Berliner, Shlomo; Halpern, Zamir; Maharshak, Nitsan; Dekel, Roy

doi:10.1111/nmo.13037

Cited by 68 publications

(91 citation statements)

References 52 publications

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“…Agreement between reviewers for assessment of trial eligibility was excellent (kappa statistic = 0.85). Eighteen of the RCTs of probiotics in IBS were identified since our last systematic review …”

Section: Resultsmentioning

confidence: 99%

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Systematic review with meta‐analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome

Ford

Harris

Lacy

et al. 2018

Aliment Pharmacol Ther

464

339

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Summary Background Irritable bowel syndrome (IBS) is a chronic functional bowel disorder. Disturbances in the gastrointestinal microbiome may be involved in its aetiology. Aim To perform a systematic review and meta‐analysis to examine the efficacy of prebiotics, probiotics, synbiotics and antibiotics in IBS. Methods MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (up to July 2017). Randomised controlled trials (RCTs) recruiting adults with IBS, comparing prebiotics, probiotics, synbiotics or antibiotics with placebo or no therapy were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI). Continuous data were pooled using a standardised mean difference with a 95% CI. Results The search identified 4017 citations. Data for prebiotics and synbiotics were sparse. Fifty‐three RCTs of probiotics, involving 5545 patients, were eligible. Particular combinations of probiotics, or specific species and strains, appeared to have beneficial effects on global IBS symptoms and abdominal pain, but it was not possible to draw definitive conclusions about their efficacy. There were five trials of similar design that used rifaximin in non‐constipated IBS patients, which was more effective than placebo (RR of symptoms persisting = 0.84; 95% CI 0.79‐0.90). Adverse events were no more common with probiotics or antibiotics. Conclusions Which particular combination, species or strains of probiotics are effective for IBS remains, for the most part, unclear. Rifaximin has modest efficacy in improving symptoms in non‐constipated IBS.

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Section: Resultsmentioning

confidence: 99%

“…The 53 RCTs of probiotics in IBS involved 5545 patients. [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] The proportion of women in trials ranged between 9% and 100%.…”

Section: Efficacy and Safety Of Probiotics In Ibsmentioning

confidence: 99%

Systematic review with meta‐analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome

Ford

Harris

Lacy

et al. 2018

Aliment Pharmacol Ther

464

339

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“…Patients with conditions who could mimic IBS symptoms, or may affect intestinal microbiome, were excluded …”

Section: Methodsmentioning

confidence: 99%

“…We previously demonstrated that an 8‐week treatment with a multispecies probiotic agent improved symptoms in women with irritable bowel syndrome‐diarrhea (IBS‐D). This improvement, however, was not superior to placebo . Nevertheless, in an effort to better understand the mechanisms in which probiotics affect IBS symptoms and possibly characterize patients who are more likely to respond to this treatment, we carried out the current analysis on the samples and data collected during the trial.…”

Section: Introductionmentioning

confidence: 99%

The effect of a multispecies probiotic on microbiota composition in a clinical trial of patients with diarrhea‐predominant irritable bowel syndrome

Hod

Dekel

Cohen

et al. 2018

Neurogastroenterology Motil

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“…Since the previous monograph a total of 18 new trials were identified (47,(83)(84)(85)(86)(87)(88)(89)(90)(91)(92)(93)(94)(95)(96)(97)(98)(99). Therefore, in total, there were 53 RCTs (47,, involving 5545 patients.…”

Section: Quality Of Evidence: Lowmentioning

confidence: 99%

American College of Gastroenterology Monograph on Management of Irritable Bowel Syndrome

Ford

Martin

Chey

et al. 2018

American Journal of Gastroenterology

276

396

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IntroductionIrritable bowel syndrome (IBS) is the most prevalent of the functional gastrointestinal disorders (FGIDs). Current estimates are that IBS affects up to 10-12% of adults in North America (1,2). Although it can affect all individuals regardless of age, creed, or gender, IBS is more common among women and is most commonly diagnosed in younger individuals (< age 50) (2, 3). IBS is characterized by recurrent abdominal pain and altered bowel habits; bloating and distention frequently coexist. The diagnosis of IBS is made by taking a careful history, eliciting key symptoms, as well as performing a physical examination and limited diagnostic testing (4-6). IBS is categorized into four main subtypes based on the predominant bowel habit: IBS with constipation (IBC-C); IBS with diarrhea (IBS-D); IBS with mixed symptomology (IBS-M); and unclassified IBS (5).IBS imposes a significant burden to the health care system and to individuals.Direct medical costs attributed to IBS in the US, excluding prescription and over-thecounter medicines, were estimated at $1.5-$10 billion per year in 2005 (7). Patients with IBS enrolled in a large Health Maintenance Organization (HMO) had significantly more outpatient visits and incurred nearly 50% more in total costs than individuals without IBS (8). A retrospective case-control study from another large HMO reported that patients with IBS had significantly more diagnostic tests, imaging, and surgery compared with patients without a diagnosis of IBS (9). Significant variations in care across the United States related to the diagnosis and treatment of IBS also play a role in excessive health care costs (10). The burden of IBS on individuals can be measured in a number of ways. Studies have demonstrated consistently that IBS impairs work-related activities (e.g., lost work time, reduced productivity while at work) and also reduces quality of life (11,12). The development Ford et al.Page 3 of 91 of effective and efficient treatment strategies for IBS assumes considerable importance, therefore, not just for the individual sufferer, but for society at large.Given the clinical heterogeneity that is a hallmark of the disorder and the absence of a single effective therapy for all sufferers, available therapies tend to focus on predominant symptomatology at presentation (i.e., altered bowel habits, abdominal pain, or bloating) (4-6). Based on their purported mode of action, many pharmacological therapies for IBS developed in recent decades have been directed towards those with a particular bowel habit, whether diarrhea or constipation.However, treating IBS patients can be difficult as no validated treatment algorithm exists, not all patients respond to treatment, and patients with similar symptoms frequently respond to the same treatment differently. Fortunately, a variety of novel therapeutic strategies are being explored and new compounds have appeared since the last iteration of the ACG monograph on IBS (4). The goal of this document, therefore, is to provide an updated, evidence-based d...

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A double‐blind, placebo‐controlled study to assess the effect of a probiotic mixture on symptoms and inflammatory markers in women with diarrhea‐predominant IBS

Cited by 68 publications

References 52 publications

Systematic review with meta‐analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome

Systematic review with meta‐analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome

The effect of a multispecies probiotic on microbiota composition in a clinical trial of patients with diarrhea‐predominant irritable bowel syndrome

American College of Gastroenterology Monograph on Management of Irritable Bowel Syndrome

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