Comparing probiotic and drug interventions in irritable bowel syndrome: a meta-analysis of randomised controlled trials

Abstract

Clinical decisions made by health professionals to recommend either drug or probiotic interventions for irritable bowel syndrome (IBS) should be supported by proper knowledge of the efficacy rates of both types of interventions. In this article, we performed a systematic review and meta-analysis to examine the efficacy of both probiotic- and drug interventions in IBS. Medline was searched between January 2015 – January 2021. Randomised controlled trials (RCT) recruiting participants > 18 years old with IBS and examining the effect of probiotics or drugs were eligible for inclusion. The data of the primary outcome, i.e. the persistence of IBS symptoms (dichotomous symptom data), were pooled to obtain a relative risk (RR), with a 95% confidence interval (CI). Secondary outcomes, abdominal pain- and bloating scores (continuous data), were pooled using a standardised mean difference with a 95% CI. The search identified 269 citations of which 32 RCTs were eligible. Our meta-analysis indicated that both probiotic and drug interventions are able to improve the persistence of IBS symptoms (RR 0.60 [0.51; 0.92] versus 0.87 [0.81; 0.92], respectively) and abdominal pain scores (standardised mean difference (SMD) -0.35 [-0.56; -0.14] versus -0.10 [-0.20; 0.00], respectively). However, determining the overall efficacy of both intervention types is inherently complex and such results should be interpreted with care, due to the large diversity of probiotic- and drug types and doses, which is also complicated by variety in IBS subtypes. Hence, as a first step, more large scale randomised double blind placebo-controlled trials focussing on a specific IBS subtype targeted with specific probiotic strains or specific pharmaceutical modalities should be executed, enabling a more proper comparison between trials.

Relationship between the Incidence of Neonatal Hyperbilirubinemia and Gestatinal Age as a Risk Factor

“…From the results of the study, table 2 showed that the majority or as many as 76 babies (48.1%) experienced an increase in NH on the first to second day. These results are in line with research Van der Geest et al, (2022) which states that the majority of neonatal population samples experiencing NH will experience a yellow manifestation after 24 hours. This theory is also in line with research Thielemans et al, (2021) which stated a significant association between an increase in neonatal bilirubin levels at 48 hours of neonatal life and the incidence of NH (P = 0.009)…”

Probiotics in irritable bowel syndrome and inflammatory bowel disease: review of mechanisms and effectiveness

“…Details of many older trials that are not the focus of the current review can be found in that report. At least six systematic reviews have since been published on probiotics in IBS, examining the effects of probiotics at different levels of specificity [23 ▪ –28 ▪ ]; the considerable variation in reported effectiveness between different genera, species and strains is summarized in Table 1.…”

“…These meta-analyses found that, when analysed globally across all probiotics, overall they led to beneficial impacts on global symptoms, abdominal pain and bloating in IBS patients [25 ▪ ,27 ▪ ]. However, aggregating the effects of different probiotics into a meta-analysis should be undertaken with caution as different probiotics have different characteristics that will inevitably impact on their efficacy.…”

Inadequate safety reporting in the publications of randomised clinical trials in irritable bowel syndrome: drug versus probiotic interventions

“…The CONSORT Statement offers a standard way for authors to prepare reports of trial findings, facilitating their complete and transparent reporting, and aiding their critical appraisal and interpretation. Hence, this tandem publication aimed to determine both efficacy (Van der Geest et al, 2022) and safety (this article) of RCTs, contributing to an assessment of a burden to benefit ratio to substantiate medical decisions. This article will determine safety profiles by analysing the AEs reported in RCTs.…”