Efficacy of Probiotics in Irritable Bowel Syndrome: A Meta-Analysis of Randomized, Controlled Trials

Nikfar, Shekoufeh; Rahimi, Roja; Rahimi, Fatemeh; Derakhshani, Shaghayegh; Abdollahi, Mohammad

doi:10.1007/s10350-008-9335-z

Cited by 132 publications

(66 citation statements)

References 29 publications

(71 reference statements)

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“…Step 2: we identified 10 meta-analyses and systematic reviews (published between 2008 and 2015) related to probiotic trials in IBS, [18][19][20][21][22][23][24][25][26]28 reporting a total of 44 RCTs with variable number of trials in each of them that increased over the years. One "systematic review" of complementary and alternative therapies in IBS was not comprehensive at all for IBS probiotic trials 18 ; it included only 4 studies that were also analysed and discussed in all other reviews.…”

Section: Resultsmentioning

confidence: 99%

“…19,20,23,25,28 One 22 did perform a systematic review instead of a meta-analysis, but nevertheless mixed both groups.…”

Section: Resultsmentioning

confidence: 99%

“…A number of systematic reviews and meta-analyses [18][19][20][21][22][23][24][25][26] analysed the efficacy of probiotics in the management of IBS and these publications are frequently mentioned and cited in consensus papers. 27 Over the years general assessments have remained rather similar, presuming an overall positive effect whilst claiming a lack of high-quality data: "Probiotics may improve symptoms of irritable bowel syndrome and can be used as supplement to standard therapy."…”

Section: Introductionmentioning

confidence: 99%

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Probiotic Therapy of the Irritable Bowel Syndrome: Why Is the Evidence Still Poor and What Can Be Done About It?

Mazurak

Broelz²,

Storr

et al. 2015

J Neurogastroenterol Motil

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Background/AimsDespite numerous randomized clinical trials and meta-analyses, there is no increased evidence for the efficacy of probiotics in the treatment of irritable bowel syndrome (IBS). We review this evidence, identify and analyse the reasons for this lack of evidence and propose methodological improvements for future studies. MethodsBased on a literature search, we identified 56 papers that matched the purpose of our analyses. Twenty-seven studies used multi-species bacterial preparations and 29 used single-strain probiotics. They were analysed regarding patients included, treatment duration, probiotic dosage, and outcome measures. ResultsTrials in both groups suffered from heterogeneity with respect to probiotic concentration, duration of treatment, and other methodological issues (crossover design and underpowered studies). This heterogeneity did not allow the application of a meta-analytic approach and a systematic review was therefore performed instead. Multi-strain preparations combined 2 to 8 different bacterial subspecies, mostly lactobacilli or bifidobacteria, and used variable lengths of treatments. Overall, more than 50% of trials presented negative outcomes. The majority of the single-strain probiotic trials employing lactobacilli or Saccharomyces were negative, whereas trials employing bifidobacteria showed positive results. ConclusionsThe heterogeneity of the studies of probiotics in IBS questions the value of meta-analyses. The use of different bacterial strains and different mixtures of these strains, as well as different dosages, are the main contributors to this heterogeneity. Current data provides limited evidence for the efficacy of a small number of single-strain probiotics in IBS (mostly bifidobacteria) and

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Section: Resultsmentioning

confidence: 99%

“…19,20,23,25,28 One 22 did perform a systematic review instead of a meta-analysis, but nevertheless mixed both groups.…”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Probiotic Therapy of the Irritable Bowel Syndrome: Why Is the Evidence Still Poor and What Can Be Done About It?

Mazurak

Broelz²,

Storr

et al. 2015

J Neurogastroenterol Motil

View full text Add to dashboard Cite

show abstract

“…In recent years many drugs from synthetic or natural sources have been introduced. Most researchers in recent years have focused on phosphodiesterase inhibitors [8], melatonin [9], herbal products [5], and probiotics [10].…”

mentioning

confidence: 99%

“…Two broad metaanalysis studies [10,20] were conducted in recent years with somewhat different concerns about homogeneity of included studies [21]. Despite the diversity in results of the studies, both meta-analyses concluded that probiotics improve symptoms of IBS and thus can be used as a supplement to standard therapy in patients with IBS.…”

mentioning

confidence: 99%