Methodological Quality Assessment of Meta-Analyses and Systematic Reviews of Probiotics in Inflammatory Bowel Disease and Pouchitis

Abstract

BackgroundProbiotics are widely used for the induction and maintenance of remission in inflammatory bowel disease (IBD) and pouchitis. There are a large number of meta-analyses (MAs)/ systematic reviews (SRs) on this subject, the methodological quality of which has not been evaluated.ObjectivesThis study aimed to evaluate the methodological quality of and summarize the evidence obtained from MAs/SRs of probiotic treatments for IBD and pouchitis patients.MethodsThe PubMed, EMBASE, Cochrane Library and China National Knowledge Infrastructure (CNKI) databases were searched to identify Chinese and English language MAs/SRs of the use of probiotics for IBD and pouchitis. The Assessment of Multiple Systematic Reviews (AMSTAR) scale was used to assess the methodological quality of the studies.ResultsA total of 36 MAs/SRs were evaluated. The AMSTAR scores of the included studies ranged from 1 to 10, and the average score was 5.81. According to the Canadian Agency for Drugs and Technologies in Health, 4 articles were classified as high quality, 24 articles were classified as moderate quality, and 8 articles were classified as low quality. Most of the MAs/SRs suggested that probiotics had potential benefits for patients with ulcerative colitis (UC), but failed to show effectiveness in the induction and maintenance of remission in Crohn’s disease (CD). The probiotic preparation VSL#3 may play a beneficial role in pouchitis.ConclusionThe overall methodological quality of the current MAs/SRs in the field of probiotics for IBD and pouchitis was found to be low to moderate. More MAs/SRs of high quality are required to support using probiotics to treat IBD and pouchitis.

Systematic review with meta‐analysis: the efficacy of probiotics in inflammatory bowel disease

“…Previous meta-analyses have examined the benefit of probiotics in specific subgroups of patients with IBD, [26][27][28][29][30][31][32][33][34][35][36] but none have synthesised all current available evidence for their role in IBD, and some have important limitations which have been reported previously. 37 Most notably, several prior meta-analyses have combined data from trials of probiotics and synbiotics, 28,29,33,36 or pooled data from studies in paediatric and adult populations. [28][29][30]33,35 Furthermore, only two meta-analyses have assessed the effect of probiotics on relapse of disease activity in post-operative CD, 36,38 but neither provided data on the efficacy of preventing endoscopic recurrence at differing severities of Rutgeerts' endoscopic score, nor did they extract data using intention-to-treat analysis.…”

Methodological Quality Assessment of Systematic Review or Meta-Analysis Using AMSTAR-2: the Long-Term Effectiveness or Efficacy of Opioids for Chronic Non-Cancer Pain

“…However, most non-Cochrane reviews only provided a list of included studies. If we rely on inappropriate reasons to exclude studies, it would introduce bias, which would in uence the transparency, validity and reported quality of our results 51,52 . Hence, it was obvious that Cochrane reviews showed better methodological quality than non-Cochrane review 46,47 .…”

Factores ambientales en el desarrollo y evolución de la enfermedad inflamatoria intestinal

“…En CU, los lactobacilos han demostrado atenuar el daño histológico y conducir en un porcentaje importante a la remisión 13 . En un metaanálisis se demostró que los probióticos aumentan significativamente las tasas de remisión en pacientes con CU activa (RR 1,51; p = 0,01) 14 . El análisis de subgrupos encontró que solo VSL#3 (mezcla de cepas de Bifidobacterium, Lactobacillus y Streptococcus salivarius spp.…”

“…La combinación de probióticos con 5-aminosalicilatos (5-ASA) es superior a 5-ASA solo en la inducción y mantenimiento de la remisión en CU. En cambio, los probióticos no son superiores al placebo para la inducción a la remisión y mantenimiento en la EC 14 . A pesar de la importancia de la microbiota y de los resultados referidos, creemos que aún faltan estudios que sustenten mejor la efectividad real de esta estrategia terapéutica en el manejo de la EII.…”