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

Abstract

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.

Systematic review with meta‐analysis: efficacy of faecal microbiota transplantation for the treatment of irritable bowel syndrome

“…A recent meta-analysis reported a beneficial effect of Lactobacillus plantarum DSM 9843, Escherichia coli DSM1752, Streptococcus faecium, and specific multi-strain probiotic formulations, although the evidence was not robust enough to make any conclusive recommendations as to which individual species or strain was most effective. 13 This clinical evidence for a role of the gut microbiota in IBS is reinforced by available microbiological data. Firstly, several studies have demonstrated that the gut microbiota are altered in patients with IBS, compared with healthy subjects.…”

“…Numerous different probiotic mixtures and strains have also been evaluated in patients with IBS over the last 15 years. A recent meta‐analysis reported a beneficial effect of Lactobacillus plantarum DSM 9843, Escherichia coli DSM1752, Streptococcus faecium , and specific multi‐strain probiotic formulations, although the evidence was not robust enough to make any conclusive recommendations as to which individual species or strain was most effective …”

“…8,11 Additionally, therapeutic modulators of the gut microbiota have beneficial effects in unselected patients with IBS. Rifaximin, a minimally absorbable antibiotic, has been shown to be effective in randomised controlled trials (RCTs) in both IBS with diarrhoea (IBS-D) and IBS with mixed stool pattern (IBS-M), [12][13][14][15] for both global symptoms and bloating. Numerous different probiotic mixtures and strains have also been evaluated in patients with IBS over the last 15 years.…”

Editorial: raising the bar on probiotic foods

“…Functional bowel disorders are possible surrogates for “gut health” or rather the lack of it. For irritable bowel syndrome (IBS), an earlier meta‐analysis concluded that probiotics are effective, but an update by the same authors was more circumspect and stated that it was not possible to draw firm conclusions about the efficacy of probiotics . Heterogeneity among different studies was highlighted as a tempering factor; 5545 subjects with various forms of IBS defined by various criteria were involved in trials employing a large array of products (29 probiotic combinations, 12 Lactobacillus , 5 Saccharomyces , 5 Bifidobacterium , 2 E coli and 1 Streptococcus ) all given at varying doses …”

A Message from the Editors

“…During 2019, the number of individual downloads via Wiley Online Library (WOL) was 1,763,117 representing an increase of 17% over the same period for the preceding year. The 10 most frequently downloaded papers on WOL, published between 1st October 2018 and 30th September 2019, covered a variety of topics including prebiotics and probiotics for IBS, potassium‐competitive acid blockers in reflux disease, dietary FODMAPs, the microbiome (inevitably) and the cholestatic consequences of bodybuilding supplements . These 10 papers will be free‐access for the next 12 months.…”