Effectiveness of probiotics in irritable bowel syndrome: Updated systematic review with meta-analysis

Abstract

Aim: To investigate the efficacy of probiotics in irritable bowel syndrome (IBS) patients.

Methods: PubMed, Cochrane library, Scopus, Google Scholar, and Clinicaltrial.gov databases were searched for literature published between September 2007 and December 2013. The applied Mesh terms were "probiotics," "irritable bowel syndrome," and "irritable bowel syndrome treatment." The collected data contained24 clinical trials, of which 15 were eligible for meta-analysis and nine were reviewed systematically. All studies were randomized placebo-controlled trials in patients with IBS that investigated the efficacy of probiotics in IBS improvement. The Jadad score was used to assess the methodological quality of trials. The quality scale ranges from 0 to 5 points, with a score ≤ 2 indicating a low quality report, and a score of ≥ 3 indicating a high quality report. Relative risk (RR), standardized effect size, and 95%CI were calculated using the DerSimonian-Laird method. The Cochran Q test was used to test heterogeneity with P < 0.05. Funnel plots were constructed and Egger's and Begg-Mazumdar tests were performed to assess publication bias.

Results: A total of 1793 patients were included in the meta-analysis. The RR of responders to therapies based on abdominal pain score in IBS patients for two included trials comparing probiotics to placebo was 1.96 (95%CI: 1.14-3.36; P = 0.01). RR of responders to therapies based on a global symptom score in IBS patients for two included trials comparing probiotics with placebo was 2.43 (95%CI: 1.13-5.21; P = 0.02). For adequate improvement of general symptoms in IBS patients, the RR of seven included trials (six studies) comparing probiotics with placebo was 2.14 (95%CI: 1.08-4.26; P = 0.03). Distension, bloating, and flatulence were evaluated using an IBS severity scoring system in three trials (two studies) to compare the effect of probiotic therapy in IBS patients with placebo, the standardized effect size of mean differences for probiotics therapy was -2.57 (95%CI: -13.05--7.92).

Conclusion: Probiotics reduce pain and symptom severity scores. The results demonstrate the beneficial effects of probiotics in IBS patients in comparison with placebo.

Keywords: Clinical trial; Evidence-based medicine; Irritable bowel syndrome; Meta-analysis; Probiotics; Systematic review.

Figures

Figure 1

Flow diagram for study selection.

Figure 2

Responders to therapies based on abdominal pain score. A: Individual and pooled relative risk in studies comparing probiotics and placebo in irritable bowel syndrome patients; B: Heterogeneity indicators for the studies.

Figure 3

Individual and pooled effect size for standardized mean for abdominal pain in studies comparing probiotics and placebo in irritable bowel syndrome patients.

Figure 4

Individual and pooled effect size for standardized mean for distension, bloating, and flatulence in studies comparing probiotics and placebo in irritable bowel syndrome patients.

Figure 5

Individual and pooled effect size for standardized mean for bowel habit dissatisfaction in studies comparing probiotics and placebo in irritable bowel syndrome patients.

Figure 6

Responders to therapies based on global symptom score. A: Individual and pooled relative risk in studies comparing probiotics and placebo in irritable bowel syndrome patients; B: Heterogeneity indicators for the studies.

Figure 7

Adequate general symptoms improvement. A: Individual and pooled relative risk in studies comparing probiotics and placebo irritable bowel syndrome patients; B: Heterogeneity indicators for the studies; C: Publication bias indicators.