Copyright
©The Author(s) 2015.
World J Gastroenterol. Mar 14, 2015; 21(10): 3072-3084
Published online Mar 14, 2015. doi: 10.3748/wjg.v21.i10.3072
Published online Mar 14, 2015. doi: 10.3748/wjg.v21.i10.3072
Table 1 Jadad quality score of randomized controlled trial included in the meta-analysis
Study | Randomization | Blinding | Withdrawals and dropouts | Total score |
Kajander et al[33] | 2 | 2 | 1 | 5 |
Williams et al[32] | 1 | 2 | 1 | 4 |
Zeng et al[39] | 1 | 2 | 1 | 4 |
Enck et al[35] | 1 | 1 | 1 | 3 |
Drouault-Holowacz et al[37] | 2 | 2 | 1 | 5 |
Sinn et al[42] | 2 | 2 | 1 | 5 |
Enck et al[36] | 1 | 2 | 1 | 4 |
Simrén et al[40] | 2 | 2 | 1 | 5 |
Sondergaard et al[43] | 2 | 2 | 1 | 5 |
Guglielmetti et al[44] | 2 | 2 | 1 | 5 |
Ducrotté et al[45] | 1 | 2 | 1 | 4 |
Kruis et al[34] | 2 | 2 | 1 | 5 |
Ki cha et al[38] | 2 | 2 | 1 | 5 |
Dapoigny et al[46] | 1 | 2 | 1 | 4 |
Roberts et al[41] | 2 | 2 | 1 | 5 |
Table 2 Characteristics of studies included in the meta-analysis
Trial | Type of IBS | Criteria | Age (yr) | Sex (Male/Female) | Probiotic | Probiotic dosage | Duration of treatment | Follow-up | Outcome | ||
Probiotic | Placebo | Probiotic | Placebo | ||||||||
Kajander et al[33] | All types | Rome II | 50 | 46 | 2/41 | 4/39 | Lactobacillusrhamnosus GG | 1 × 107 CFU | 20 wk | 3 wk | ↑ Stabilization of intestinal microbiota |
L. rhamnosus Lc705 | ↓ Distension and abdominal pain in probiotic group | ||||||||||
Propionibacteriumfreudenreichiissp. shermanii JS | ↓ IBS symptoms | ||||||||||
Bifidobacteriumanimalisssp. lactis Bb-12 | |||||||||||
Williams et al[32] | All types | Rome II | 40 | 38 | 3/25 | 8/20 | L. acidophilus CUL60 | 2.5 × 1010 CFU | 8 wk | 2 wk | ↑ QoL |
L. acidophilus CUL21 | ↓ Symptom severity, bloating not improved | ||||||||||
B. lactis CUL34, | |||||||||||
B. bifidum CUL20 | |||||||||||
Zeng et al[39] | D-IBS | Rome II | 44.6 | 45.8 | 10/4 | 9/6 | Streptococcusthermophilus | 1 × 108 CFU | 4 wk | - | Mucosal barrier function and bowel symptoms improved |
L. bulgaricus | 1 × 107 CFU | ↓ Small bowel permeability | |||||||||
L. acidophilus | |||||||||||
B. longum | |||||||||||
Enck et al[35] | All types | ICHPPC and WONCA | 49.8 | 49.4 | 76/72 | 75/75 | Escherichia coli (Symbioflor 2) | 1.5-4.5 ×107 CFU | 8 wk | ND | ↓ Typical symptoms of IBS patients |
Drouault-Holowacz et al[37] | All types | Rome II | 47 | 44 | 8/40 | 16/36 | B. longum LA101 | 1 × 1010 CFU | 4 wk | - | ↑ QoL |
L. acidophilus LA102 | ↓ Flatulence | ||||||||||
Lactococcusl actis LA103 | ↓ Abdominal pain and bloating | ||||||||||
S. thermophilus LA104 | |||||||||||
Sinn et al[42] | All types | Rome III | 41.9 | 47.5 | 6/14 | 8/12 | L. acidophilus SDC 2012, 2013 | 2 × 109 CFU | 4 wk | - | ↓ IBS symptoms, abdominal pain and discomfort |
Enck et al[36] | All types | ICHPPC and WONCA | 49.8 | 49.4 | 77/72 | 73/75 | E. coli and Enterococcusfaecalis (Pro Symbioflor) | 3-9 × 107 CFU | 8 wk | - | ↓ 50% global symptom score and abdominal pain score |
Simrén et al[40] | All types | Rome II | 42 | 44 | 11/26 | 11/26 | L. paracasei F19 | 5 × 107 CFU | 8 wk | 8 wk | Improvement in both groups in pain frequency, pain and bloating severity, satisfaction with bowel habits, and interference with daily life |
L. acidophilus La5 | |||||||||||
B. lactis Bb-12 | |||||||||||
Sondergaard et al[43] | ND | Rome II | 53.9 | 48.5 | 7/20 | 6/19 | L. paracasei F19 | 5 × 107 CFU | 8 wk | 8 wk | Symptom relief in both groups;no difference between probiotics and placebo |
L. acidophilus La5 | (500 mL) | ||||||||||
B. lactis Bb-12 | |||||||||||
Guglielmetti et al[44] | All types | Rome III | 36.65 | 40.98 | 21/41 | 19/41 | B. bifidum MIMBb75 | 1 × 109 CFU | 4 wk | 4 wk | ↓ IBS symptoms like: pain, discomfort distension, bloating, digestive disorders |
↑ QoL | |||||||||||
Ducrotté et al[45] | D-IBS (in majority of patients) | Rome III | 36.53 | 38.4 | 70/38 | 81/25 | L. plantarum 299v | 1 × 1010 CFU | 4 wk | 3 wk | ↓ Abdominal pain and bloating |
Kruis et al[34] | D-IBS | Rome II | 46.3 | 45.1 | 12/48 | 16/44 | E. coli (Nissle 1917) | 2.5-25 × 109 CFU | 12 wk | - | No significant effects of probiotics in general symptoms, but enteric flora altered due to gastroenterocolitis or administration of antibiotics before IBS initiation |
Ki Cha et al[38] | D-IBS | Rome III | 37.9 | 40.3 | 12/13 | 14/11 | L. acidophilus | 1 × 1010 CFU | 8 wk | 2 wk | ↑ QoL |
L. plantarum | |||||||||||
L. rhamnosus | |||||||||||
B. breve | |||||||||||
B. lactis | |||||||||||
B. longum | |||||||||||
S. thermophilus | |||||||||||
Dapoigny et al[46] | All types | Rome III | 46.1 | 48.8 | 5/20 | 10/15 | L. caseirhamnosus (LCR 35) | 6 × 108 CFU | 4 wk | 2 wk | ↓ IBS patients complaining of diarrhea |
(250 mg) | ↓ 50% reduction in IBS severity score in probiotic arm | ||||||||||
Roberts et al[41] | C-IBS, A-IBS | Rome III | 44.66 | 43.71 | 14/74 | 14/77 | B. lactis CNCMI-2494 | 1.25 × 1010 CFU | 12 wk | - | Significant improvement in IBS symptoms in both groups |
Table 3 Characteristics of studies included in the systematic review
Trial | Type of IBS | Criteria | Age (yr) | Sex (Male/Female) | Probiotic | Probiotic dosage | Duration of treatment | Follow-up | Outcome | ||
Probiotic | Placebo | Probiotic | Placebo | ||||||||
Agrawal et al[51] | C-IBS | Rome III | 39.6 | 0/19 | 0/19 | Bifidobacteriumlactis DN-173010 | 1.25 × 1010 CFU | 4 wk | 1 wk | ↓ Abdominal distension and bloating | |
Hun[48] | D-IBS | Rome II | 48.36 | 9/41 | Bacillusc oagulans GBI-306086 | 8× 108 CFU | 8 wk | - | ↓ Bloating and abdominal pain | ||
Dolin[67] | D-IBS | Rome III | 52.3 | 44 | 7/19 | 6/23 | B. coagulans GBI-306086 | 2 × 109 CFU | 8wk | 2 wk | ↓ Number of daily bowel movements |
Guandalini et al[47] | Alltypes | Rome II | 4-18 | 31/28 | VSL#3 | 4.5 × 1011 bacteria | 6 wk | 6 wk after 2-wk wash-out | ↓ Percentage of symptoms, severity and frequency of abdominal pain and bloating | ||
↑ QoL | |||||||||||
Ligaarden et al[53] | All types | Rome II | 46.5 (18-75) | 5/11 | Lactobacillusplantarum MF1298 | 1 × 1010 CFU | 3 wk | - | Daily symptom scores not different between probiotic and placebo groups | ||
Francavilla et al[50] | ND | Rome II | 6.5 | 6.3 | 43/24 | 35/23 | L. rhamnosus GG | 3 × 109 CFU | 12wk | 8 wk | ↓ Frequency and severity of pain, and improved intestinal permeability |
Hong et al[49] | All types | Rome III | 33 | 33 | 12/25 | 10/26 | Lactobacillus sp. HY7801 | 4 × 109 CFU | 8 wk | - | ↑ Intestinal barrier function in females |
B. longum HY804 | ↓ Pain and flatulence defection | ||||||||||
L. brevis HY7401 | |||||||||||
Choi et al[54] | D-IBS, A-IBS | Rome II | 40.2 | 40.6 | 18/17 | 19/20 | Saccharomycesboulardii | 2 × 1011 CFU | 4 wk | - | ↑ QoL |
Michail et al[52] | D-IBS | Rome III | 21.8±17 | 5/10 | 3/6 | VSL#3 | 9 × 1011 bacteria | 8 wk | - | ↑ QoL | |
No change in gut microbiota | |||||||||||
↑ Specific GSRS-IBS scores |
Table 4 Numbers and causes of reported withdrawals in the included clinical trials in the meta-analysis
Study | Group (n) | Cause of withdrawal | |||
Adverse effect | Non-compliance | Lack of efficacy | Symptom worsening | ||
Drouault-Holowacz et al[37] | Placebo (53) | NR | 1 | NR | NR |
Probiotic (53) | NR | 5 | NR | NR | |
Kajander et al[33] | Placebo (43) | 2 | NR | NR | NR |
Probiotic (43) | 2 | NR | NR | NR | |
Kruis et al[34] | Placebo (60) | NR | NR | 2 | NR |
Probiotic (60) | 2 | NR | NR | NR | |
Enck et al[35] | Placebo (148) | NR | 1 | 1 | NR |
Probiotic (149) | 2 | NR | NR | NR | |
Enck et al[36] | Placebo (150) | 2 | NR | NR | NR |
Probiotic (148) | 3 | NR | NR | NR | |
Dapoigny et al[46] | Placebo (26) | NR | NR | NR | 3 |
Probiotic (26) | NR | NR | NR | NR | |
Ki Cha et al[38] | Placebo (25) | NR | NR | NR | 2 |
Probiotic (25) | NR | NR | NR | NR |
- Citation: Didari T, Mozaffari S, Nikfar S, Abdollahi M. Effectiveness of probiotics in irritable bowel syndrome: Updated systematic review with meta-analysis. World J Gastroenterol 2015; 21(10): 3072-3084
- URL: https://www.wjgnet.com/1007-9327/full/v21/i10/3072.htm
- DOI: https://dx.doi.org/10.3748/wjg.v21.i10.3072