Efficacy and Safety of Probiotics, Prebiotics and Synbiotics in the Treatment of Irritable Bowel Syndrome: A systematic review and meta-analysis

Abstract

Treatments that target alterations in gut microbiota may be beneficial for patients with irritable bowel syndrome (IBS). A systematic review and meta-analysis was conducted of randomised clinical trials (RCTs) evaluating the efficacy and safety of probiotics, prebiotics and synbiotics. Factors considered in the analysis included global IBS symptoms and/or abdominal pain, secondary symptoms and the frequency of adverse events. A total of 33 RCTs involving 4,321 patients were identified. Overall, probiotics significantly improved global IBS symptoms compared to placebos (standardised mean difference = −0.32, 95% confidence interval: −0.48 to −0.15; P <0.001), with significant heterogeneity between studies (I2 = 72%; P <0.001). This remained apparent in both single- and multi-strain probiotic interventions as well as synbiotic formulations. However, evidence regarding prebiotics was scarce. There were no significant inter-group differences in terms of the frequency of adverse events. Future RCTs should address methodological limitations, including short follow-up periods and patient adherence.Keywords: Irritable Bowel Syndrome; Gastrointestinal Microbiome; Dietary Supplements; Probiotics; Prebiotics; Synbiotics; Meta-Analysis; Systematic Review.

The Effectiveness of Synbiotic Preparation Containing Lactobacillus and Bifidobacterium Probiotic Strains and Short Chain Fructooligosaccharides in Patients with Diarrhea Predominant Irritable Bowel Syndrome—A Randomized Double-Blind, Placebo-Controlled Study

“…The currently published systemic reviews and meta-analyses of randomized clinical trials have indicated that probiotics have beneficial clinical effects and can help to reduce global and specific IBS symptoms significantly [ 17 , 18 , 19 , 20 ]. In contrast, little evidence for the use of synbiotics in IBS has been demonstrated [ 18 , 19 ].…”

“…The currently published systemic reviews and meta-analyses of randomized clinical trials have indicated that probiotics have beneficial clinical effects and can help to reduce global and specific IBS symptoms significantly [ 17 , 18 , 19 , 20 ]. In contrast, little evidence for the use of synbiotics in IBS has been demonstrated [ 18 , 19 ]. Unlike probiotics, whose clinical effects have been evaluated in numerous studies (59 randomized double-blind clinical trials, enrolling 6761 IBS patients, were included in the 2020 meta-analysis [ 17 ]), there are few clinical trials showing the effects of synbiotics.…”

Prebióticos e probióticos na saúde e no tratamento de doenças intestinais: uma revisão integrativa

“…Em uma meta-análise realizada por Asha & Khalil (2020), viu-se que os benefícios dos prebióticos, como fruto-oligossacarídeos e goma guar parcialmente hidrolisada, não foram significativos, e o papel dos prebióticos na melhora dos sintomas da SII ainda são controversos, uma vez que a maioria deles são monossacarídeos, dissacarídeos, polióis e oligossacarídeos fermentáveis. Esses compostos, incluindo frutose e frutanos, não possuem boa absorção no intestino delgado e sofrem fermentação, intensificando, portanto, os sintomas da SII.…”

“…Shirota não apresentaram efeito ou melhora significativa nos sintomas da SII durante ou após o tratamento (Thijssen et al, 2016;Stevenson et al, 2019). Esse resultado diverge do encontrado em estudo de revisão sistemática com meta-análise realizado por Asha & Khalil (2020), no qual o uso dos produtos contendo Lactobacillus resultaram na redução da dor intensa e em uma melhora na qualidade de vida.…”

Dietary Patterns and Interventions to Alleviate Chronic Pain

“…Gut microbiota contributes to digestion and absorption of food and a normal immune function, while dysbiosis is associated with the irritable bowel syndrome and chronic abdominal pain [38,39]. Prebiotics and probiotics represent promising solutions for regulating this disorder [40,41].…”