Gut Microbiota and the Use of Probiotics in Constipation in Children and Adolescents: Systematic Review

Abstract

Objective: To perform a systematic review of literature data on gut microbiota and the efficacy of probiotics for the treatment of constipation in children and adolescents. Data source: The research was performed in the PubMed, the Scientific Electronic Library Online (SciELO) and the Latin American and Caribbean Health Sciences Literature (LILACS) databases in English, Portuguese and Spanish. All original articles that mentioned the evaluation of the gut microbiota or the use of probiotics in children with constipation in their title and abstract were selected. Data synthesis: 559 articles were found, 47 of which were selected for reading. From these, 12 articles were included; they studied children and adolescents divided into two categories: a gut microbiota evaluation (n=4) and an evaluation of the use of probiotics in constipation therapy (n=8). The four papers that analyzed fecal microbiota used different laboratory methodologies. No typical pattern of gut microbiota was found. Regarding treatment, eight clinical trials with heterogeneous methodologies were found. Fifteen strains of probiotics were evaluated and only one was analyzed in more than one article. Irregular beneficial effects of probiotics have been demonstrated in some manifestations of constipation (bowel frequency or consistency of stool or abdominal pain or pain during a bowel movement or flatulence). In one clinical trial, a complete control of constipation without the use of laxatives was obtained. Conclusions: There is no specific pattern of fecal microbiota abnormalities in constipation. Despite the probiotics’ positive effects on certain characteristics of the intestinal habitat, there is still no evidence to recommend it in the treatment of constipation in pediatrics.

Functional Constipation and the Gut Microbiome in Children: Preclinical and Clinical Evidence

“…To date, five studies have investigated the gut microbiome of children with constipation ( 51 , 52 ). Zhu and collaborators ( 28 ) carried out the first study using 16s rRNA gene pyrosequencing, finding that obese children with constipation consumed less fiber and had lower levels of Prevotella and increased levels of butyrate-producing taxa ( Coprococcus, Roseburia , and Faecalibacterium ) than controls.…”

“…Paradoxically, more research has been conducted on the effects of probiotics than on the gut microbiome itself. The latest systematic review ( 51 ) assessed eight randomized placebo-controlled trials (RCTs) which investigated the role of various strains of probiotics on the treatment of childhood FC. Only one RCT showed significant improvement in stool frequency and consistency, and reduction in abdominal pain using Lactobacillus casei rhamnosus Lcr35 ( 64 ), however, these findings were contradicted by a later trial ( 65 ), and the pooled results of the two RCTs showed no statistical significance for treatment success ( 66 ).…”

The effect of probiotics on functional constipation in adults

“…Although the human microbiome comprises more than 400 bacterial species, evidence has shown that a decrease in the population of Bifidobacterium and Lactobacillus in adults can result in intestinal constipation. [ 12 – 14 ] Consequently, the probiotics used in humans for the treatment of constipation are more often of the species Lactobacillus and Bifidobacterium . According to Ceresola et al [ 8 ] these Lactobacillus and Bifidobacterium can shorten the migratory myoelectric complex period and accelerate small intestine transit, partly due to increased release of serotonin (5-HT) which has promotility effects.…”

“…[ 20 ] However, there is no consensus on probiotic strains and dosages for the treatment of constipation. [ 12 , 21 ]…”

Use of probiotics in children with chronic constipation

“…Furthermore, based on a systematic review of literature data on gut microbiota, Gomes et al . also considered that there is still no basis for recommending probiotics for the treatment of constipation in children and adolescents …”