Positive Effect of Probiotics on Constipation in Children: A Systematic Review and Meta-Analysis of Six Randomized Controlled Trials

Abstract

Context: Constipation in children is a prevalent, burdensome, and psychologically important pediatric issue, the treatment of which remains a global challenge. The use of probiotics has been reported for management of the gastrointestinal microbiota.Objective: This study reviewed the existing literatures of 6 Randomized Control Trials (RCTs) to ascertain some baseline understanding and available information for the effects of probiotics on stool frequency and consistency in children with constipation.Data Sources: PubMed, Springer, Elsevier Science, Cochrane Library, Scopus, Ovid (Medline, EMBASE, PsycINFO), Orbis, and Web of Science from the earliest record in each database to 15 September, 2016.Study selection: Eligible studies were randomized controlled trials that compared the effect of probiotics interventions to any control intervention on stool frequency and consistency.Data Extraction: Studies were identified by searching electronic databases. The meta-analysis was performed by Review Manager 5.3 software using a randomized model.Results: Six studies were identified. The use of probiotics significantly increased the stool frequency [mean difference (MD), 0.73; 95% confidence interval (CI), 0.14–1.31; P = 0.02]. Subgroup assessment showed a significantly increased stool frequency in Asian patients (MD, 1.18; 95% CI, 0.33–2.02; P = 0.006), but no significant difference in stool consistency (MD, −0.07; 95% CI, −0.21–0.06; P = 0.27).Limitations: Only six RCTs met the criteria and were included. Each RCT in this study was performed in a different country, and some of the included studies had a small sample size, which might have influenced the reliability and validity of the conclusions.Conclusion: The present study shows that probiotics increase stool frequency and have beneficial effects in Asian children. However, caution is needed when interpreting these outcomes because of the existence of heterogeneity. Evidence from larger samples and more adequately powered RCTs with results obtained by standardized measurements are necessary to determine which species and dosage of probiotics and what length of treatment are most efficacious for constipation in children.

Efficacy of Probiotics on Anxiety: A Meta-analysis of Randomized Controlled Trials

“…Based on this finding, some studies have used active probiotics to treat anxiety disorders. Probiotics, defined as living microorganisms, are believed to provide health benefits [14,15]. Probiotics refer to ingested microorganisms with benefits for both humans and animals.…”

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

“…According to the literature, there are several mechanisms that can potentially explain the action of probiotics in the treatment of functional constipation: modification of the gut microbiota, considering the changes that have been shown in individuals with constipation; increased production of lactate and short chain fatty acids, reducing luminal pH, which could improve colonic peristalsis and decrease intestinal transit time. 8,[29][30][31] Taking this into consideration, there is a growing interest in using probiotics in the treatment of constipation.…”

“…In the literature, five systematic review articles were found, 30,[33][34][35][36] Two had a meta-analysis, 30,34 which addressed the use of probiotics in the treatment of functional constipation in children and adolescents. An article published in 2010 33 included two clinical trials in children 18,21 and three adult trials, and concluded that only L. rhamnosus Lcr35 showed a beneficial effect for the treatment of constipation in children.…”

“…A systematic review published in 2016 35 on the use of prebiotics, probiotics and symbiotics for the treatment of functional constipation in children concluded that there is still insufficient evidence to support the recommendation of probiotics in this treatment. At the same time as the present article was being completed, two systematic reviews were published 30,36 addressing this theme. In 2017, a systematic meta-analysis review highlighted the effectiveness of probiotics for improving bowel movement frequency in Asian children, and highlighted the heterogeneity of the studies.…”

“…In 2017, a systematic meta-analysis review highlighted the effectiveness of probiotics for improving bowel movement frequency in Asian children, and highlighted the heterogeneity of the studies. 30 Another systematic review, published that same year, included studies published up until February 2017, and evaluated seven clinical trials. 16,[18][19][20][21][22][23] It was noted that some probiotic strains had some effects on the frequency of bowel movements, but no effects on the frequency of fecal incontinence and abdominal pain.…”