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. 2018 Apr;47(8):1054-1070.
doi: 10.1111/apt.14539. Epub 2018 Feb 20.

Systematic review: probiotics in the management of lower gastrointestinal symptoms - an updated evidence-based international consensus

A P S Hungin  1 , C R Mitchell  2 , P Whorwell  3 , C Mulligan  4 , O Cole  2 , L Agréus  5 , P Fracasso  6 , C Lionis  7 , J Mendive  8 , J-M Philippart de Foy  9 , B Seifert  10 , K-A Wensaas  11 , C Winchester  2 , N de Wit  12 ; European Society for Primary Care Gastroenterology
Affiliations

Systematic review: probiotics in the management of lower gastrointestinal symptoms - an updated evidence-based international consensus

A P S Hungin et al. Aliment Pharmacol Ther. 2018 Apr.

Abstract

Background: In 2013, a systematic review and Delphi consensus reported that specific probiotics can benefit adult patients with irritable bowel syndrome (IBS) and other gastrointestinal (GI) problems.

Aim: To update the consensus with new evidence.

Methods: A systematic review identified randomised, placebo-controlled trials published between January 2012 and June 2017. Evidence was graded, previously developed statements were reassessed by an 8-expert panel, and agreement was reached via Delphi consensus.

Results: A total of 70 studies were included (IBS, 34; diarrhoea associated with antibiotics, 13; diarrhoea associated with Helicobacter pylori eradication therapy, 7; other conditions, 16). Of 15 studies that examined global IBS symptoms as a primary endpoint, 8 reported significant benefits of probiotics vs placebo. Consensus statements with 100% agreement and "high" evidence level indicated that specific probiotics help reduce overall symptom burden and abdominal pain in some patients with IBS and duration/intensity of diarrhoea in patients prescribed antibiotics or H. pylori eradication therapy, and have favourable safety. Statements with 70%-100% agreement and "moderate" evidence indicated that, in some patients with IBS, specific probiotics help reduce bloating/distension and improve bowel movement frequency/consistency.

Conclusions: This updated review indicates that specific probiotics are beneficial in certain lower GI problems, although many of the new publications did not report benefits of probiotics, possibly due to inclusion of new, less efficacious preparations. Specific probiotics can relieve lower GI symptoms in IBS, prevent diarrhoea associated with antibiotics and H. pylori eradication therapy, and show favourable safety. This study will help clinicians recommend/prescribe probiotics for specific symptoms.

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Figures

Figure 1
Figure 1
Flow diagram of literature searches. MEDLINE and Embase searches were performed in July 2016 and June 2017. RCT, randomised controlled trial
Figure 2
Figure 2
Breakdown of voting agreement for each individual statement in the original and updated Delphi consensus
See this image and copyright information in PMC

Comment in

References

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