Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul;98(27):e16068.
doi: 10.1097/MD.0000000000016068.

Efficacy of different probiotic protocols in irritable bowel syndrome: A network meta-analysis

Ding Liang  1 , Ning Longgui, Xu Guoqiang
Affiliations

Efficacy of different probiotic protocols in irritable bowel syndrome: A network meta-analysis

Ding Liang et al. Medicine (Baltimore). 2019 Jul.

Abstract

Background: Probiotics is a prevalence therapeutic method for irritable bowel syndrome (IBS), but there is lack of comparison in different protocols. We aim to differentiate the reasonable protocols by assessing the efficacy and safety through the combined way of traditional and network meta-analysis.

Method: PubMed, Medline, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials databases were searched from January 2006 to April 2019. The relative risk (RR) with a 95% confidence interval (CI) was used to combine dichotomous data of responders.

Result: Among 14 studies included 1695 patients were identified as suitable for inclusion. The proportion of responders was associated with the administration of multispecies probiotics (RR: 1.39; 95% CI: 1.19-1.61) and the dose of 10∼10 (RR: 2.08; 95% CI: 1.59-2.71). In network meta-analysis, the protocol of DUO had a significant effect for diarrhea type of IBS compared with placebo (RR: 7.46; 95% CI: 2.00-32.23). In the rest of 4 protocols, no significant difference was found in each other except F19 which appears inferior when compared with Pro (RR: 0.16; 95% CI: 0.03-0.88). Meanwhile, Pro showed a superior effect for undifferentiated-type IBS compared with placebo (RR: 7.16; 95% CI: 1.72-29.89). No probiotics-associated severe adverse event was reported in included studies.

Conclusion: Probiotics is a safety choice to improve the overall symptoms for IBS patient. The protocols with suitable dose combined of Lactobacillus and Bifidobacterium can have prepotent effects compared with single species or over-dosage protocols. Network meta-analysis shows that DUO may be the first recommendation for diarrhea-type IBS. In the remaining 4 regimes of this study, Pro has a high rank for undifferentiated-type IBS.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest

Figures

Figure 1
Figure 1
Flow diagram of assessment of studies identified in the meta-analysis.
Figure 2
Figure 2
Risk of bias graph.
Figure 3
Figure 3
Risk of bias summary.
Figure 4
Figure 4
Forest plot of probiotic effect on overall symptoms: subgroup of probiotic species.
Figure 5
Figure 5
Forest plot of probiotic effect for L+B group: subgroup of dosage.
Figure 6
Figure 6
Star-shape network diagram.
Figure 7
Figure 7
Funnel plot for publication bias. (A) Funnel plot for overall studies. (B) Funnel plot for studies of L+B group.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Enck P, Aziz Q, Barbara G, et al. Irritable bowel syndrome. Nat Rev Dis Prime 2016;2:16014. - PMC - PubMed
    1. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol 2012;10:712.e4–21.e4. - PubMed
    1. Nellesen D, Yee K, Chawla A, et al. A systematic review of the economic and humanistic burden of illness in irritable bowel syndrome and chronic constipation. J Manag Care Pharm 2013;19:755–64. - PMC - PubMed
    1. Wu JC. Complementary and alternative medicine modalities for the treatment of irritable bowel syndrome: facts or myths? Gastroenterol Hepatol (N Y) 2010;6:705–11. - PMC - PubMed
    1. Rousseaux C, Thuru X, Gelot A, et al. Lactobacillus acidophilus modulates intestinal pain and induces opioid and cannabinoid receptors. Nat Med 2007;13:35–7. - PubMed

Publication types

MeSH terms