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Meta-Analysis
. 2019 Nov 27;11(12):2886.
doi: 10.3390/nu11122886.

The Effects of Probiotic Supplementation on the Incidence of Diarrhea in Cancer Patients Receiving Radiation Therapy: A Systematic Review with Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials

Navin Kumar Devaraj  1 , Subapriya Suppiah  2 , Sajesh K Veettil  3 , Siew Mooi Ching  1 , Kai Wei Lee  1 , Rohit Kunnath Menon  4 , Man Jun Soo  1 , Inas Deuraseh  1 , Fan Kee Hoo  5 , Dhashani Sivaratnam  6
Affiliations
Meta-Analysis

The Effects of Probiotic Supplementation on the Incidence of Diarrhea in Cancer Patients Receiving Radiation Therapy: A Systematic Review with Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials

Navin Kumar Devaraj et al. Nutrients. .

Abstract

The protective effects of probiotic supplementation against radiation-induced diarrhea (RID) have been reported in previous systematic reviews; however so far, only non-conclusive results have been obtained. The objective of this study was to systematically update and evaluate the available evidence for probiotic supplementation. The protocol of this systematic review has been registered (CRD42018106059) with the International Prospective Register of Systematic Reviews (PROSPERO). The primary efficacy outcome was the incidence of RID. Secondary outcomes were the incidence of watery stool, soft stool, and antidiarrheal medication use. There were eight trials, and a total of 1116 participants were included in the primary analysis. Compared with placebo, probiotics were associated with a lower risk of RID [risk ratio (RR) = 0.62, 95% CI = 0.46, 0.83]. A requisite heterogeneity-adjusted trial sequential analysis indicated conclusive evidence for this beneficial effect. No statistically significant reduction in RID (RR = 0.52, 95% CI = 0.14, 1.91) was observed on subgroup analysis in patients receiving both radiation therapy and chemotherapy. However, those patients receiving only radiation therapy (RT) demonstrated significant benefit (RR = 0.61, 95% CI = 0.48, 0.78). There was a significant difference in the antidiarrheal medication use (RR = 0.54, 95% CI = 0.35, 0.84) observed with the use of probiotics. However, no significant difference was observed for the incidence of soft and watery stool. The use of probiotics is beneficial in preventing RID in patients receiving RT.

Keywords: chemotherapy; placebo; probiotics; radiation-induced diarrhea; randomized controlled trials; trial-sequential analysis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure A1
Figure A1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of the literature screening process.
Figure 1
Figure 1
The effect of probiotics on the incidence of radiation-induced diarrhea.
Figure 2
Figure 2
The effect of probiotics on the incidence of radiation-induced diarrhea in patients receiving radiotherapy with or without chemotherapy.
Figure 3
Figure 3
Trial sequential analysis on the incidence of radiation-induced diarrhea.
See this image and copyright information in PMC

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