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. 2023 Jan 10:13:1007654.
doi: 10.3389/fphar.2022.1007654. eCollection 2022.

Efficacy and safety of probiotics in Parkinson's constipation: A systematic review and meta-analysis

Li Xie  1 , Dongmei Chen  1 , Xinghui Zhu  1 , Cisong Cheng  1
Affiliations

Efficacy and safety of probiotics in Parkinson's constipation: A systematic review and meta-analysis

Li Xie et al. Front Pharmacol. .

Abstract

Background: Parkinson's disease (PD) is the most common neurodegenerative disease closely related to the immune system, among whose prodromes constipation is a representative symptom. Recent Randomized Controlled Trials (RCTs) have proved that probiotics can be used to effectively treat PD constipation, but the results are inconsistent. We performed a meta-analysis to assess the efficacy and safety of probiotic therapy on Parkinson's constipation. Methods: Questions about the research focus were constructed based on the Participants, Intervention, Comparison and Outcomes (PICO) Criteria. We searched electronic databases such as PubMed, Web of Science, EMBASE, Scopus, EBSCO, Cochrane and Google Scholar until March 2022 for eligible literatures. Our primary endpoints were stool frequency, stool consistency, the number of laxatives uses, UPDRS-III scores and adverse events. Results: 12 eligible studies (n = 818 patients) met the inclusion and endpoint criteria. Meta-analysis results showed that constipation symptoms were improved after probiotic treatment, including an increased stool frequency (WMD = 0.94, 95% CI:0.53 to 1.34; OR = 3.22, 95% CI:1.97-5.29), an improved stool consistency (WMD = 1.46, 95% CI:0.54-2.37), a reduced use of laxatives (WMD = -0.72, 95%CI: -1.04 to-0.41), and also a reduced Parkinson's UPDRS-III score (WMD = -6.58, 95%CI: -12.02 to -1.14); there was no significant difference in total adverse events (OR = 0.82, 95%CI:0.39-1.72). Conclusion: Our analysis suggests that probiotics can be used to improve the constipation and motor symptoms for patients with Parkinson's constipation, possibly by reducing the inflammatory response and improving gut-brain axis neuron function, whose safety also proved to be good.

Keywords: Parkinson's disease; constipation; gut-brain axis; inflammation; meta-analysis; probiotics.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart of literature retrieval and extraction.
FIGURE 2
FIGURE 2
Evaluation of the risk of bias biases in all RCTs. RCTs in all groups were at the risk of biases, a low risk of biases (+), a high risk of biases (-) or an unknown risk of biases (?).
FIGURE 3
FIGURE 3
Forest plot of Stool frequency in the probiotic intervention group versus that of the control group with MD and a 95% CI analysis using a random-effects effect model.
FIGURE 4
FIGURE 4
Forest plot of Stool frequency in the probiotic intervention group versus that of the control group. Fixed-effects models were used to analyze OR and 95% CI.
FIGURE 5
FIGURE 5
Forest plot of Stool consistency in the probiotic intervention group versus that of the control group, a random-effects model was used to analyze MD and 95% CI.
FIGURE 6
FIGURE 6
Forest plot of the Number of laxatives used in the probiotic intervention group versus that of the control group, with MD and a 95% CI analysis using a random-effects model.
FIGURE 7
FIGURE 7
Forest plot of UPDRS-III scores in the probiotic intervention group versus that of the control group, with MD and a 95% CI analysis using a random-effects model.
FIGURE 8
FIGURE 8
Forest plot of adverse effects in the probiotic intervention group versus that of the control group, with OR and a 95% CI analyzed analysis using a fixed-effects model.
FIGURE 9
FIGURE 9
Publication bias analysis funnel plot.
FIGURE 10
FIGURE 10
Mechanism of PD causing constipation.
FIGURE 11
FIGURE 11
Potential mechanisms of the probiotic modulation in PD constipation.
See this image and copyright information in PMC

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