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Comparative Study
. 2025 Jun 1;83(6):1006-1034.
doi: 10.1093/nutrit/nuae119.

Efficacy of Probiotics Compared With Pharmacological Treatments for Maintenance Therapy for Functional Constipation in Children: A Systematic Review and Network Meta-analysis

Rebecca G Harris  1   2 , Elizabeth P Neale  1   2 , Marijka Batterham  2   3
Affiliations
Comparative Study

Efficacy of Probiotics Compared With Pharmacological Treatments for Maintenance Therapy for Functional Constipation in Children: A Systematic Review and Network Meta-analysis

Rebecca G Harris et al. Nutr Rev. .

Abstract

Context: There has been an increase in randomized controlled trials (RCTs) comparing probiotics with various maintenance therapies, such as polyethylene glycol, lactulose, and mineral oil, to treat functional constipation in children.

Objective: The aim was to compare probiotics with all other oral maintenance therapies for functional constipation in children and rank all treatments in terms of effectiveness in a network meta-analysis.

Methods: RCTs were identified through systematically searching the MEDLINE, Scopus, EMBASE, and Cochrane Library databases, trial registries, and forward and backward citation searching. Within-study risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and confidence in the estimates was assessed using the CINeMA (Confidence in Network Meta-Analysis) framework. Random-effects network meta-analyses were conducted.

Results: Data were pooled from 41 and 29 RCTs for network meta-analysis of defecation frequency and treatment success, respectively. Probiotics did not significantly increase the number of bowel movements per week when compared with any conventional treatment or placebo. A combination of mineral oil and probiotics was the most effective treatment for increasing defecation frequency (mean difference: 3.13; 95% confidence interval [CI]: 0.64, 5.63). The most effective treatments for increasing the risk of treatment success as compared with placebo were mineral oil (relative risk [RR]: 2.41; 95% CI: 1.53, 3.81) and a combined treatment of polyethylene glycol and lactulose (RR: 2.45; 95% CI: 1.21, 4.97). Confidence in the estimates ranged from very low to moderate.

Conclusion: Currently, there is no evidence to suggest that probiotics should be used as a standalone treatment for functional constipation in children. More high-quality studies are needed to evaluate different strains of probiotics and their potential benefit as an additional treatment component to conventional treatments. Mineral oil and polyethylene glycol were the most effective treatments to increase defecation frequency and treatment success rates and should remain the first line of treatment for children with functional constipation.

Systematic review registration: PROSPERO registration no.

CRD42022360977 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=360977).

Keywords: children; functional constipation; laxatives; maintenance therapy; network meta-analysis; probiotics; randomized controlled trials; systematic review.

PubMed Disclaimer

Conflict of interest statement

None declared.

Figures

Figure 1.
Figure 1.
Flow Diagram Describing the Study Selection Process. *Trial protocols published in online registries identified by the search were matched to published articles of the corresponding RCTs where available. Abbreviations: FC, functional constipation; RCT, randomized controlled trial
Figure 2.
Figure 2.
Network Plot Showing Direct Comparisons Between Treatments for the Outcome of Defecation Frequency. The thickness of lines corresponds to the number of trials comparing the linked treatments. The sizes of the nodes (blue circles) correspond to the number of participants randomized to each treatment. Abbreviation: PEG, polyethylene glycol
Figure 3.
Figure 3.
Forest Plot Depicting the Treatment Effects of Conventional Treatments and Placebo as Compared With Probiotics From Random-Effects Network Meta-analysis of Defecation Frequency. Pooled effect estimates (squares) with 95% CIs are shown for standard network meta-analysis. Treatments are ordered from highest to lowest P scores (probability of being the most effective treatment) from the standard network meta-analysis model. Abbreviations: BM, bowel movement; CI, confidence interval; MD, mean difference; PEG, polyethylene glycol
Figure 4.
Figure 4.
Network Plot Showing Direct Comparisons Between Treatments for the Outcome of Treatment Success. The thickness of lines corresponds to the number of trials comparing the linked treatments. The sizes of the nodes (blue circles) correspond to the number of participants randomized to each treatment. Abbreviation: PEG, polyethylene glycol
Figure 5.
Figure 5.
Forest Plot Depicting the Treatment Effects of Conventional Treatments and Placebo as Compared With Probiotics From Random-Effects Network Meta-analysis of Treatment Success. Pooled effect estimates (squares) with 95% CIs are shown for both standard network meta-analyses. Treatments are ordered from highest to lowest P scores (probability of being the most effective treatment) from the standard network meta-analysis model. Abbreviations: CI, confidence interval; MD, mean difference; PEG, polyethylene glycol; RR, relative risk
See this image and copyright information in PMC

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