Outcome-Specific Efficacy of Different Probiotic Strains and Mixtures in Irritable Bowel Syndrome: A Systematic Review and Network Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy and Eligibility Criteria
- RCTs that compared the efficacy of probiotics with placebo or different probiotics for IBS;
- Participants were diagnosed with IBS based on Rome I, II, III, or IV criteria, Manning criteria, or physician’s opinion;
- Patients in the test group received single or multistrain probiotics;
- Patients in the control group received placebo or another probiotic;
- RCTs should report at least one of the targeted outcomes (see 2.2 Outcome assessment). Outcomes should be reported as data at baseline and endpoint, or as absolute changes during the study;
- The treatment duration was at least two weeks.
- Open-label trials, single-arm studies, nonrandomized trials, reviews, protocols, and letters. Crossover RCTs that did not report data from the first stage were excluded;
- Duplicate study;
- Studies involving pregnant or lactating mothers, patients with a history of gastrointestinal surgery, and patients aged < 18 years;
- Studies involving patients who received combined treatments, such as synbiotics, antibiotics, antidepressants, and psychological therapy.
2.2. Outcome Assessment
2.3. Data Extraction
2.4. Risk of Bias and Evidence Quality
2.5. Statistical Analysis
2.6. Efficacy Classification
- Level A (among the most effective): probiotics that are significantly superior to placebo and at least one probiotic at Level B;
- Level B: probiotics that are more effective than placebo, but not superior to any other probiotic(s) superior to placebo;
- Level C (among the least effective): probiotics with no significant difference compared with placebo.
3. Results
3.1. Characteristics of Included Studies
3.2. Risk of Bias within Studies
3.3. Critical Results of Network Meta-Analysis
3.3.1. IBS-SSS
3.3.2. IBS-QOL
3.3.3. HADS Score
3.3.4. Abdominal Pain Score
3.3.5. Abdominal Bloating Score
3.3.6. Bowel Movement Frequency (Per Week) in the IBS-D and IBS-C Groups
3.3.7. Bristol Stool form Scale in IBS-D and IBS-C
3.4. Adverse Events
3.5. Heterogeneity and Inconsistency
3.6. Quality of Evidence
3.7. Alteration of Gut Microbiota
4. Discussion
4.1. Key Findings
4.2. Associations with Current Studies
4.3. Study Merits and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Outcome | Efficacy Level A 1 | Efficacy Level B | Efficacy Level C | ||||
---|---|---|---|---|---|---|---|
Probiotic | NMA 2 | GRADE | Probiotic | NMA | GRADE | Probiotic | |
IBS-SSS | L. acidophilus DDS-1 | −77.70 (−101.72, −53.68) | M | EF + LA + X | −35.00 (−60.44, −9.56) | M | L. acidophilus ATCC 700396, L. plantarum 299v, L. plantarum CCFM8610, L. casei LCR35, L. paracasei HA-196, B. longum R0175, BAL + ST + LB, LR + PF + X |
BL + LR | −80.99 (−130.73, −31.26) | M | B. bifidum MIMBb75 | −29.83 (−48.24, −11.42) | H | ||
LC + LP + BAL | −76.42 (−114.90, −37.95) | M | C. butyricum CGMCC0313.1 | −21.38 (−40.47, −2.29) | H | ||
LP + LC + BL + ST + LA + X | −63.96 (−78.66, −49.26) | M | BAL + LA + BB + X | −18.86 (−25.88, −11.85) | M | ||
B. lactis UABla-12 | −48.80 (−73.00, −24.60) | M | |||||
IBS-QOL | LP + LC + BL + ST + LA + X | 24.80 (20.65, 28.95) | M | C. butyricum CGMCC0313.1 | 4.07 (0.50, 7.65) | H | LP + LC + BL + ST + LA + X, S. boulardii CNCM I-475, LC + LP + BAL, LA + LR + ST + BL + BBR + X, EF + LA + X, BAL + ST + LB, LPA + LA + BAL, L. acidophilus ATCC 700396 |
HADS-total score | B. longum R0175 | −0.34 (−0.48, −0.20) | H | None | L. paracasei HA-196, L. acidophilus ATCC 700396 | ||
HADS-anxiety | None | None | B. longum NCC3001, L. acidophilus ATCC 700396, LPA + LA + BAL | ||||
HADS-depression | B. longum NCC3001 | −3.00 (−4.92, −1.08) | H | None | L. paracasei CNCM I-1572, L. acidophilus ATCC 700396, LPA + LA + BAL |
Outcome | Efficacy Level A 1 | Efficacy Level B | Efficacy Level C | ||||
---|---|---|---|---|---|---|---|
Probiotic | NMA 2 | GRADE | Probiotic | NMA | GRADE | Probiotic | |
Abdominal pain score | B. coagulans MTCC 5856 | −41.80 (−61.59, −22.00) | M | L. gasseri BNR17 | −36.10 (−64.53, −7.67) | M | BL + LR, L. acidophilus SDC 2012,2013, B. lactis UABla-12, BAL + LA + BB + X, LR + PF + X, LA + LR + ST + BL + BBR + X, B. bifidum MIMBb75, LP + LP + PA, LP + LC + BL + ST + LA + X, LA + LA, C. butyricum CGMCC0313.1, L. plantarum 299v, L. acidophilus ATCC 700396, L. casei LCR35, BAL + ST + LB, LPA + LA + BAL, BAL + LA + LR + X, S. boulardii CNCM I-475, B. infantis 35624, L. plantarum CCFM8610 |
B. coagulans Unique IS2 | −32.00 (−45.35, −18.65) | M | L. plantarum Apsulloc 331261 | −26.59 (−47.07, −6.11) | M | ||
L. acidophilus DDS-1 | −19.53 (−33.49, −5.57) | M | |||||
LPA + LS + LP | −20.00 (−35.97, −4.03) | L | |||||
S. cerevisiae CNCM I-3856 | −15.24 (−24.62, −5.87) | M | |||||
VSL#3 | −12.93 (−25.59, −0.26) | L | |||||
EF + LA + X | −11.37 (−21.68, −1.06) | M | |||||
LA + ST + X | −8.14 (−15.54, −0.75) | M | |||||
Abdominal bloating score | None | BL + LR | −34.00 (−56.94, −11.06) | M | B. coagulans MTCC 5856, L. plantarum Apsulloc 331261, L. acidophilus DDS-1, LR + PF + X, LA + ST + X, B. coagulans Unique IS2, S. cerevisiae CNCM I-3856, BAL + LA + BB + X, B. lactis UABla-12, LP + LC + BL + ST + LA + X, EF + LA + X, LA + LR + ST + BL + BBR + X, L. acidophilus ATCC 700396, BAL + LA + LR + X, S. boulardii CNCM I-475, C. butyricum CGMCC0313.1, BAL + ST + LB, B. infantis 35624, LPA + LA + BAL | ||
L. plantarum CCFM8610 | −19.92 (−34.91, −4.94) | M | |||||
L. plantarum 299v | −14.79 (−29.11, −0.48) | M | |||||
VSL#3 | −13.71 (−22.12, −5.30) | L | |||||
B. bifidum MIMBb75 | −11.83 (−22.93, −0.74) | M |
Outcome | Efficacy Level A 1 | Efficacy Level B | Efficacy Level C | ||||
---|---|---|---|---|---|---|---|
Probiotic | Network Meta-Analysis 2 | GRADE | Probiotic | Network Meta-Analysis | GRADE | Probiotic | |
Bowel movement frequency (IBS-D) | EF + LA + X | −3.95 (−5.02, −2.88) | M | L. paracasei B21060 | −5.11 (−9.98, −0.24) | H | L. plantarum Apsulloc 331261, LP + LC + BL + ST + LA + X, C. butyricum CGMCC0313.1, S. cerevisiae CNCM I-3856, S. boulardii CNCM I-475 |
L. paracasei HA-196 | −3.13 (−4.63, −1.62) | H | |||||
B. coagulans GBI-306086 | −2.11 (−3.00, −1.23) | M | |||||
B. longum R0175 | −1.95 (−3.45, −0.45) | H | |||||
Bowel movement frequency (IBS-C) | None | None | B. bifidum MIMBb75, LA + ST + X, S. cerevisiae CNCM I-3856, L. paracasei HA-196, B. coagulans Unique IS2, B. longum R0175, BAL + ST + LB | ||||
Bristol stool form scale (IBS-D) | B. coagulans MTCC 5856 | −3.28 (−5.21, −1.34) | L | BL + LR | −0.80 (−1.57, −0.03) | L | L. paracasei HA-196, B. bifidum MIMBb75, VSL#3, C. butyricum CGMCC0313.1, B. longum R0175, LP + LC + BL + ST + LA + X, S. boulardii CNCM I-475 |
S. cerevisiae CNCM I-3856 | −1.24 (−1.63, −0.86) | L | LA + LR + ST + BL + BBR + X | −0.70 (−1.32, −0.08) | M | ||
LP + LP + PA | −0.50 (−0.76, −0.24) | L | |||||
Bristol stool form scale (IBS-C) | None | None | L. paracasei HA-196, S. cerevisiae CNCM I-3856, B. longum R0175, BAL + ST + LB |
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Xie, P.; Luo, M.; Deng, X.; Fan, J.; Xiong, L. Outcome-Specific Efficacy of Different Probiotic Strains and Mixtures in Irritable Bowel Syndrome: A Systematic Review and Network Meta-Analysis. Nutrients 2023, 15, 3856. https://doi.org/10.3390/nu15173856
Xie P, Luo M, Deng X, Fan J, Xiong L. Outcome-Specific Efficacy of Different Probiotic Strains and Mixtures in Irritable Bowel Syndrome: A Systematic Review and Network Meta-Analysis. Nutrients. 2023; 15(17):3856. https://doi.org/10.3390/nu15173856
Chicago/Turabian StyleXie, Peiwei, Mei Luo, Xuehong Deng, Jiahui Fan, and Lishou Xiong. 2023. "Outcome-Specific Efficacy of Different Probiotic Strains and Mixtures in Irritable Bowel Syndrome: A Systematic Review and Network Meta-Analysis" Nutrients 15, no. 17: 3856. https://doi.org/10.3390/nu15173856
APA StyleXie, P., Luo, M., Deng, X., Fan, J., & Xiong, L. (2023). Outcome-Specific Efficacy of Different Probiotic Strains and Mixtures in Irritable Bowel Syndrome: A Systematic Review and Network Meta-Analysis. Nutrients, 15(17), 3856. https://doi.org/10.3390/nu15173856