Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol

Department of Health Services Research and Development, VA Puget Sound Health Care System, Seattle WA 98101, United States.
World Journal of Gastroenterology (Impact Factor: 2.37). 06/2008; 14(17):2650-61. DOI: 10.3748/wjg.14.2650
Source: PubMed


Irritable bowel syndrome (IBS) is a chronic condition affecting 3%-25% of the general population. As no curative treatment is available, therapy is aimed at reducing symptoms, often with little success. Because alteration of the normal intestinal microflora has been observed in IBS, probiotics (beneficial microbes taken to improve health) may be useful in reducing symptoms. This paper systematically reviews randomized, controlled, blinded trials of probiotics for the treatment of IBS and synthesizes data on efficacy across trials of adequate quality. PubMed, Medline, Google Scholar, NIH registry of clinical trials, metaRegister, and the Cochrane Central Register of Controlled Trials were searched from 1982-2007. We also conducted secondary searches of reference lists, reviews, commentaries, relevant articles on associated diseases, books and meeting abstracts. Twenty trials with 23 probiotic treatment arms and a total of 1404 subjects met inclusion criteria. Probiotic use was associated with improvement in global IBS symptoms compared to placebo [pooled relative risk (RR pooled) 0.77, 95% confidence interval (95% CI) 0.62-0.94]. Probiotics were also associated with less abdominal pain compared to placebo [RR pooled = 0.78 (0.69-0.88)]. Too few studies reported data on other IBS symptoms or on specific probiotic strains to allow estimation of a pooled RR. While our analyses suggest that probiotic use may be associated with improvement in IBS symptoms compared to placebo, these results should be interpreted with caution, given the methodological limitations of contributing studies. Probiotics warrant further study as a potential therapy for IBS.

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    • "Furthermore , the differences in the proportion of patients with bowel symptoms, the mean changes of colorectal cancer-related quality of life scores, and functional well-being scores were significantly greater in the probiotic group compared with the placebo group. Recent studies have revealed many beneficial effects of probiotics on human health, especially the positive effects of probiotics on bowel symptoms in IBS patients131415. In addition, emerging data suggest a protective role of probiotics on colorectal carcinogenesis . Probiotics are considered to have chemo-preventive effects against colorectal cancer by producing anti-tumour agents [24], enhancing host immune function [25,26], and binding carcinogens [10,27]. "
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    ABSTRACT: Probiotics may help resolve bowel symptoms and improve quality of life. We investigated the effects of 12 weeks of probiotics administration in colorectal cancer patients. We conducted a double-blind, randomized, placebo-controlled trial. The participants took probiotics (Lacidofil) or placebo twice a day for 12 weeks. The cancer-related quality of life (FACT), patient's health-9 (PHQ-9), and bowel symptom questionnaires were completed by each participant. We obtained data for 32 participants in the placebo group and 28 participants in the probiotics group. The mean ages of total participants were 56.18±8.86 years and 58.3% were male. Administration of probiotics significantly decreased the proportion of patients suffering from irritable bowel symptoms (0 week vs. 12 week; 67.9% vs. 45.7%, p=0.03), improved colorectal cancer-related FACT (baseline vs. 12 weeks: 19.79±4.66 vs. 21.18±3.67, p=0.04) and fatigue-related FACT (baseline vs. 12 weeks: 43.00 (36.50-45.50) vs. 44.50 (38.50-49.00), p=0.02) and PHQ-9 scores (0 weeks vs. 12 weeks; 3.00 (0-8.00) vs. 1.00 (0-3.00), p=0.01). We found significant differences in changes of the proportion of patients with bowel symptoms (p<0.05), functional well-being scores (p=0.04) and cancer-related FACT scores (p=0.04) between the two groups. Probiotics improved bowel symptoms and quality of life in colorectal cancer survivors. Copyright © 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
    Full-text · Article · Dec 2014 · Digestive and Liver Disease
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    • "Based on this latter possibility, therapeutic approaches designed to manipulate gut flora with the replenishment of probiotics have been tested in both of patients and animal models with IBS. Several systematic reviews and meta-analyses report that probiotics have a statistically significant effect in improving overall and individual symptoms of IBS patients[11], [12], [13], [14], [15], [16]. Unfortunately, studies of the curative effect of probiotics in IBS have usually, but not always, been positive. "
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    ABSTRACT: Research has increasingly suggested that gut flora plays an important role in the development of post-infectious irritable bowel syndrome (PI-IBS). Studies of the curative effect of probiotics for IBS have usually been positive but not always. However, the differences of treatment effects and mechanisms among probiotic stains, or mixture of them, are not clear. In this study, we compared the effects of different probiotics (Befidobacterium, Lactobacillus, Streptococcus or mixture of the three) on intestinal sensation, barrier function and intestinal immunity in PI-IBS mouse model.
    Full-text · Article · Mar 2014 · PLoS ONE
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    • "It has been shown that factors related to IBD include acquired factors (e.g., smoking and diet), pathogens, genetic factors, and irregular immune system [2]. Over the past decades, the homeostatic functions of microflora on host GI tract have attracted much attention because growing numbers of clinical studies have suggested that probiotics exhibit anti-inflammatory effects on IBD patients [3,4]. Arseneau et al. [5] suggested that innate immune responses play an equally significant, even more primary character compared with adaptive immune responses in IBD initiation and progression due to the observation that probiotics elicit anti- inflammatory effects in the GI tract by means of mucosal innate immune system stimulation, instead of suppression. "
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    ABSTRACT: Crohn's disease and ulcerative colitis are the major types of chronic inflammatory bowel disease occurring in the colon and small intestine. A growing body of research has proposed that probiotics are able to attenuate the inflammatory symptoms of these diseases in vitro and in vivo. However, the mechanism of probiotic actions remains unclear. Our results suggested Lactobacillus plantarum MYL26 inhibited inflammation in Caco-2 cells through regulation of gene expressions of TOLLIP, SOCS1, SOCS3, and IkappaBalpha, rather than SHIP-1 and IRAK-3. We proposed that live/ heat-killed Lactobacillus plantarum MYL26 and bacterial cell wall extract treatments impaired TLR4-NFkappab signal transduction through Tollip, SOCS-1 and SOCS-3 activation, thus inducing LPS tolerance. Our findings suggest that either heat-killed probiotics or probiotic cell wall extracts are able to attenuate inflammation through pathways similar to that of live bacteria.
    Full-text · Article · Aug 2013 · BMC Microbiology
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