Probiotics for the Treatment of Irritable Bowel Syndrome: A Systematic Review on Randomized Controlled Trials_Chinese Journal of Evidence-Based Medicine

Authors：

SHU Xiaochuang , ZHOU Shuping , CHEN Chunyan , WANG Shaodong ,  WANG Fangyu

Department of Medical Gastroenterology, School of Medicine, Nanjing University/Nanjing General Hospital of Nanjing Military Command, Nanjing 210002, China;

Corresponding author：

WANG Fangyu, Email: wangfangyu65@yahoo.com.cn

Keywords：

Department of Medical Gastroenterology, School of Medicine, Nanjing University/Nanjing General Hospital of Nanjing

DOI：

10.7507/1672-2531.20120128

Video：

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Objective 　To evaluate the efficacy of probiotics for treating irritable bowel syndrome (IBS).
Methods 　The following databases as PubMed, The Cochrane Library, Web of Science, EMbase, MD Consult, CNKI, CBM and WanFang Data were searched from the data of their establishment to June 2011 to collect the randomized controlled trials (RCTs) on probiotics for treating IBS. The data were extracted and cross-checked independently by two reviewers, the methodological quality of trials was evaluated with Cochrane Handbook 5.0.2 criteria, and Meta-analysis was conducted using RevMan 5.1 software.
Results 　A total of 20 RCTs involving 1 713 patients were included. Results of meta-analyses showed that compared with the placebo, probiotics was statistically and significantly better in improving the overall symptoms, alleviating abdominal pain/discomfort and relieving abdominal distention.
Conlusion 　Current evidence shows probiotics may play a role in improving the symptoms of IBS. Due to a lot of differences existing among the included studies in aspects of methodological quality, diagnostic criteria, evaluation methods, dosage and course of treatment, this conclusion should be further tested with more strictly-designed and high-quality RCTs.

Citation： SHU Xiaochuang,ZHOU Shuping,CHEN Chunyan,WANG Shaodong,WANG Fangyu. Probiotics for the Treatment of Irritable Bowel Syndrome: A Systematic Review on Randomized Controlled Trials. Chinese Journal of Evidence-Based Medicine, 2012, 12(7): 840-847. doi: 10.7507/1672-2531.20120128 Copy

1.	熊理守, 陈旻湖, 陈惠新, 等. 广东省社区人群肠易激综合征的流行病学研究. 中华医学杂志, 2004, (4): 18-21.
2.	中华医学会消化病学分会胃肠动力学组. 肠易激综合征诊断和治疗的共识意见 (2007, 长沙). 中华消化杂志, 2008, 28(1): 3.
3.	Nobaek S, Johansson ML, Molin G, et al. Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Am J Gastroenterol, 2000, 95(5): 1231-1238.
4.	O’Sullivan MA, O’Morain CA. Bacterial supplementation in the irritable bowel syndrome. A randomised double-blind placebo-controlled crossover study. Dig Liver Dis, 2000, 32(4): 294-301.
5.	Kim HJ, Camilleri M, Mckinzie S, et al. A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther, 2003, 17(7): 895-904.
6.	Kajander K, Hatakka K, Poussa T, et al. A probiotic mixture alleviates symptoms in irritable bowel syndrome patients: a controlled 6-month intervention. Aliment Pharmacol Ther, 2005, 22(5): 387-394.
7.	Kim HJ, Vazquez RM, Camilleri M, et al. A randomized controlled trial of a probiotic combination VSL# 3 and placebo in irritable bowel syndrome with bloating. Neurogastroenterol Motil, 2005, 17(5): 687-696.
8.	Niv E, Naftali T, Hallak R, et al. The efficacy of Lactobacillus reuteri ATCC 55730 in the treatment of patients with irritable bowel syndrome--a double blind, placebo-controlled, randomized study. Clin Nutr, 2005, 24(6): 925-931.
9.	O’Mahony L, Mccarthy J, Kelly P, et al. Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. Gastroenterology, 2005, 128(3): 541-551.
10.	Whorwell PJ, Altringer L, Morel J, et al. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol, 2006, 101(7): 1581-1590.
11.	Guyonnet D, Chassany O, Ducrotte P, et al. Effect of a fermented milk containing Bifidobacterium animalis DN-173 010 on the health-related quality of life and symptoms in irritable bowel syndrome in adults in primary care: a multicentre, randomized, double-blind, controlled trial. Aliment Pharmacol Ther, 2007, 26(3): 475-486.
12.	Andriulli A, Neri M, Loguercio C, et al. Clinical trial on the efficacy of a new symbiotic formulation, Flortec, in patients with irritable bowel syndrome: a multicenter, randomized study. J Clin Gastroenterol, 2008, 42 Suppl 3 Pt 2(8): S218-S223.
13.	Drouault-Holowacz S, Bieuvelet S, Burckel A, et al. A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroenterol Clin Biol, 2008, 32(2): 147-152.
14.	Kajander K, Myllyluoma E, Rajilic-Stojanovic M, et al. Clinical trial: multispecies probiotic supplementation alleviates the symptoms of irritable bowel syndrome and stabilizes intestinal microbiota. Aliment Pharmacol Ther, 2008, 27(1): 48-57.
15.	Sinn DH, Song JH, Kim HJ, et al. Therapeutic effect of Lactobacillus acidophilus-SDC 2012, 2013 in patients with irritable bowel syndrome. Dig Dis Sci, 2008, 53(10): 2714-2718.
16.	Williams EA, Stimpson J, Wang D, et al. Clinical trial: a multistrain probiotic preparation significantly reduces symptoms of irritable bowel syndrome in a double-blind placebo-controlled study. Aliment Pharmacol Ther, 2008, 29(1): 97-103.
17.	Agrawal A, Houghton LA, Morris J, et al. Clinical trial: the effects of a fermented milk product containing Bifidobacterium lactis DN-173 010 on abdominal distension and gastrointestinal transit in irritable bowel syndrome with constipation. Aliment Pharmacol Ther, 2009, 29(1): 104-114.
18.	Hong KS, Kang HW, Im JP, et al. Effect of probiotics on symptoms in korean adults with irritable bowel syndrome. Gut Liver, 2009, 3(2): 101-107.
19.	Simren M, Ohman L, Olsson J, et al. Clinical trial: the effects of a fermented milk containing three probiotic bacteria in patients with irritable bowel syndrome - a randomized, double-blind, controlled study. Aliment Pharmacol Ther, 2010, 31(2): 218-227.
20.	Guglielmetti S, Mora D, Gschwender M, et al. Randomised clinical trial: Bifidobacterium bifidum MIMBb75 significantly alleviates irritable bowel syndrome and improves quality of life - a double-blind, placebo-controlled study. Aliment Pharmacol Ther, 2011, 33(10): 1123-1132.
21.	Hong YS, Hong KS, Park MH, et al. Metabonomic understanding of probiotic effects in humans with irritable bowel syndrome. J Clin Gastroenterol, 2011, 45(5): 415-425.
22.	Sondergaard B, Olsson J, Ohlson K, et al. Effects of probiotic fermented milk on symptoms and intestinal flora in patients with irritable bowel syndrome: a randomized, placebo-controlled trial. Scand J Gastroenterol, 2011, 46(6): 663-672.
23.	Horvath A, Dziechciarz P, Szajewska H. Meta-analysis: Lactobacillus rhamnosus GG for abdominal pain-related functional gastrointestinal disorders in childhood. Aliment Pharmacol Ther, 2011, 33(12): 1302-1310.
24.	Aragon G, Graham DB, Borum M, et al. Probiotic therapy for irritable bowel syndrome. Gastroenterol Hepatol (NY), 2010, 6(1): 39-44.

1. 熊理守, 陈旻湖, 陈惠新, 等. 广东省社区人群肠易激综合征的流行病学研究. 中华医学杂志, 2004, (4): 18-21.
2. 中华医学会消化病学分会胃肠动力学组. 肠易激综合征诊断和治疗的共识意见 (2007, 长沙). 中华消化杂志, 2008, 28(1): 3.
3. Nobaek S, Johansson ML, Molin G, et al. Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Am J Gastroenterol, 2000, 95(5): 1231-1238.
4. O’Sullivan MA, O’Morain CA. Bacterial supplementation in the irritable bowel syndrome. A randomised double-blind placebo-controlled crossover study. Dig Liver Dis, 2000, 32(4): 294-301.
5. Kim HJ, Camilleri M, Mckinzie S, et al. A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther, 2003, 17(7): 895-904.
6. Kajander K, Hatakka K, Poussa T, et al. A probiotic mixture alleviates symptoms in irritable bowel syndrome patients: a controlled 6-month intervention. Aliment Pharmacol Ther, 2005, 22(5): 387-394.
7. Kim HJ, Vazquez RM, Camilleri M, et al. A randomized controlled trial of a probiotic combination VSL# 3 and placebo in irritable bowel syndrome with bloating. Neurogastroenterol Motil, 2005, 17(5): 687-696.
8. Niv E, Naftali T, Hallak R, et al. The efficacy of Lactobacillus reuteri ATCC 55730 in the treatment of patients with irritable bowel syndrome--a double blind, placebo-controlled, randomized study. Clin Nutr, 2005, 24(6): 925-931.
9. O’Mahony L, Mccarthy J, Kelly P, et al. Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. Gastroenterology, 2005, 128(3): 541-551.
10. Whorwell PJ, Altringer L, Morel J, et al. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol, 2006, 101(7): 1581-1590.
11. Guyonnet D, Chassany O, Ducrotte P, et al. Effect of a fermented milk containing Bifidobacterium animalis DN-173 010 on the health-related quality of life and symptoms in irritable bowel syndrome in adults in primary care: a multicentre, randomized, double-blind, controlled trial. Aliment Pharmacol Ther, 2007, 26(3): 475-486.
12. Andriulli A, Neri M, Loguercio C, et al. Clinical trial on the efficacy of a new symbiotic formulation, Flortec, in patients with irritable bowel syndrome: a multicenter, randomized study. J Clin Gastroenterol, 2008, 42 Suppl 3 Pt 2(8): S218-S223.
13. Drouault-Holowacz S, Bieuvelet S, Burckel A, et al. A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroenterol Clin Biol, 2008, 32(2): 147-152.
14. Kajander K, Myllyluoma E, Rajilic-Stojanovic M, et al. Clinical trial: multispecies probiotic supplementation alleviates the symptoms of irritable bowel syndrome and stabilizes intestinal microbiota. Aliment Pharmacol Ther, 2008, 27(1): 48-57.
15. Sinn DH, Song JH, Kim HJ, et al. Therapeutic effect of Lactobacillus acidophilus-SDC 2012, 2013 in patients with irritable bowel syndrome. Dig Dis Sci, 2008, 53(10): 2714-2718.
16. Williams EA, Stimpson J, Wang D, et al. Clinical trial: a multistrain probiotic preparation significantly reduces symptoms of irritable bowel syndrome in a double-blind placebo-controlled study. Aliment Pharmacol Ther, 2008, 29(1): 97-103.
17. Agrawal A, Houghton LA, Morris J, et al. Clinical trial: the effects of a fermented milk product containing Bifidobacterium lactis DN-173 010 on abdominal distension and gastrointestinal transit in irritable bowel syndrome with constipation. Aliment Pharmacol Ther, 2009, 29(1): 104-114.
18. Hong KS, Kang HW, Im JP, et al. Effect of probiotics on symptoms in korean adults with irritable bowel syndrome. Gut Liver, 2009, 3(2): 101-107.
19. Simren M, Ohman L, Olsson J, et al. Clinical trial: the effects of a fermented milk containing three probiotic bacteria in patients with irritable bowel syndrome - a randomized, double-blind, controlled study. Aliment Pharmacol Ther, 2010, 31(2): 218-227.
20. Guglielmetti S, Mora D, Gschwender M, et al. Randomised clinical trial: Bifidobacterium bifidum MIMBb75 significantly alleviates irritable bowel syndrome and improves quality of life - a double-blind, placebo-controlled study. Aliment Pharmacol Ther, 2011, 33(10): 1123-1132.
21. Hong YS, Hong KS, Park MH, et al. Metabonomic understanding of probiotic effects in humans with irritable bowel syndrome. J Clin Gastroenterol, 2011, 45(5): 415-425.
22. Sondergaard B, Olsson J, Ohlson K, et al. Effects of probiotic fermented milk on symptoms and intestinal flora in patients with irritable bowel syndrome: a randomized, placebo-controlled trial. Scand J Gastroenterol, 2011, 46(6): 663-672.
23. Horvath A, Dziechciarz P, Szajewska H. Meta-analysis: Lactobacillus rhamnosus GG for abdominal pain-related functional gastrointestinal disorders in childhood. Aliment Pharmacol Ther, 2011, 33(12): 1302-1310.
24. Aragon G, Graham DB, Borum M, et al. Probiotic therapy for irritable bowel syndrome. Gastroenterol Hepatol (NY), 2010, 6(1): 39-44.

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Probiotics for the Treatment of Irritable Bowel Syndrome: A Systematic Review on Randomized Controlled Trials

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