Review

Review

Efficacy of Prebiotics, Probiotics, and Synbiotics in Irritable Bowel Syndrome and Chronic Idiopathic Constipation: Systematic Review and Meta-analysis

  • The American Journal of Gastroenterology (2014) 109, 15471561 (2014)
  • doi:10.1038/ajg.2014.202
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Abstract

OBJECTIVES:

Irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC) are functional bowel disorders. Evidence suggests that disturbance in the gastrointestinal microbiota may be implicated in both conditions. We performed a systematic review and meta-analysis to examine the efficacy of prebiotics, probiotics, and synbiotics in IBS and CIC.

METHODS:

MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (up to December 2013). Randomized controlled trials (RCTs) recruiting adults with IBS or CIC, which compared prebiotics, probiotics, or synbiotics with placebo or no therapy, were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI). Continuous data were pooled using a standardized or weighted mean difference with a 95% CI.

RESULTS:

The search strategy identified 3,216 citations. Forty-three RCTs were eligible for inclusion. The RR of IBS symptoms persisting with probiotics vs. placebo was 0.79 (95% CI 0.70–0.89). Probiotics had beneficial effects on global IBS, abdominal pain, bloating, and flatulence scores. Data for prebiotics and synbiotics in IBS were sparse. Probiotics appeared to have beneficial effects in CIC (mean increase in number of stools per week=1.49; 95% CI=1.02–1.96), but there were only two RCTs. Synbiotics also appeared beneficial (RR of failure to respond to therapy=0.78; 95% CI 0.67–0.92). Again, trials for prebiotics were few in number, and no definite conclusions could be drawn.

CONCLUSIONS:

Probiotics are effective treatments for IBS, although which individual species and strains are the most beneficial remains unclear. Further evidence is required before the role of prebiotics or synbiotics in IBS is known. The efficacy of all three therapies in CIC is also uncertain.

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Acknowledgements

We thank Peter Bytzer, Philippe Ducrotte, Paul Enck, Per Farup, Simone Guglielmetti, Lesley Houghton, Solveig Ligaarden, Julie Morris, Yehuda Ringel, Magnus Simren, and Bo Sondergaard for responding to our queries about their papers and, in some instances, providing us with extra data.

Author information

Affiliations

  1. Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK

    • Alexander C Ford
  2. Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK

    • Alexander C Ford
  3. Division of Gastroenterology and Hepatology, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA

    • Eamonn M M Quigley
  4. Dartmouth-Hitchcock Medical Center, Gastroenterology, One Medical Center Drive, Lebanon, New Hampshire, USA

    • Brian E Lacy
  5. The Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    • Anthony J Lembo
  6. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA

    • Yuri A Saito
  7. Digestive Health Associates of Texas, Baylor University Medical Center, Dallas, Texas, USA

    • Lawrence R Schiller
  8. Division of Gastroenterology at Cedars-Sinai, University of Southern California, Los Angeles, California, USA

    • Edy E Soffer
  9. Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA

    • Brennan M R Spiegel
  10. Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, Ontario, Canada

    • Paul Moayyedi

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Competing interests

Guarantor of the article: Alexander C. Ford, MBChB, MD.

Specific author contributions: A.C.F., E.M.M.Q., B.E.L. A.J.L., Y.A.S., L.R.S., E.E.S., B.M.R.S., and P.M. conceived the study; A.C.F. and P.M. collected all data; A.C.F. and P.M. analyzed and interpreted the data; A.C.F. drafted the manuscript; and all authors commented on the drafts of the paper and approved the final draft of the manuscript.

Financial support: This work was supported by American College of Gastroenterology.

Potential competing interests: None.

Corresponding author

Correspondence to Alexander C Ford.

Supplementary information

SUPPLEMENTARY MATERIAL is linked to the online version of the paper at http://www.nature.com/ajg