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Network meta-analysis of probiotics, prebiotics, and synbiotics for the treatment of chronic constipation in adults

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Abstract

Objective

To compare the outcomes associated with the use of probiotics, prebiotics, and synbiotics for the treatment of chronic constipation in adults.

Methods

We searched eight electronic databases from database inception to July 11, 2023, to identify randomized controlled trials (RCTs) that report efficacy and safety for the treatment of chronic constipation. The risk of bias in the included RCTs was evaluated according to the Cochrane tool, and the certainty of the evidence was assessed using the Confidence in Network Meta-Analysis framework. The analysis was conducted using R version 4.3.0.

Results

Out of the 37 RCTs, a total of 21 different types of interventions were reported, involving 3,903 patients. This NMA demonstrated that both prebiotics and synbiotics resulted in an increase in frequency of stool movements per week. Compared to placebo, lactulose (Mean difference [MD] = 3.39, 95% Confdence interval [CI] [1.13, 5.65], moderate certainty), mix2 (consisting of Lactulose and Bacillus coagulans) (MD = 3.63, 95% CI [1.37, 5.89], moderate certainty), mix6 (consisting of Lactulose and Bifidobacterium coagulans) (MD = 4.30, 95% CI [1.04, 7.54], low certainty), and mix7 (consisting of Lactulose, Bifidobacterium subtilis, and Enterococcus faecium) (MD = 4.58, 95% CI [1.35, 7.78], moderate certainty) exhibited a significant effect. Notably, mix7 demonstrated the highest probability of being the most effective intervention (94.8%). Furthermore, when compared to L. plantarum, four probiotics and two synbiotics showed significant advantages in the Patient Assessment of Constipation Symptoms (PAC-SYM) score. L. reuteri (MD = -13.74, 95% CI [-22.20, -4.66], very low certainty) exhibited a significant effect in improving the Patient Assessment of Constipation Quality of Life (PAC-QoL) score. In terms of safety, there were no statistically significant differences between the intervention and control groups in all adverse event analyses.

Conclusions

Moderate to very low evidence supports the use of lactulose and synbiotics to increase the number of weekly stool movements in patients, particularly highlighting the significant impact of synbiotics in increasing the number of weekly stool movements in patients with constipation. The use of L. paracasei showed improvements in PAC-SYM scores, while L. reuteri demonstrated enhancements in PAC-QoL scores.

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Acknowledgements

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Funding

This research is supported by the Fundamental Research Funds for the Central Universities: lzujbky-2021-ct06, lzujbky-2021-kb22.

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Author notes

  1. Xinxin Deng and Cui Liang are co-first authors.

Authors and Affiliations

  1. Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, China

    Xinxin Deng, Cui Liang, Liying Zhou, Yongsheng Wang, Wendi Liu, Shanshan Liang & Xiuxia Li

  2. Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, China

    Xinxin Deng, Cui Liang, Liying Zhou, Xu Hui, Liangying Hou, Yongsheng Wang, Wendi Liu, Shanshan Liang, Kehu Yang & Xiuxia Li

  3. Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China

    Xinxin Deng, Cui Liang, Liying Zhou, Xu Hui, Liangying Hou, Yongsheng Wang, Wendi Liu, Shanshan Liang, Kehu Yang & Xiuxia Li

  4. School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China

    Xue Shang

  5. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada

    Liang Yao

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  1. Xinxin Deng
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Contributions

Xinxin Deng: Methodology, Validation, Investigation, Resources, Data curation, Writing – original draft, Writing – review & editing, Visualization, Supervision. Cui Liang: Conceptualization, Methodology, Validation, Investigation, Resources, Data curation. Liying Zhou, Xue Shang: Conceptualization, Validation, Investigation, Visualization. Xu Hui, Liangying Hou: Validation, Investigation, Resources, Data curation. Yongsheng Wang, Wendi Liu: Investigation, Resources, Data curation. Shanshan Liang, Liang Yao: Methodology, Resources. Kehu Yang: Validation, Writing – review & editing, Visualization, Supervision. Xiuxia Li: Validation, Writing – review & editing, Visualization, Supervision.

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Correspondence to Kehu Yang or Xiuxia Li.

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Deng, X., Liang, C., Zhou, L. et al. Network meta-analysis of probiotics, prebiotics, and synbiotics for the treatment of chronic constipation in adults. Eur J Nutr (2024). https://doi.org/10.1007/s00394-024-03410-1

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