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The effects of probiotics on gastrointestinal symptoms and microbiota in patients with celiac disease: a systematic review and meta-analysis on clinical trials

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Abstract

Gluten-free diet (GFD) is the most effective method to manage celiac disease (CD). Many patients do not reach the complete symptom alleviation, even by strict GFD. Recent studies have reported inconsistent results regarding the beneficial benefits of taking probiotics. Therefore, we aimed to evaluate the effects of probiotics on gastrointestinal (GI) symptoms and the possible underlying causes in CD and celiac disease autoimmunity (CDA) patients. Databases, including PubMed, Scopus, Embase, Web of Science and Google Scholar, were searched for clinical trials published until July 2022 about assessing the effects of probiotics or synbiotics on CD or CDA patients. We collected data on GI symptoms, CD markers, inflammatory and immune responses, adverse events, and gut microbiota. A random effect meta-analysis was used to estimate the pooled standardized mean difference (SMD) and confidence interval (CI). We screened 7234 articles, of which 14 were included in the qualitative analysis and 5 in the quantitative analysis. Probiotics might alleviate GI symptoms, especially in the highly symptomatic patients, and improve immune response in CD and CDA patients. Results of the meta-analysis showed that probiotics increased the abundance of Bifidobacterium (SMD: 0.72, 95%CI (0.13, 1.30) and Lactobacillus (SMD: 0.49, 95%CI (0.18, 0.80) as compared with placebo. Probiotics did not increase the adverse events compared to the placebo. Probiotics might alleviate GI symptoms and immune response and improve dysbiosis in CD and CDA patients. However, high-quality clinical trials are needed to increase the level of evidence. Also, the most suitable combination of probiotics is yet to find.

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Acknowledgements

The authors would like to appreciate the Clinical Research Development Unit of Shahid Rajaei Hospital, Alborz University of Medical Sciences, Karaj, Iran, for their administrative cooperation.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Author notes

  1. Hanieh-Sadat Ejtahed and Mostafa Qorbani equally contributed as corresponding authors.

Authors and Affiliations

  1. Clinical Research Development Unit, Alborz University of Medical Sciences, Karaj, Iran

    Mohammadhossein Mozafarybazargany

  2. Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran

    Mohammadian Khonsari

  3. Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran

    Leily Sokoty & Mostafa Qorbani

  4. Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Hanieh-Sadat Ejtahed

  5. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Hanieh-Sadat Ejtahed

  6. Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Mostafa Qorbani

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  1. Mohammadhossein Mozafarybazargany
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Contributions

H–S and MQ conceptualized the study. MM and LS developed the search strategy and performed the literature search. MM and NMK extracted the data. NMK performed the meta-analysis. MM, NMK, and H-SE prepared the draft. H-SE and MQ supervised the team. All authors critically revised the manuscript for important intellectual content and gave final approval to publish the version.

Corresponding authors

Correspondence to Hanieh-Sadat Ejtahed or Mostafa Qorbani.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical considerations

The study protocol was approved by Ethic Committee of Alborz University of Medical Sciences, Karaj, Iran.

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Mozafarybazargany, M., Khonsari, M., Sokoty, L. et al. The effects of probiotics on gastrointestinal symptoms and microbiota in patients with celiac disease: a systematic review and meta-analysis on clinical trials. Clin Exp Med 23, 2773–2788 (2023). https://doi.org/10.1007/s10238-022-00987-x

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