A Systematic Review of Probiotic Interventions for Gastrointestinal Symptoms and Irritable Bowel Syndrome in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME)
- 393 Downloads
Gastrointestinal (GI) symptoms and irritable bowel (IB) symptoms have been associated with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). The aim of this study was to conduct a systematic review of these symptoms in CFS/ME, along with any evidence for probiotics as treatment. Pubmed, Scopus, Medline (EBSCOHost) and EMBASE databases were searched to source relevant studies for CFS/ME. The review included any studies examining GI symptoms, irritable bowel syndrome (IBS) and/or probiotic use. Studies were required to report criteria for CFS/ME and study design, intervention and outcome measures. Quality assessment was also completed to summarise the level of evidence available. A total of 3381 publications were returned using our search terms. Twenty-five studies were included in the review. Randomised control trials were the predominant study type (n = 24). Most of the studies identified examined the effect of probiotic supplementation on the improvement of IB symptoms in IBS patients, or IB symptoms in CFS/ME patients, as well as some other significant secondary outcomes (e.g. quality of life, other gastrointestinal symptoms, psychological symptoms). The level of evidence identified for the use of probiotics in IBS was excellent in quality; however, the evidence available for the use of probiotic interventions in CFS/ME was poor and limited. There is currently insufficient evidence for the use of probiotics in CFS/ME patients, despite probiotic interventions being useful in IBS. The studies pertaining to probiotic interventions in CFS/ME patients were limited and of poor quality overall. Standardisation of protocols and methodology in these studies is required.
KeywordsChronic fatigue syndrome Myalgic encephalomyelitis Gastrointestinal symptoms Irritable bowel symptoms Probiotics
Gratitude is extended to Dr. Samantha Johnston for assistance with this manuscript.
MC designed the study, search strategy, performed the searches and screenings, analysis, primary quality assessment, and wrote the draft and final manuscript. NC completed the secondary quality assessment and provided consultation on the writing of the manuscript. DS critically reviewed the drafts and provided input for the final manuscript. SMG supervised the study, critically reviewed the drafts and provided input for the final manuscript. MC, DS and SMG all critically reviewed the final version of the manuscript and approved it for publication.
Compliance with Ethical Standards
The lead author confirms that this manuscript is an accurate, honest and transparent account of the study undertaken and being reported, with no aspects being omitted and any discrepancies explained. The reporting of this work is compliant with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
Conflict of Interest
The authors declare that they have no conflicts of interest.
- 1.Campagnolo N, Johnston S, Collatz A, Staines D, Marshall-Gradisnik S (2017) Dietary and nutrition interventions for the therapeutic treatment of chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review. J Hum Nutr Diet 30(3):247–259. https://doi.org/10.1111/jhn.12435 CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A (1994) The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med 121(12):953–959. https://doi.org/10.7326/0003-4819-121-12-199412150-00009 CrossRefPubMedGoogle Scholar
- 5.Johnston S, Brenu E, Staines D, Marshall-Gradisnik (2013) The prevalence of chronic fatigue syndrome/ myalgic encephalomyelitis: a meta-analysis. Clin Epidemiol:105. https://doi.org/10.2147/CLEP.S39876
- 13.Kennedy G, Abbot NC, Spence V, Underwood C, Belch JJ (2004) The specificity of the CDC-1994 criteria for chronic fatigue syndrome: comparison of health status in three groups of patients who fulfill the criteria. Ann Epidemiol 14(2):95–100. https://doi.org/10.1016/j.annepidem.2003.10.004 CrossRefPubMedGoogle Scholar
- 17.Jain AK, Carruthers BM, van de Sande MI, Barron SR, Donaldson CCS, Dunne JV, Gingrich E, Heffez DS, Leung FYK, Malone DG, Romano TJ, Russell IJ, Saul D, Seibel DG (2003) Fibromyalgia syndrome: Canadian clinical working case definition, diagnostic and treatment protocols—a consensus document. J Musculoskelet Pain 11(4):3–107. https://doi.org/10.1300/J094v11n04_02 CrossRefGoogle Scholar
- 18.Abbas Z, Yakoob J, Jafri W, Ahmad Z, Azam Z, Usman MW, Shamim S, Islam M (2014) Cytokine and clinical response to Saccharomyces boulardii therapy in diarrhea-dominant irritable bowel syndrome: a randomized trial. Eur J Gastroenterol Hepatol 26:630–639. https://doi.org/10.1097/MEG.0000000000000094 CrossRefPubMedGoogle Scholar
- 19.Andriulli A, Neri M, Loguercio C, Terreni N, Merla A, Cardarella MP, Federico A, Chilovi F, Milandri GL, de Bona M, Cavenati S, Gullini S, Abbiati R, Garbagna N, Cerutti R, Grossi E (2008) Clinical trial on the efficacy of a new symbiotic formulation, Flortec, in patients with irritable bowel syndrome: a multicenter, randomized study. J Clin Gastroenterol 42(Suppl 3 Pt 2):S218–S223. https://doi.org/10.1097/MCG.0b013e31817fadd6 CrossRefPubMedGoogle Scholar
- 20.Begtrup LM, de Muckadell OBS, Kjeldsen J, Christensen RP, Jarbøl DE (2013) Long-term treatment with probiotics in primary care patients with irritable bowel syndrome—a randomised, double-blind, placebo controlled trial. Scand J Gastroenterol 48(10):1127–1135. https://doi.org/10.3109/00365521.2013.825314 CrossRefPubMedGoogle Scholar
- 21.Cappello C, Tremolaterra F, Pascariello A, Ciacci C, Iovino P (2013) A randomised clinical trial (RCT) of a symbiotic mixture in patients with irritable bowel syndrome (IBS): effects on symptoms, colonic transit and quality of life. Int J Color Dis 28(3):349–358. https://doi.org/10.1007/s00384-012-1552-1 CrossRefGoogle Scholar
- 22.Dapoigny M, Piche T, Ducrotte P, Lunaud B, Cardot JM, Bernalier-Donadille A (2012) Efficacy and safety profile of LCR35 complete freeze-dried culture in irritable bowel syndrome: a randomized, double-blind study. World J Gastroenterol 18(17):2067–2075. https://doi.org/10.3748/wjg.v18.i17.2067 CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Faghihi AH, Agah S, Masoudi M et al (2015) Efficacy of probiotic Escherichia coli Nissle 1917 in patients with irritable bowel syndrome: a double blind placebo-controlled randomized trial. Acta Medica Indones 47:201–208Google Scholar
- 26.Guglielmetti S, Mora D, Gschwender M, Popp K (2011) 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 33(10):1123–1132. https://doi.org/10.1111/j.1365-2036.2011.04633.x CrossRefPubMedGoogle Scholar
- 27.Guyonnet D, Chassany O, Ducrotte P et al (2007) 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 26(3):475–486. https://doi.org/10.1111/j.1365-2036.2007.03362.x CrossRefPubMedGoogle Scholar
- 29.Kajander K, Myllyluoma E, Rajilić-Stojanović M et al (2008) Clinical trial: multispecies probiotic supplementation alleviates the symptoms of irritable bowel syndrome and stabilizes intestinal microbiota. Aliment Pharmacol Ther 27(1):48–57. https://doi.org/10.1111/j.1365-2036.2007.03542.x CrossRefPubMedGoogle Scholar
- 30.Ki Cha B, Mun Jung S, Hwan Choi C, Song ID, Woong Lee H, Joon Kim H, Hyuk J, Kyung Chang S, Kim K, Chung WS, Seo JG (2012) The effect of a multispecies probiotic mixture on the symptoms and fecal microbiota in diarrhea-dominant irritable bowel syndrome: a randomized, double-blind, placebo-controlled trial. J Clin Gastroenterol 46(3):220–227. https://doi.org/10.1097/MCG.0b013e31823712b1 CrossRefPubMedGoogle Scholar
- 32.Kruis W, Chrubasik S, Boehm S, Stange C, Schulze J (2012) A double-blind placebo-controlled trial to study therapeutic effects of probiotic Escherichia coli Nissle 1917 in subgroups of patients with irritable bowel syndrome. Int J Color Dis 27(4):467–474. https://doi.org/10.1007/s00384-011-1363-9 CrossRefGoogle Scholar
- 34.Majeed M, Nagabhushanam K, Natarajan S, Sivakumar A, Ali F, Pande A, Majeed S, Karri SK (2015) Bacillus coagulans MTCC 5856 supplementation in the management of diarrhea predominant irritable bowel syndrome: a double blind randomized placebo controlled pilot clinical study. Nutr J 15(1). https://doi.org/10.1186/s12937-016-0140-6
- 35.Mezzasalma V, Manfrini E, Ferri E, Sandionigi A, la Ferla B, Schiano I, Michelotti A, Nobile V, Labra M, di Gennaro P (2016) A randomized, double-blind, placebo-controlled trial: the efficacy of multispecies probiotic supplementation in alleviating symptoms of irritable bowel syndrome associated with constipation. Biomed Res Int 2016:4740907. https://doi.org/10.1155/2016/4740907 CrossRefPubMedPubMedCentralGoogle Scholar
- 37.Ringel-Kulka T, Palsson OS, Maier D, Carroll I, Galanko JA, Leyer G, Ringel Y (2011) Probiotic bacteria Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 versus placebo for the symptoms of bloating in patients with functional bowel disorders: a double-blind study. J Clin Gastroenterol 45(6):518–525. https://doi.org/10.1097/MCG.0b013e31820ca4d6 CrossRefPubMedPubMedCentralGoogle Scholar
- 38.Simrén M, Ohman L, Olsson J et al (2010) 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 31:218–227. https://doi.org/10.1111/j.1365-2036.2009.04183.x CrossRefPubMedGoogle Scholar
- 40.Williams EA, Stimpson J, Wang D et al (2009) Clinical trial: a multistrain probiotic preparation significantly reduces symptoms of irritable bowel syndrome in a double-blind placebo-controlled study. Aliment Pharmacol Ther 29(1):97–103. https://doi.org/10.1111/j.1365-2036.2008.03848.x CrossRefPubMedGoogle Scholar
- 41.Zeng J, Li Y-Q, Zuo X-L et al (2008) Clinical trial: effect of active lactic acid bacteria on mucosal barrier function in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 28(8):994–1002. https://doi.org/10.1111/j.1365-2036.2008.03818.x CrossRefPubMedGoogle Scholar
- 47.Vork L, Weerts ZZRM, Mujagic Z, Kruimel JW, Hesselink MAM, Muris JWM, Keszthelyi D, Jonkers DMAE, Masclee AAM (2017) Rome III vs Rome IV criteria for irritable bowel syndrome: a comparison of clinical characteristics in a large cohort study. Neurogastroenterol Motil 30(2). https://doi.org/10.1111/nmo.13189
- 50.Enck P, Zimmermann K, Menke G et al (2008) A mixture of Escherichia coli (DSM 17252) and Enterococcus faecalis (DSM 16440) for treatment of the irritable bowel syndrome—a randomized controlled trial with primary care physicians. Neurogastroenterol Motil 20(10):1103–1109. https://doi.org/10.1111/j.1365-2982.2008.01156.x CrossRefPubMedGoogle Scholar
- 52.Niedzielin K, Kordecki H, Birkenfeld B (2001) A controlled, double-blind, randomized study on the efficacy of Lactobacillus plantarum 299V in patients with irritable bowel syndrome. Eur J Gastroenterol Hepatol 13(10):1143–1147. https://doi.org/10.1097/00042737-200110000-00004 CrossRefPubMedGoogle Scholar
- 53.Compare D, Rocco A, Sgamato C, Coccoli P, Campo SMA, Nazionale I, Larussa T, Luzza F, Chiodini P, Nardone G (2015) Lactobacillus paracasei F19 versus placebo for the prevention of proton pump inhibitor-induced bowel symptoms: a randomized clinical trial. Dig Liver Dis 47(4):273–279. https://doi.org/10.1016/j.dld.2015.01.004 CrossRefPubMedGoogle Scholar
- 54.Lee J-Y, Chu S-H, Jeon JY, Lee MK, Park JH, Lee DC, Lee JW, Kim NK (2014) Effects of 12 weeks of probiotic supplementation on quality of life in colorectal cancer survivors: a double-blind, randomized, placebo-controlled trial. Dig Liver Dis 46(12):1126–1132. https://doi.org/10.1016/j.dld.2014.09.004 CrossRefPubMedGoogle Scholar
- 55.Kirchgessner A (2016) The role of the microbiota and potential for dietary intervention in chronic fatigue syndrome. Gut-Brain Axis Elsevier:439–463. https://doi.org/10.1016/B978-0-12-802304-4.00021-9