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Clinical effects and gut microbiota changes of using probiotics, prebiotics or synbiotics in inflammatory bowel disease: a systematic review and meta-analysis

A Correction to this article was published on 24 May 2021

This article has been updated

Abstract

Purpose

Probiotics have been reported to be beneficial for inflammatory bowel disease (IBD), but the types, number of strains, dosage, and intervention time of probiotics used remain controversial. Furthermore, the changes of gut microbiota in IBD’s patients are also intriguing. Thus, this meta-analysis was to explore the clinical effects and gut microbiota changes of using probiotics, prebiotics and synbiotics in IBD.

Methods

The search was performed in PubMed, Web of Science and the Cochrane library from inception to April 2020. Qualified randomized controlled trials were included. IBD’s remission rate, disease activity index and recurrence rate were extracted and analyzed. Changes in the gut microbiota of patients with IBD are comprehensively described.

Results

Thirty-eight articles were included. Probiotics, prebiotics and synbiotics can induce/maintain IBD’s remission and reduce ulcerative colitis (UC) disease activity index (RR = 1.13, 95% CI 1.02, 1.26, P < 0.05; SMD = 1.00, 95% CI 0.27, 1.73, P < 0.05). In subgroup analyses of IBD remission rate and UC disease activity index, we obtained some statistically significant results in some subgroup (P < 0.05). To some extent, probiotic supplements can increase the number of beneficial bacteria (especially Bifidobacteria) in the intestinal tract of patients with IBD.

Conclusions

Our results support the treatment of IBD (especially UC) with pro/pre/synbiotics, and synbiotics are more effective. Probiotic supplements that are based on Lactobacillus and Bifidobacterium or more than one strain are more likely to be beneficial for IBD remission. The dose of 1010–1012 CFU/day may be a reference range for using probiotics to relieve IBD.

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Data availability

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

Change history

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Acknowledgements

This research was financially supported by the National Natural Science Foundation of China (31372453) and Henan Institute of Science and Technology (152102310260). The assistance of the staff is gratefully acknowledged.

Funding

This research was financially supported by the National Natural Science Foundation of China (31372453) and Henan Institute of Science and Technology (152102310260).

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Contributions

XFZ and XXG participated in the study design. XFZ, XXG, YJT and JFS searched the literature and selected studies. XKW and WDW extracted data and assessed quality. XFZ and XXG drafted the manuscript. JMF revised the draft and all authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Jian-Ming Fan.

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Zhang, XF., Guan, XX., Tang, YJ. et al. Clinical effects and gut microbiota changes of using probiotics, prebiotics or synbiotics in inflammatory bowel disease: a systematic review and meta-analysis. Eur J Nutr 60, 2855–2875 (2021). https://doi.org/10.1007/s00394-021-02503-5

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  • DOI: https://doi.org/10.1007/s00394-021-02503-5

Keywords

  • Probiotics
  • Prebiotics
  • Synbiotics
  • Inflammatory bowel disease
  • Remission
  • Gut microbiota