Diseases of the Colon & Rectum

, Volume 51, Issue 12, pp 1775–1780 | Cite as

Efficacy of Probiotics in Irritable Bowel Syndrome: A Meta-Analysis of Randomized, Controlled Trials

  • Shekoufeh Nikfar
  • Roja Rahimi
  • Fatemeh Rahimi
  • Saeed Derakhshani
  • Mohammad Abdollahi
Original Contribution

Abstract

Purpose

This study was designed to evaluate whether probiotics improve symptoms in patients with irritable bowel syndrome.

Methods

PubMed, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were searched for studies that investigated the efficacy of probiotics in the management of irritable bowel syndrome. Clinical improvement was the key outcome of interest. Data were searched within the time period of 1966 through September 2007.

Results

Eight randomized, placebo-controlled, clinical trials met our criteria and were included in the analysis. Pooling of eight trials for the outcome of clinical improvement yielded a significant relative risk of 1.22 (95 percent confidence interval, 1.07–1.4; P = 0.0042).

Conclusions

Probiotics may improve symptoms of irritable bowel syndrome and can be used as supplement to standard therapy.

Key words

Probiotics Irritable bowel syndrome Meta-analysis Clinical improvement 

References

  1. 1.
    Croghan A, Heitkemper MM. Recognizing and managing patients with irritable bowel syndrome. J Am Acad Nurse Pract 2005;17:51–9.PubMedCrossRefGoogle Scholar
  2. 2.
    American College of Gastroenterology Functional Gastrointestinal Disorders Task Force. Evidence-based position statement on the management of irritable bowel syndrome in North America. Am J Gastroenterol 2002;97:S1−S5.Google Scholar
  3. 3.
    Wilson S, Roberts L, Roalfe A, Bridge P, Singh S. Prevalence of irritable bowel syndrome: a community survey. Br J Gen Pract 2004;54:495−502.PubMedGoogle Scholar
  4. 4.
    Bommelaer G, Dorval E, Denis P, et al. Prevalence of irritable bowel syndrome in the French population according to the Rome I criteria. Gastroenterol Clin Biol 2002;26:1118−1123.PubMedGoogle Scholar
  5. 5.
    Foxx-Orenstein A. IBS: review and what’s new. Med Gen Med 2006;8:20.Google Scholar
  6. 6.
    Quartero AO, Meineche-Schmidt V, Muris J, Rubin G, de Wit N. Bulking agents, antispasmolytic and antidepressant medication for the treatment of irritable bowel syndrome. Cochrane Database Syst Rev 2005;2:CD003460.PubMedGoogle Scholar
  7. 7.
    Zamani MJ, Sharifzadeh M, Rezaie A, Mashayekhi F, Abdollahi M. Effects of sildenafil on rat irritable bowel syndrome. Therapy 2005;2:237–42.CrossRefGoogle Scholar
  8. 8.
    Elahi B, Nikfar S, Derakhshani S, Vafaie M, Abdollahi M. On the benefit of probiotics in the management of pouchitis in patients underwent ileal pouch anal anastomosis: a meta-analysis of controlled clinical trials. Dig Dis Sci 2007;53:1278–84.PubMedCrossRefGoogle Scholar
  9. 9.
    McFarland LV. Meta-analysis of probiotics for the prevention of traveler’‘s diarrhea. Travel Med Infect Dis 2007;5:97–105.PubMedCrossRefGoogle Scholar
  10. 10.
    Jones JL, Foxx-Orenstein AE. The role of probiotics in inflammatory bowel disease. Dig Dis Sci 2007;52:607–11.PubMedCrossRefGoogle Scholar
  11. 11.
    Gawronska A, Dziechciarz P, Horvath A, Szajewska H. A randomized double-blind placebo-controlled trial of Lactobacillus GG for abdominal pain disorders in children. Aliment Pharmacol Ther 2007;25:177–84.PubMedGoogle Scholar
  12. 12.
    Kim HJ, Camilleri M, McKinzie S, et al. A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 2003;17:895–904.PubMedCrossRefGoogle Scholar
  13. 13.
    Nobaek S, Johansson ML, Molin G, Ahrne S, Jeppsson B. Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Am J Gastroenterol 2000;95:1231–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Kajander K, Hatakka K, Poussa T, Farkkila M, Korpela R. A probiotic mixture alleviates symptoms in irritable bowel syndrome patients: a controlled 6-month intervention. Aliment Pharmacol Ther 2005;22:387–94.PubMedCrossRefGoogle Scholar
  15. 15.
    Niedzielin K, Kordecki H, Birkenfeld B. A controlled, double-blind, randomized study on the efficacy of Lactobacillus plantarum 299 V in patients with irritable bowel syndrome. Eur J Gastroenterol Hepatol 2001;13:1143–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Guyonnet D, Chassany O, Ducrotte P, et al. 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 2007;26:475–86.PubMedGoogle Scholar
  17. 17.
    Saggioro A. Probiotics in the treatment of irritable bowel syndrome. J Clin Gastroenterol 2004;38:S104–S106.PubMedCrossRefGoogle Scholar
  18. 18.
    O’Mahony L, McCarthy J, Kelly P, et al. Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. Gastroenterology 2005;128:541–51.PubMedCrossRefGoogle Scholar
  19. 19.
    Bausserman M, Michail S. The use of Lactobacillus GG in irritable bowel syndrome in children: a double-blind randomized control trial. J Pediatr 2005;147:197–201.PubMedCrossRefGoogle Scholar
  20. 20.
    Sen S, Mullan MM, Parker TJ, Woolner JT, Tarry SA, Hunter JO. Effect of Lactobacillus plantarum 299 v on colonic fermentation and symptoms of irritable bowel syndrome. Dig Dis Sci 2002;47:2615–20.PubMedCrossRefGoogle Scholar
  21. 21.
    O’Sullivan MA, O’Morain CA. Bacterial supplementation in the irritable bowel syndrome. A randomised double-blind placebo-controlled crossover study. Dig Liver Dis 2000;32:294–301.PubMedCrossRefGoogle Scholar
  22. 22.
    Niv E, Naftali T, Hallak R, Vaisman N. The efficacy of Lactobacillus reuteri ATCC 55730 in the treatment of patients with irritable bowel syndrome: a double-blind, placebo-controlled, randomized study. Clin Nutr 2005;24:925–31.PubMedCrossRefGoogle Scholar
  23. 23.
    Quigley EM, Flourie B. Probiotics and irritable bowel syndrome: a rationale for their use and an assessment of the evidence to date. Neurogastroenterol Motil 2007;19:166–72.PubMedCrossRefGoogle Scholar
  24. 24.
    Young P, Cash BD. Probiotic use in irritable bowel syndrome. Curr Gastroenterol Rep 2006;8:321–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Camilleri M. Probiotics and irritable bowel syndrome: rationale, putative mechanisms, and evidence of clinical efficacy. J Clin Gastroenterol 2006;40:264–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Verdu EF, Collins SM. Irritable bowel syndrome and probiotics: from rationale to clinical use. Curr Opin Gastroenterol 2005;21:697–701.PubMedCrossRefGoogle Scholar
  27. 27.
    Jadad A. Randomised controlled trials. London: BMJ Books, 1998.Google Scholar
  28. 28.
    Kim HJ, Vazquez Roque MI, Camilleri M, et al. A randomized controlled trial of a probiotic combination VSL# 3 and placebo in irritable bowel syndrome with bloating. Neurogastroenterol Motil 2005;17:687–96.PubMedCrossRefGoogle Scholar
  29. 29.
    Whorwell PJ, Altringer L, Morel J, et al. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol 2006;101:1581–90.PubMedCrossRefGoogle Scholar
  30. 30.
    Park J, Floch MH. Prebiotics, probiotics, and dietary fiber in gastrointestinal disease. Gastroenterol Clin North Am. 2007;36:47–63.PubMedCrossRefGoogle Scholar
  31. 31.
    Rahimi R, Nikfar S, Abdollahi M. Meta-analysis technique confirms the effectiveness of anti-TNF-a in the management of active ulcerative colitis when administered in combination with corticosteroids. Med Sci Monit 2007;13:PI13–PI18.PubMedGoogle Scholar
  32. 32.
    Rahimi R, Nikfar S, Rezaie A, Abdollahi M. A meta-analysis of antibiotic therapy for active ulcerative colitis. Dig Dis Sci 2007;52:2920–5.PubMedCrossRefGoogle Scholar
  33. 33.
    Rahimi R, Nikfar S, Abdollahi M. Do anti-tumor necrosis factors induce response and remission in patients with acute refractory Crohn’s disease? A systematic meta-analysis of controlled clinical trials. Biomed Pharmacother 2007;61:75–80.CrossRefGoogle Scholar
  34. 34.
    Rahimi R, Nikfar S, Rezaie A, Abdollahi M. A meta-analysis of broad spectrum antibiotic therapy in patients with active Crohn’s disease. Clin Ther 2006;28:1983–8.PubMedCrossRefGoogle Scholar

Copyright information

© The American Society of Colon and Rectal Surgeons 2008

Authors and Affiliations

  • Shekoufeh Nikfar
    • 1
  • Roja Rahimi
    • 2
  • Fatemeh Rahimi
    • 2
  • Saeed Derakhshani
    • 3
  • Mohammad Abdollahi
    • 4
  1. 1.Drug Selecting Committee, Food and Drug Organization, Food & Drug Laboratory Research CenterMinistry of Health & Medical EducationTehranIran
  2. 2.Pharmaceutical Sciences Research CenterTehran University of Medical SciencesTehranIran
  3. 3.Baharan Colorectal Surgical CenterTehranIran
  4. 4.Faculty of Pharmacy, Pharmaceutical Sciences Research CenterTehran University of Medical SciencesTehranIran

Personalised recommendations