Abstract
Background
Probiotics may be an effective alternative to traditional drug therapy for constipation in the elderly.
Objective
To assess the efficacy and safety of probiotics in managing constipation among the elderly.
Methods
Eight databases were queried for randomized controlled trials (RCTs) investigating probiotics’ efficacy in addressing constipation among the elderly until January 2023. The meta-analysis was conducted employing R software version 4.2.2. The Cochrane risk of bias tool was utilized to evaluate the risk of bias, and the GRADE approach was employed to assess the credibility of the evidence concerning the efficacy of probiotics in treating constipation in older individuals.
Results
A total of six RCTs involving 444 patients were included. Two studies were rated as low risk of bias. The meta-analysis findings revealed that probiotics, when compared to a placebo, led to an increase in stool frequency (MD = 1.02,95% CI [0.21, 2.07], p<0.05, very low quality), the probiotic group exhibited a notable impact on ameliorating symptoms associated with constipation (OR = 11.28, 95%CI [7.21, 17.64], p < 0.05, very low quality), no significant disparities were observed in terms of efforts to evacuate, manual maneuvers, and the incidence of adverse events (p>0.05).
Conclusion
The available evidence indicates a degree of uncertainty, ranging from low-to-very low, suggesting the efficacy of probiotics in augmenting bowel frequency and ameliorating constipation-related symptoms among elderly patients with constipation. Nevertheless, given the quality of the studies included, it is advisable to conduct further well-designed investigations with substantial sample sizes to substantiate the findings of this study.
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References
Rajindrajith S, Devanarayana NM, Crispus Perera BJ, Benninga MA. Childhood constipation as an emerging public health problem. World J Gastroenterol. Aug 14 2016;22(30):6864–75. doi:https://doi.org/10.3748/wjg.v22.i30.6864
Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology. Jan 2021;160(1):99–114.e3. doi:https://doi.org/10.1053/j.gastro.2020.04.014
Abrahamsson H, Antov S, Bosaeus I. Gastrointestinal and colonic segmental transit time evaluated by a single abdominal x-ray in healthy subjects and constipated patients. Scand J Gastroenterol Suppl. 1988;152:72–80. doi:https://doi.org/10.3109/00365528809095938
Blake MR, Raker JM, Whelan K. Validity and reliability of the Bristol Stool Form Scale in healthy adults and patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. Oct 2016;44(7):693–703. doi:https://doi.org/10.1111/apt.13746
Frank L, Kleinman L, Farup C, Taylor L, Miner P, Jr. Psychometric validation of a constipation symptom assessment questionnaire. Scand J Gastroenterol. Sep 1999;34(9):870–7. doi:https://doi.org/10.1080/003655299750025327
Emmanuel A, Cools M, Vandeplassche L, Kerstens R. Prucalopride improves bowel function and colonic transit time in patients with chronic constipation: an integrated analysis. Am J Gastroenterol. Jun 2014;109(6):887–94. doi:https://doi.org/10.1038/ajg.2014.74
Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. Apr 2006;130(5):1480–91. doi:https://doi.org/10.1053/j.gastro.2005.11.061
Belsey J, Greenfield S, Candy D, Geraint M. Systematic review: impact of constipation on quality of life in adults and children. Aliment Pharmacol Ther. May 2010;31(9):938–49. doi:https://doi.org/10.1111/j.1365-2036.2010.04273.x
An evidence-based approach to the management of chronic constipation in North America. Am J Gastroenterol. 2005;100 Suppl 1:S1–4. doi:https://doi.org/10.1111/j.1572-0241.2005.50613_1.x
Basilisco G, Coletta M. Chronic constipation: a critical review. Dig Liver Dis. Nov 2013;45(11):886–93. doi:https://doi.org/10.1016/j.dld.2013.03.016
Johanson JF, Kralstein J. Chronic constipation: a survey of the patient perspective. Aliment Pharmacol Ther. Mar 1 2007;25(5):599–608. doi:https://doi.org/10.1111/j.1365-2036.2006.03238.x
Attaluri A, Jackson M, Valestin J, Rao SS. Methanogenic flora is associated with altered colonic transit but not stool characteristics in constipation without IBS. Am J Gastroenterol. Jun 2010;105(6):1407–11. doi:https://doi.org/10.1038/ajg.2009.655
Kamiński M, Skonieczna-Żydecka K, Łoniewski I, Koulaouzidis A, Marlicz W. Are probiotics useful in the treatment of chronic idiopathic constipation in adults? A review of existing systematic reviews, meta-analyses, and recommendations. Prz Gastroenterol. 2020;15(2):103–118. doi:https://doi.org/10.5114/pg.2019.86747
Quigley EM. Probiotics in Irritable Bowel Syndrome: The Science and the Evidence. J Clin Gastroenterol. Nov–Dec 2015;49 Suppl 1:S60–4. doi:https://doi.org/10.1097/mcg.0000000000000348
Applegate JA, Fischer Walker CL, Ambikapathi R, Black RE. Systematic review of probiotics for the treatment of community-acquired acute diarrhea in children. BMC Public Health. 2013;13 Suppl 3(Suppl 3):S16. doi:https://doi.org/10.1186/1471-2458-13-s3-s16
Szajewska H, Canani RB, Guarino A, et al. Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Children. J Pediatr Gastroenterol Nutr. Mar 2016;62(3):495–506. doi:https://doi.org/10.1097/mpg.0000000000001081
Dimidi E, Mark Scott S, Whelan K. Probiotics and constipation: mechanisms of action, evidence for effectiveness and utilisation by patients and healthcare professionals. Proc Nutr Soc. Feb 2020;79(1):147–157. doi:https://doi.org/10.1017/s0029665119000934
Chmielewska A, Szajewska H. Systematic review of randomised controlled trials: probiotics for functional constipation. World J Gastroenterol. Jan 7 2010;16(1):69–75. doi:https://doi.org/10.3748/wjg.v16.i1.69
Waller PA, Gopal PK, Leyer GJ, et al. Dose-response effect of Bifidobacterium lactis HN019 on whole gut transit time and functional gastrointestinal symptoms in adults. Scand J Gastroenterol. Sep 2011;46(9):1057–64. doi:https://doi.org/10.3109/00365521.2011.584895
Wallace C, Sinopoulou V, Gordon M, et al. Probiotics for treatment of chronic constipation in children. Cochrane Database Syst Rev. Mar 29 2022;3(3):Cd014257. doi:https://doi.org/10.1002/14651858.CD014257.pub2
Harris RG, Neale EP, Ferreira I. When poorly conducted systematic reviews and meta-analyses can mislead: a critical appraisal and update of systematic reviews and meta-analyses examining the effects of probiotics in the treatment of functional constipation in children. Am J Clin Nutr. Jul 1 2019;110(1):177–195. doi:https://doi.org/10.1093/ajcn/nqz071
Yang W, He T, Zhang W, Gu L, Tu R, Liu H. Effectiveness and safety of lactobacilli in children with functional constipation: Study protocol for a meta-analysis and systematic review. Medicine (Baltimore). May 2019;98(20):e15675. doi:https://doi.org/10.1097/md.0000000000015675
Huang R, Hu J. Positive Effect of Probiotics on Constipation in Children: A Systematic Review and Meta-Analysis of Six Randomized Controlled Trials. Front Cell Infect Microbiol. 2017;7:153. doi:https://doi.org/10.3389/fcimb.2017.00153
van der Schoot A, Helander C, Whelan K, Dimidi E. Probiotics and synbiotics in chronic constipation in adults: A systematic review and meta-analysis of randomized controlled trials. Clin Nutr. Dec 2022;41(12):2759–2777. doi:https://doi.org/10.1016/j.clnu.2022.10.015
Zhang C, Jiang J, Tian F, et al. Meta-analysis of randomized controlled trials of the effects of probiotics on functional constipation in adults. Clin Nutr. Oct 2020;39(10):2960–2969. doi:https://doi.org/10.1016/j.clnu.2020.01.005
Dimidi E, Christodoulides S, Fragkos KC, Scott SM, Whelan K. The effect of probiotics on functional constipation in adults: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. Oct 2014;100(4):1075–84. doi:https://doi.org/10.3945/ajcn.114.089151
Higgins JPT, J. Thomas, J. Chandler, M. Cumpston, T. Li, M. J. Page, and V. A. Welch.. Cochrane handbook for systematic reviews of interventions.. 2022
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj. Mar 29 2021;372:n71. doi:https://doi.org/10.1136/bmj.n71
Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Bmj. Oct 18 2011;343:d5928. doi:https://doi.org/10.1136/bmj.d5928
Li X, Li Y, Guo K, et al. Evidence Based Social Science in China Paper 3: The quality of social science RCTs published from 2000–2020. J Clin Epidemiol. Jan 2022;141:64–73. doi:https://doi.org/10.1016/j.jclinepi.2021.09.014
Balduzzi S, Rücker G, Schwarzer G. How to perform a meta-analysis with R: a practical tutorial. Evid Based Ment Health. Nov 2019;22(4):153–160. doi:https://doi.org/10.1136/ebmental-2019-300117
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Bmj. Sep 6 2003;327(7414):557–60. doi:https://doi.org/10.1136/bmj.327.7414.557
Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. Apr 2011;64(4):383–94. doi:https://doi.org/10.1016/j.jclinepi.2010.04.026
Li Y, Cao L, Zhang Z, et al. Reporting and methodological quality of COVID-19 systematic reviews needs to be improved: an evidence mapping. J Clin Epidemiol. Jul 2021;135:17–28. doi:https://doi.org/10.1016/j.jclinepi.2021.02.021
Takeda T, Asaoka D, Nojiri S, et al. Usefulness of Bifidobacterium longum BB536 in Elderly Individuals With Chronic Constipation: A Randomized Controlled Trial. Am J Gastroenterol. Dec 23 2022;doi:https://doi.org/10.14309/ajg.0000000000002028
Kondo J, Xiao JZ, Shirahata A, et al. Modulatory effects of Bifidobacterium longum BB536 on defecation in elderly patients receiving enteral feeding. World J Gastroenterol. 2013;19(14):2162–70. doi:https://doi.org/10.3748/wjg.v19.i14.2162
Shan L. Analysis of digestive medical treatment and clinical effect in elderly patients with functional constipation of type 2 diabetes mellitus. Guide to health care. 2020;(3):28–29.
Yeun Y, Lee J. Effect of a double-coated probiotic formulation on functional constipation in the elderly: a randomized, double blind, controlled study. Arch Pharm Res. Jul 2015;38(7):1345–50. doi:https://doi.org/10.1007/s12272-014-0522-2
Ghafar MYA, Yaakup H, Ali RAR, Shah SA. Evaluation of the Efficacy of Probiotics (MCP® BCMC® Strains) Treating Constipation in Elderly Patients with Multiple Chronic Co-Morbidities: A Randomized Control Trial. J Nutr Health Aging. 2020;24(10):1066–1072. doi:https://doi.org/10.1007/s12603-020-1494-1
Ouwehand AC, Lagström H, Suomalainen T, Salminen S. Effect of probiotics on constipation, fecal azoreductase activity and fecal mucin content in the elderly. Ann Nutr Metab. 2002;46(3–4):159–62. doi:https://doi.org/10.1159/000063075
Jin L, Deng L, Wu W, Wang Z, Shao W, Liu J. Systematic review and meta-analysis of the effect of probiotic supplementation on functional constipation in children. Medicine (Baltimore). Sep 2018;97(39):e12174. doi:https://doi.org/10.1097/md.0000000000012174
Dimidi E, Zdanaviciene A, Christodoulides S, et al. Randomised clinical trial: Bifidobacterium lactis NCC2818 probiotic vs placebo, and impact on gut transit time, symptoms, and gut microbiology in chronic constipation. Aliment Pharmacol Ther. Feb 2019;49(3):251–264. doi:https://doi.org/10.1111/apt.15073
Araújo MM, Botelho PB. Probiotics, prebiotics, and synbiotics in chronic constipation: Outstanding aspects to be considered for the current evidence. Front Nutr. 2022;9:935830. doi:https://doi.org/10.3389/fnut.2022.935830
Angelakis E, Merhej V, Raoult D. Related actions of probiotics and antibiotics on gut microbiota and weight modification. Lancet Infect Dis. Oct 2013;13(10):889–99. doi:https://doi.org/10.1016/s1473-3099(13)70179-8
Hempel S, Newberry S, Ruelaz A, et al. Safety of probiotics used to reduce risk and prevent or treat disease. Evid Rep Technol Assess (Full Rep). Apr 2011;(200):1–645.
Shang X, E FF, Guo KL, et al. Effectiveness and Safety of Probiotics for Patients with Constipation-Predominant Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of 10 Randomized Controlled Trials. Nutrients. Jun 15 2022;14(12) doi:https://doi.org/10.3390/nu14122482
Ioannidis JP. Adverse events in randomized trials: neglected, restricted, distorted, and silenced. Arch Intern Med. Oct 26 2009;169(19):1737–9. doi:https://doi.org/10.1001/archinternmed.2009.313
Wang X, Chen Y, Akl EA, et al. The reporting checklist for public versions of guidelines: RIGHT-PVG. Implement Sci. Jan 11 2021;16(1):10. doi:https://doi.org/10.1186/s13012-020-01066-z
Wang Y, Chen N, Guo K, et al. Reporting and methodological quality of acupuncture network meta-analyses could be improved: an evidence mapping. J Clin Epidemiol. Jan 2023;153:1–12. doi:https://doi.org/10.1016/j.jclinepi.2022.11.004
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Funding: Natural Science Foundation of Gansu Province (grant number 18JR3RA062)
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Ethical standard: Based on prior research; no human or animal studies included.
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Xinxin Deng and Xue Shang are co-first authors.
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Deng, X., Shang, X., Zhou, L. et al. Efficacy and Safety of Probiotics in Geriatric Patients with Constipation: Systematic Review and Meta-Analysis. J Nutr Health Aging 27, 1140–1146 (2023). https://doi.org/10.1007/s12603-023-2028-4
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DOI: https://doi.org/10.1007/s12603-023-2028-4