Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA. Emeritus Professor of Clinical Medicine, David Geffen-UCLA School of Medicine, Los Angeles, CA, USA.
Am J Gastroenterol. 2018 Aug;113(8):1125-1136. doi: 10.1038/s41395-018-0138-0. Epub 2018 Jun 19.
Probiotic usage has become popular with both medical practitioners and the community in general; patients commonly seek advice regarding what, if any, such preparation would be useful for their own diseases. Since such advice should be evidence-based, identified randomized clinical trials (RCTs) for a number of gastrointestinal conditions were reviewed; the data were organized by individual probiotic genera/species. Only trials in adults were considered. Most of the identified RCTs were small and low-quality, so any conclusions to be drawn will be limited at least by methodologic problems. Using the GRADE system to consider the reliability of the evidence generated from these RCTs, it did appear that the use of fecal microbial transplantation to treat recurrent Clostridium difficile infection is well justified. Given the methodologic issues, there was moderately good evidence for preventing antibiotic-associated diarrhea with Lactobacillus, Bifidobacterium, Streptococcus, or Saccharomyces boulardii and for using Lactobacillus, Bifidobacterium, or Saccharomyces as adjunct therapy in the treatment of Helicobacter pylori. There were other conditions for which some supportive evidence was available. These conditions include VSL#3 for maintaining remissions in patients with pouchitis or treating active ulcerative colitis (UC), fecal microbial transplantation for treating active UC, Bifidobacterium for treating patients with UC in remission, Lactobacillus in patients with painful diverticulosis, a variety of probiotics (Lactobacillus, Bifidobacterium, Streptococcus, or VSL#3) in patients with minimal hepatic encephalopathy, and providing synbiotics to patients postoperatively after liver transplantation. Unfortunately, other limitations in the evidence made it very likely that future research will have an effect on the estimated benefit; these interventions cannot yet be recommended for routine use.
益生菌的使用在医疗从业者和普通大众中都变得越来越流行；患者经常寻求有关此类制剂对自身疾病是否有用的建议。由于此类建议应该基于证据，因此我们对一些胃肠道疾病的随机对照试验（RCT）进行了回顾；这些数据按单个益生菌属/种进行了组织。仅考虑了成人的试验。大多数已确定的 RCT 规模较小且质量较低，因此得出的任何结论至少会受到方法学问题的限制。使用 GRADE 系统来考虑从这些 RCT 中生成的证据的可靠性，似乎确实有充分的理由使用粪便微生物移植来治疗复发性艰难梭菌感染。鉴于方法学问题，对于使用乳杆菌、双歧杆菌、链球菌或布拉氏酵母菌预防抗生素相关性腹泻以及使用乳杆菌、双歧杆菌或酿酒酵母菌作为辅助治疗幽门螺杆菌感染，有中等质量的证据。对于其他一些疾病，也有一些支持性证据。这些疾病包括 VSL#3 用于维持 pouchitis 或治疗活动期溃疡性结肠炎（UC）的缓解，粪便微生物移植用于治疗活动期 UC，双歧杆菌用于治疗缓解期 UC 患者，乳杆菌用于治疗有疼痛憩室病的患者，各种益生菌（乳杆菌、双歧杆菌、链球菌或 VSL#3）用于治疗轻微肝性脑病患者，以及为肝移植术后患者提供合生菌。不幸的是，证据中的其他局限性使得未来的研究极有可能对估计的益处产生影响；这些干预措施还不能常规推荐使用。
