State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, 214122, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, 214122, China.
State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, 214122, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, 214122, China; National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, Jiangsu, 214122, China; Wuxi Translational Medicine Research Center and Jiangsu Translational Medicine Research Institute Wuxi Branch, China; (Yangzhou) Institute of Food Biotechnology, Jiangnan University, Yangzhou, 225004, China.
Clin Nutr. 2020 Oct;39(10):2960-2969. doi: 10.1016/j.clnu.2020.01.005. Epub 2020 Jan 14.
BACKGROUND & AIMS: Clinical trials have reported controversial results regarding the effectiveness of probiotics in alleviating functional constipation in adults. We reviewed relevant randomized controlled trials to elucidate the effectiveness of probiotics on constipation symptoms in adults with functional constipation.
We searched Medline, the Cochrane Library, Web of Science, and Google Scholar for relevant articles published up to April 2019. The primary outcomes of interest were stool frequency, gut transit time (GTT), stool consistency, and bloating. Two authors independently performed the study selection, risk-of-bias assessment, and data extraction. The outcome data were extracted from each included study and synthesized using weighted mean differences (WMDs) or standardized mean differences (SMDs). Pooled data synthesis was performed using a random-effects model.
In total, 2327 relevant studies were identified, 15 of which were found to be eligible randomized controlled trials and were included in the meta-analysis. Pooling of the extracted data demonstrated that probiotic consumption significantly reduced the whole GTT by 13.75 h [95% confidence interval (CI): -21.93 to -5.56 h] and increased the stool frequency by 0.98 (95% CI: 0.36 to 1.60) bowel movements per week. This increase was significant with the consumption of multispecies probiotics [at least two bacteria; WMD: 1.22 (95% CI: 0.50 to 1.94) bowel movements per week] but not with the consumption of Bifidobacterium lactis [WMD: 1.34 (95% CI: -0.27 to 2.94) bowel movements per week] or B. longum [WMD: -0.02 (95% CI: -0.56 to 0.53) bowel movements per week] alone. Multispecies probiotics (WMD: 1.37; 95% CI: 0.72 to 2.01), but not single-species probiotics (WMD: 1.18; 95% CI: -0.59 to 2.96), improved stool consistency (WMD: 1.30; 95% CI: 0.22 to 2.38). Similarly, multispecies probiotics (at least two bacteria; WMD: -0.49; 95% CI: -0.85 to -0.13), but not single-species probiotics (WMD: -0.24; 95% CI: -0.55 to 0.07), significantly decreased bloating. Performance bias were high, whereas detection bias was unclear because of inadequate reporting.
Consumption of probiotics, in particular, multispecies probiotics, may substantially reduce the GTT, increase the stool frequency, and improve the stool consistency. Thus, probiotics can be regarded as safe and natural agents for alleviation of functional constipation in adults.
临床试验对益生菌缓解成人功能性便秘的疗效报告结果存在争议。我们对相关的随机对照试验进行了综述，以阐明益生菌对成人功能性便秘的便秘症状的疗效。
我们检索了截至 2019 年 4 月的 Medline、Cochrane 图书馆、Web of Science 和 Google Scholar 中的相关文章。主要结局指标为粪便频率、肠道转运时间（GTT）、粪便稠度和腹胀。两名作者独立进行了研究选择、偏倚风险评估和数据提取。从纳入的研究中提取结局数据，并使用加权均数差（WMD）或标准化均数差（SMD）进行综合。使用随机效应模型进行汇总数据合成。
共确定了 2327 项相关研究，其中 15 项为符合条件的随机对照试验，被纳入荟萃分析。提取数据的汇总表明，益生菌的摄入可显著减少整个 GTT 13.75 小时[95%置信区间（CI）：-21.93 至-5.56 小时]，每周增加 0.98 次（95%CI：0.36 至 1.60）排便。这种增加在摄入多菌种益生菌[至少两种细菌；WMD：1.22（95%CI：0.50 至 1.94）每周排便]时具有显著意义，但在摄入双歧杆菌乳杆菌[WMD：1.34（95%CI：-0.27 至 2.94）每周排便]或长双歧杆菌[WMD：-0.02（95%CI：-0.56 至 0.53）每周排便]时则没有。多菌种益生菌（WMD：1.37；95%CI：0.72 至 2.01），而不是单菌种益生菌（WMD：1.18；95%CI：-0.59 至 2.96）可改善粪便稠度（WMD：1.30；95%CI：0.22 至 2.38）。同样，多菌种益生菌（至少两种细菌；WMD：-0.49；95%CI：-0.85 至-0.13），而不是单菌种益生菌（WMD：-0.24；95%CI：-0.55 至 0.07）可显著减轻腹胀。由于报告不充分，存在高度的实施偏倚，而检测偏倚则不清楚。
摄入益生菌，特别是多菌种益生菌，可能显著减少 GTT，增加粪便频率，并改善粪便稠度。因此，益生菌可被视为缓解成人功能性便秘的安全且天然的制剂。
