Li Bing, Liang Li, Deng Huijie, Guo Jinmin, Shu He, Zhang Li
Department of Pharmacy, 960th Hospital of the PLA, Jinan, China.
Front Pharmacol. 2020 Apr 3;11:332. doi: 10.3389/fphar.2020.00332. eCollection 2020.
Irritable bowel syndrome is a functional gastrointestinal disease. Evidence has suggested that probiotics may benefit IBS symptoms. However, clinical trials remain conflicting.
To implement a systematic review and meta-analysis of clinical trials regarding the efficacy and safety of probiotics for IBS patients.
We searched for relevant trials in Medline(1966 to Jan 2019), Embase(1974 to Jan 2019), the Cochrane Central Register of Controlled Trials(up to Jan 2019), the ClinicalTrials.gov trials register(up to Jan 2019), and Chinese Biomedical Literature Database(1978 to Jan 2019). Risk ratio (RR) and a 95% confidence interval (CI) were calculated for dichotomous outcomes. Standardized mean difference (SMD) and 95% CI were calculated for continuous outcomes.
A total of 59 studies, including 6,761 patients, were obtained. The RR of the improvement or response with probiotics versus placebo was 1.52 (95% CI 1.32-1.76), with significant heterogeneity (I = 71%, P < 0.001). The SMD of Probiotics in improving global IBS symptoms vs. Placebo was -1.8(95% CI -0.30 to -0.06), with significant heterogeneity (I = 65%, P < 0.001). It was impossible to draw a determinate conclusion. However, there were differences in subgroup analyses of probiotics type, dose, treatment duration, and geographic position. Probiotics seem to be safe by the analysis of adverse events(RR = 1.07; 95% CI 0.92-1.24; I = 0, P = 0.83).
Probiotics are effective and safe for IBS patients. Single probiotics with a higher dose (daily dose of probiotics ≥10) and shorter duration (< 8 weeks) seem to be a better choice, but it still needs more trials to prove it.
肠易激综合征是一种功能性胃肠疾病。有证据表明益生菌可能有助于改善肠易激综合征的症状。然而，临床试验结果仍存在冲突。
对关于益生菌治疗肠易激综合征患者的疗效和安全性的临床试验进行系统评价和荟萃分析。
我们在Medline（1966年至2019年1月）、Embase（1974年至2019年1月）、Cochrane对照试验中心注册库（截至2019年1月）、ClinicalTrials.gov试验注册库（截至2019年1月）以及中国生物医学文献数据库（1978年至2019年1月）中检索相关试验。对于二分法结局，计算风险比（RR）和95%置信区间（CI）。对于连续性结局，计算标准化均数差（SMD）和95%CI。
共纳入59项研究，包括6761例患者。益生菌组与安慰剂组相比改善或缓解的RR为1.52（95%CI 1.32 - 1.76），存在显著异质性（I² = 71%，P < 0.001）。益生菌组与安慰剂组相比改善整体肠易激综合征症状的SMD为 - 1.8（95%CI - 0.30至 - 0.06），存在显著异质性（I² = 65%，P < 0.001）。无法得出确定性结论。然而，在益生菌类型、剂量、治疗持续时间和地理位置的亚组分析中存在差异。通过不良事件分析，益生菌似乎是安全的（RR = 1.07；95%CI 0.92 - 1.24；I² = 0，P = 0.83）。
益生菌对肠易激综合征患者有效且安全。剂量较高（每日益生菌剂量≥10）且疗程较短（< 8周）的单一益生菌似乎是更好的选择，但仍需要更多试验来证实。
