McFarland Lynne V, Karakan Tarkan, Karatas Ali
Department Medicinal Chemistry, School of Pharmacy, University of Washington, 6047 38th Avenue NE, Seattle, WA 98195, United States.
Department of Gastroenterology, Gazi University Faculty of Medicine, Beşevler, Ankara 06500, Turkey.
EClinicalMedicine. 2021 Oct 18;41:101154. doi: 10.1016/j.eclinm.2021.101154. eCollection 2021 Nov.
Consistent guidance for choosing an appropriate probiotic for the treatment of irritable bowel syndrome is lacking.
Literature databases searched included: PubMed, Google Scholar and NIH registry of clinical trials from inception to June 2021. Inclusion criteria: randomized controlled trials (RCTs) enrolling adult or pediatric IBS patients comparing probiotics against controls and ≥ 2 RCTs with common IBS outcome measures within each type of probiotic. Five common measures of IBS symptoms (changes in global Irritable Bowel Syndrome Severity Scoring System or IBS-SSS scores, frequency of global responders, changes in bloating or abdominal pain scores and frequency of abdominal pain relief) were used. This study was registered at Prospero (#CRD42018109169).
We screened 521 studies and included 42 randomized controlled trials (45 treatment arms, = 3856). Four probiotics demonstrated significant reduction in abdominal pain relief: MTCC5260 (RR= 49, 95% C.I. 33, 73), 299v (RR= 46, 95% CI 19, 110), CNCM I-745 (RR= 15, 95% C.I. 11, 21) and CNCM I-3856 (RR= 13, 95% C.I. 104, 16). Mild-moderate adverse events were reported in 51% of the trials, none were more associated with the probiotic compared to controls.
Although the analysis of probiotic efficacy was limited by the diversity of IBS outcomes used in trials and lack of confirmatory trials for some strains, six single-strain probiotics and three different types of probiotic mixtures showed significant efficacy for at least one IBS outcome measure. These results might be relevant to clinical practice and policy.
缺乏关于选择合适益生菌治疗肠易激综合征的一致指南。
检索的文献数据库包括：从创建到2021年6月的PubMed、谷歌学术和美国国立卫生研究院临床试验注册库。纳入标准：纳入成年或儿科肠易激综合征患者的随机对照试验（RCT），比较益生菌与对照组，且每种益生菌类型内有≥2项采用常见肠易激综合征结局指标的随机对照试验。采用了五项常见的肠易激综合征症状指标（全球肠易激综合征严重程度评分系统或IBS-SSS评分的变化、总体缓解者的频率、腹胀或腹痛评分的变化以及腹痛缓解的频率）。本研究已在国际系统评价前瞻性注册库（#CRD42018109169）注册。
我们筛选了521项研究，纳入了42项随机对照试验（45个治疗组，n = 3856）。四种益生菌显示出腹痛缓解方面有显著降低：MTCC5260（相对风险[RR]=49，95%置信区间[CI] 33，73）、299v（RR = 46，95% CI 19，110）、法国国家微生物保藏中心（CNCM）I-745（RR = 15，95% CI 11，21）和CNCM I-3856（RR = 13，95% CI 104，16）。51%的试验报告了轻度至中度不良事件，与对照组相比，没有任何不良事件与益生菌的关联更强。
尽管益生菌疗效分析受到试验中使用的肠易激综合征结局指标的多样性以及某些菌株缺乏验证性试验的限制，但六种单菌株益生菌和三种不同类型的益生菌混合物对至少一项肠易激综合征结局指标显示出显著疗效。这些结果可能与临床实践和政策相关。
