Clinical Research Development Unit, Alborz University of Medical Sciences, Karaj, Iran.
Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran.
Clin Exp Med. 2023 Oct;23(6):2773-2788. doi: 10.1007/s10238-022-00987-x. Epub 2023 Jan 7.
Gluten-free diet (GFD) is the most effective method to manage celiac disease (CD). Many patients do not reach the complete symptom alleviation, even by strict GFD. Recent studies have reported inconsistent results regarding the beneficial benefits of taking probiotics. Therefore, we aimed to evaluate the effects of probiotics on gastrointestinal (GI) symptoms and the possible underlying causes in CD and celiac disease autoimmunity (CDA) patients. Databases, including PubMed, Scopus, Embase, Web of Science and Google Scholar, were searched for clinical trials published until July 2022 about assessing the effects of probiotics or synbiotics on CD or CDA patients. We collected data on GI symptoms, CD markers, inflammatory and immune responses, adverse events, and gut microbiota. A random effect meta-analysis was used to estimate the pooled standardized mean difference (SMD) and confidence interval (CI). We screened 7234 articles, of which 14 were included in the qualitative analysis and 5 in the quantitative analysis. Probiotics might alleviate GI symptoms, especially in the highly symptomatic patients, and improve immune response in CD and CDA patients. Results of the meta-analysis showed that probiotics increased the abundance of Bifidobacterium (SMD: 0.72, 95%CI (0.13, 1.30) and Lactobacillus (SMD: 0.49, 95%CI (0.18, 0.80) as compared with placebo. Probiotics did not increase the adverse events compared to the placebo. Probiotics might alleviate GI symptoms and immune response and improve dysbiosis in CD and CDA patients. However, high-quality clinical trials are needed to increase the level of evidence. Also, the most suitable combination of probiotics is yet to find.
无麸质饮食（GFD）是管理乳糜泻（CD）的最有效方法。许多患者即使通过严格的 GFD 也无法完全缓解症状。最近的研究报告了关于益生菌有益作用的不一致结果。因此，我们旨在评估益生菌对 CD 和乳糜泻自身免疫（CDA）患者胃肠道（GI）症状和潜在原因的影响。我们检索了包括 PubMed、Scopus、Embase、Web of Science 和 Google Scholar 在内的数据库，以查找截至 2022 年 7 月评估益生菌或合生菌对 CD 或 CDA 患者影响的临床试验。我们收集了关于 GI 症状、CD 标志物、炎症和免疫反应、不良事件和肠道微生物群的数据。使用随机效应荟萃分析来估计汇总标准化均数差（SMD）和置信区间（CI）。我们筛选了 7234 篇文章，其中 14 篇进行了定性分析，5 篇进行了定量分析。益生菌可能缓解 GI 症状，尤其是在症状高度明显的患者中，并改善 CD 和 CDA 患者的免疫反应。荟萃分析结果表明，与安慰剂相比，益生菌增加了双歧杆菌（SMD：0.72，95%CI（0.13，1.30）和乳杆菌（SMD：0.49，95%CI（0.18，0.80）的丰度。与安慰剂相比，益生菌并未增加不良反应。益生菌可能缓解 CD 和 CDA 患者的 GI 症状和免疫反应，并改善肠道菌群失调。然而，需要高质量的临床试验来提高证据水平。此外，还需要找到最合适的益生菌组合。
