Goodoory Vivek C, Khasawneh Mais, Black Christopher J, Quigley Eamonn M M, Moayyedi Paul, Ford Alexander C
Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom.
Division of Gastroenterology and Hepatology, Lynda K. and David M. Underwood Center for Digestive Disorders, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas.
Gastroenterology. 2023 Nov;165(5):1206-1218. doi: 10.1053/j.gastro.2023.07.018. Epub 2023 Aug 3.
BACKGROUND & AIMS: Some probiotics may be beneficial in irritable bowel syndrome (IBS), but differences in species and strains used, as well as endpoints reported, have hampered attempts to make specific recommendations as to which should be preferred. We updated our previous meta-analysis examining this issue.
MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (up to March 2023). Randomized controlled trials (RCTs) recruiting adults with IBS, comparing probiotics with placebo were eligible. Dichotomous symptom data were pooled to obtain a relative risk of global symptoms, abdominal pain, or abdominal bloating or distension persisting after therapy, with a 95% confidence interval (CI). Continuous data were pooled using a standardized mean difference with a 95% CI. Adverse events data were also pooled.
We identified 82 eligible trials, containing 10,332 patients. Only 24 RCTs were at low risk of bias across all domains. For global symptoms, there was moderate certainty in the evidence for a benefit of Escherichia strains, low certainty for Lactobacillus strains and Lactobacillus plantarum 299V, and very low certainty for combination probiotics, LacClean Gold S, Duolac 7s, and Bacillus strains. For abdominal pain, there was low certainty in the evidence for a benefit of Saccharomyces cerevisae I-3856 and Bifidobacterium strains, and very low certainty for combination probiotics, Lactobacillus, Saccharomyces, and Bacillus strains. For abdominal bloating or distension there was very low certainty in the evidence for a benefit of combination probiotics and Bacillus strains. The relative risk of experiencing any adverse event, in 55 trials, including more than 7000 patients, was not significantly higher with probiotics.
Some combinations of probiotics or strains may be beneficial in IBS. However, certainty in the evidence for efficacy by GRADE criteria was low to very low across almost all of our analyses.
一些益生菌可能对肠易激综合征（IBS）有益，但所使用的菌种和菌株的差异以及所报告的终点指标，阻碍了我们做出关于哪种益生菌更值得推荐的具体建议。我们更新了之前关于此问题的荟萃分析。
检索了MEDLINE、EMBASE和Cochrane对照试验注册库（截至2023年3月）。纳入招募IBS成年患者、比较益生菌与安慰剂的随机对照试验（RCT）。汇总二分法症状数据以获得治疗后全球症状、腹痛或腹胀持续存在的相对风险，并给出95%置信区间（CI）。使用标准化均数差及95%CI汇总连续数据。也汇总了不良事件数据。
我们确定了82项符合条件的试验，涉及10332例患者。所有领域中只有24项RCT的偏倚风险较低。对于全球症状，有中等确定性的证据表明大肠埃希菌菌株有益，乳酸杆菌菌株和植物乳杆菌299V的证据确定性低，联合益生菌、LacClean Gold S、Duolac 7s和芽孢杆菌菌株的证据确定性极低。对于腹痛，有低确定性的证据表明酿酒酵母I - 3856和双歧杆菌菌株有益，联合益生菌、乳酸杆菌、酿酒酵母和芽孢杆菌菌株的证据确定性极低。对于腹胀，联合益生菌和芽孢杆菌菌株有益的证据确定性极低。在包括7000多名患者的55项试验中，使用益生菌发生任何不良事件的相对风险并无显著升高。
某些益生菌组合或菌株可能对IBS有益。然而，几乎在我们所有的分析中，根据GRADE标准，疗效证据的确定性都很低至极低。
