Department of Colorectal Diseases, Hospital of Chengdu University of Traditional Chinese Medicine.
Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China.
Int J Surg. 2023 Nov 1;109(11):3631-3647. doi: 10.1097/JS9.0000000000000658.
Previous systematic reviews demonstrated a potentially beneficial effect of probiotics on irritable bowel syndrome (IBS). However, these studies are either affected by the inclusion of insufficient trials or by the problem of dependent data across multiple outcomes, and an overall effect size has not been provided. We aimed to determine the effect of probiotics on IBS through a three-level meta-analysis and clarify potential effect moderators.
We searched MEDLINE, Embase, and Web of Science, screening for randomized controlled trials (RCTs) that examine the effect of probiotics on IBS. The primary outcome was the improvement in the severity of global IBS symptoms at the end of treatment. The secondary outcomes were the improvement in abdominal pain and the quality of life. The effect sizes of the probiotics were measured by using the standardized mean difference (SMD) and pooled by a three-level meta-analysis model.
We included 72 RCTs in the analysis. The meta-analysis showed significantly better overall effect of probiotics than placebo on the global IBS symptoms (SMD -0.55, 95% CI -0.76 to -0.34, P <0.001), abdominal pain (SMD -0.89, 95% CI -1.29 to -0.5, P <0.001) and quality of life (SMD 0.99, 95% CI 0.45 to 1.54, P <0.001), respectively. Moderator analysis found that a treatment duration shorter than 4 weeks was associated with a larger effect size in all the outcomes, and Bacillus probiotics had better improvement on the abdominal pain.
Probiotics had a short-term effect and a medium effect size on the global IBS symptoms. Treatment duration and types of probiotics affected the effect size of probiotics, and shorter durations and Bacillus probiotics were associated with better treatment effects.
Open Science Framework.
先前的系统评价表明益生菌对肠易激综合征（IBS）可能有有益的影响。然而，这些研究要么受到纳入的试验数量不足的影响，要么受到多个结局数据相关性的问题的影响，且并未提供总体效应大小。我们旨在通过三级荟萃分析来确定益生菌对 IBS 的影响，并阐明潜在的效应调节因素。
我们检索了 MEDLINE、Embase 和 Web of Science，筛选了评估益生菌对 IBS 影响的随机对照试验（RCT）。主要结局是治疗结束时全球 IBS 症状严重程度的改善。次要结局是腹痛和生活质量的改善。使用标准化均数差（SMD）来衡量益生菌的效应大小，并通过三级荟萃分析模型进行汇总。
我们纳入了 72 项 RCT 进行分析。荟萃分析显示，与安慰剂相比，益生菌对全球 IBS 症状（SMD-0.55，95%CI-0.76 至-0.34，P<0.001）、腹痛（SMD-0.89，95%CI-1.29 至-0.5，P<0.001）和生活质量（SMD0.99，95%CI0.45 至 1.54，P<0.001）的总体效果均显著更好。调节分析发现，治疗时间短于 4 周与所有结局的效应大小较大有关，且芽孢杆菌益生菌对腹痛的改善效果更好。
益生菌对全球 IBS 症状有短期的、中等程度的影响。治疗时间和益生菌类型影响益生菌的效应大小，较短的治疗时间和芽孢杆菌益生菌与更好的治疗效果相关。
开放科学框架。
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