Department of Gastroenterology, Unidade Local de Saúde Gaia Espinho (ULSGE), Vila Nova de Gaia, Portugal.
Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.
United European Gastroenterol J. 2024 Sep;12(7):960-981. doi: 10.1002/ueg2.12636. Epub 2024 Aug 6.
Probiotics show promise in inflammatory bowel disease (IBD), yet knowledge gaps persist. We performed an overview of systematic reviews and an updated metanalysis of randomized controlled trials (RCT) assessing the effect of probiotics on Crohn's disease (CD) and ulcerative colitis (UC).
MEDLINE, Web of Science, and the Cochrane Central Register of Controlled Trials were searched up to September 2023. Primary outcomes were clinical remission and recurrence; secondary outcomes included endoscopic response and remission, and adverse events. We calculated odds ratios (OR) using a random-effects model in R. The quality of systematic reviews was assessed using the AMSTAR-2; the trials' risk of bias was evaluated using the Cochrane Collaboration tool. Evidence certainty was rated using the GRADE framework.
Out of 2613 results, 67 studies (22 systematic reviews and 45 RCTs) met the eligibility criteria. In the updated meta-analysis, the OR for clinical remission in UC and CD was 2.00 (95% CI 1.28-3.11) and 1.61 (95% CI 0.21-12.50), respectively. The subgroup analysis suggested that combining 5-ASA and probiotics may be beneficial for inducing remission in mild-to-moderate UC (OR 2.35, 95% CI 1.29-4.28). Probiotics decreased the odds of recurrence in relapsing pouchitis (OR 0.03, 95% CI 0.00-0.25) and trended toward reducing clinical recurrence in inactive UC (OR 0.65, 95% CI 0.42-1.01). No protective effect against recurrence was identified for CD. Multi-strain formulations appear superior in achieving remission and preventing recurrence in UC. The use of probiotics was not associated with better endoscopic outcomes. Adverse events were similar to control. However, the overall certainty of evidence was low.
Probiotics, particularly multi-strain formulations, appear efficacious for the induction of clinical remission and the prevention of relapse in UC patients as well as for relapsing pouchitis. Notwithstanding, no significant effect was identified for CD. The favorable safety profile of probiotics was also highlighted.
益生菌在炎症性肠病（IBD）中显示出一定的疗效，但仍存在知识空白。我们对评估益生菌对克罗恩病（CD）和溃疡性结肠炎（UC）疗效的系统评价和更新的随机对照试验（RCT）进行了概述。
检索 MEDLINE、Web of Science 和 Cochrane 对照试验中心注册库，截至 2023 年 9 月。主要结局指标为临床缓解和复发；次要结局指标包括内镜缓解和缓解以及不良事件。我们在 R 中使用随机效应模型计算比值比（OR）。使用 AMSTAR-2 评估系统评价的质量；使用 Cochrane 协作工具评估试验的偏倚风险。使用 GRADE 框架评估证据确定性。
在 2613 项研究结果中，有 67 项研究（22 项系统评价和 45 项 RCT）符合入选标准。在更新的荟萃分析中，UC 和 CD 临床缓解的 OR 分别为 2.00（95%CI 1.28-3.11）和 1.61（95%CI 0.21-12.50）。亚组分析表明，将 5-ASA 和益生菌联合使用可能有利于诱导轻中度 UC 缓解（OR 2.35，95%CI 1.29-4.28）。益生菌降低了复发袋炎的复发几率（OR 0.03，95%CI 0.00-0.25），并在缓解期 UC 中倾向于降低临床复发几率（OR 0.65，95%CI 0.42-1.01）。益生菌对 CD 的复发没有保护作用。多菌株制剂在 UC 中达到缓解和预防复发方面似乎更有效。益生菌的使用与更好的内镜结局无关。不良事件与对照组相似。然而，证据的总体确定性较低。
益生菌，特别是多菌株制剂，在诱导 UC 患者临床缓解和预防复发以及复发袋炎方面似乎有效。然而，对 CD 没有明显效果。益生菌的良好安全性也得到了强调。
