Lei Yupeng, Sun Xuemei, Ruan Tiechao, Lu Wenting, Deng Bixin, Zhou Ruixi, Mu Dezhi
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan 610041, China.
Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Nutr Rev. 2025 Jan 25. doi: 10.1093/nutrit/nuae217.
The efficacy of probiotics and diet management in irritable bowel syndrome (IBS) is controversial, and their relative effectiveness remains unclear.
This study aimed to evaluate the effects of probiotics, diet management, and their combination on IBS.
PubMed, Embase, Cochrane, and Web of Science were searched from inception to July 10, 2023, for relevant studies, including symptom relief, IBS-symptom severity score (-SSS), and IBS-quality of life measure (-QOL).
Two investigators independently performed the data extraction and quality assessment.
A network meta-analysis was performed using a frequentist approach and a random-effects model to estimate the relative risk (RR) and 95% CI.
Forty-four articles were eligible for this study. In relieving IBS symptoms, compared with a sham diet, a low-fermentable oligosaccharide, disaccharide, monosaccharide, and polyols (low-FODMAP) diet (RR: 3.22; 95% CI: 1.70-6.26) and low-FODMAP diet combined with probiotics (RR: 17.79; 95% CI: 3.27-112.54) significantly relieved IBS symptoms. The control group showed significantly lower effectiveness than the probiotics group (RR: 0.47; 95% CI: 0.32-0.69). According to the surface under the cumulative rank curve (SUCRA), a low-FODMAP diet combined with probiotics (80.4%) had the best effect in relieving IBS symptoms, followed by a low-FODMAP diet (70.8%), probiotics (65.1%), and a gluten-free diet (54.3%). In reducing the total IBS-SSS, the low-FODMAP diet (90.5%) was the most effective, followed by the low-FODMAP diet combined with probiotics (76.6%), probiotics alone (62.3%), and gluten-free diet (28.3%). In reducing total IBS-QOL, probiotics (72.1%) ranked first, followed by gluten-free (57.0%) and low-FODMAP (56.9%) diets. Probiotics (34.9%) were associated with the lowest risk of adverse effects.
A low-FODMAP diet combined with probiotics is most effective in relieving IBS symptoms. A low-FODMAP diet is the most recommended diet for alleviating IBS severity, and probiotics were associated with improving the QOL of patients with IBS, with the fewest adverse events.
PROSPERO registration no. CRD42024499113.
益生菌和饮食管理对肠易激综合征（IBS）的疗效存在争议，它们的相对有效性仍不明确。
本研究旨在评估益生菌、饮食管理及其联合应用对IBS的影响。
检索了PubMed、Embase、Cochrane和Web of Science数据库，从建库至2023年7月10日的相关研究，包括症状缓解情况、IBS症状严重程度评分（-SSS）和IBS生活质量测量（-QOL）。
两名研究者独立进行数据提取和质量评估。
采用频率学派方法和随机效应模型进行网络荟萃分析，以估计相对风险（RR）和95%置信区间（CI）。
44篇文章符合本研究纳入标准。在缓解IBS症状方面，与假饮食相比，低可发酵寡糖、双糖、单糖和多元醇（低FODMAP）饮食（RR：3.22；95%CI：1.70 - 6.26）以及低FODMAP饮食联合益生菌（RR：17.79；95%CI：3.27 - 112.54）能显著缓解IBS症状。对照组的有效性显著低于益生菌组（RR：0.47；95%CI：0.32 - 0.69）。根据累积排序曲线下面积（SUCRA），低FODMAP饮食联合益生菌（80.4%）在缓解IBS症状方面效果最佳，其次是低FODMAP饮食（70.8%）、益生菌（65.1%）和无麸质饮食（54.3%）。在降低IBS总SSS方面，低FODMAP饮食（90.5%）最有效，其次是低FODMAP饮食联合益生菌（76.6%）、单独使用益生菌（62.3%）和无麸质饮食（28.3%）。在降低IBS总QOL方面，益生菌（72.1%）排名第一，其次是无麸质饮食（57.0%）和低FODMAP饮食（56.9%）。益生菌（34.9%）与最低的不良反应风险相关。
低FODMAP饮食联合益生菌在缓解IBS症状方面最有效。低FODMAP饮食是缓解IBS严重程度最推荐的饮食，益生菌与改善IBS患者的生活质量相关，且不良事件最少。
PROSPERO注册号CRD42024499113。
