Probiotics could ease constipation in IBS patients by improving stool consistency, increasing gut flora – meta-analysis
However, there was no marked difference in abdominal pain, bloating, quality of life or incidence of adverse events.
These findings were highlighted in the review titled “Effectiveness and Safety of Probiotics for Patients with Constipation-Predominant Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of 10 Randomized Controlled Trials” published in the journal Nutrients.
“Patients with IBS-C are often recommended and use lifestyle modifications or medications, such as non-prescription fibre laxatives or stool softeners, to manage their symptoms. However, these therapies can only be palliative and supportive for specific symptoms.
“When properly ingested, probiotics are living microorganisms that have potential health benefits. The effectiveness of probiotics in improving IBS symptoms has been tentatively recognised, and several probiotic strains have been demonstrated to benefit patients with IBS.
“Thus, probiotics may be a potential treatment for IBS-C. Therefore, we conducted a systematic review and meta-analysis to investigate the effectiveness and safety of probiotics in IBS-C patients,” said the researchers.
For this meta-analysis, the team found 4,584 relevant studies, narrowed to 10 RCTs involving 757 subjects to be examined. The 10 RCTs spanned various countries, from South Korea, China and India to South Africa, Italy, France and the US.
Compared to placebos, three RCTs revealed that probiotics could improve stool consistency. The studies were conducted by Preston, K. et al. (2018), Lewis E. D. et al. (2020) and Gayathri, R. et al. (2020). Upon further analysis, an eight-week course of treatment resulted in a good effect on stool consistency compared to a 12-week intervention.
Second, significantly increased numbers of faecal bacteria Bifidobacteria and Lactobacillus were discovered in 74 IBS-C patients from RCTs done by Stevenson, C. et al. (2021) and Cui, S. et al. (2012). Again, a shorter duration showed a good effect on both strains at four weeks, but an eight-week intervention showed no effect.
However, it was unclear whether the probiotics had any effect on abdominal pain through four RCTs involving 488 patients. Results from the studies showed no difference between the placebo and intervention groups. Two RCTs that involved 447 patients and investigated bloating indicated no significant differences between groups. The same situation was also reported for scores on quality of life led by the patients – no differences were recorded between the probiotic and placebo groups.
The meta-analysis showed that probiotics might benefit IBS-C patients with a certain level of safety. Hence, it is worth being considered as therapy by clinicians, said the researchers.
The improved stool consistency directly reduced the difficulty of defecating among patients. Simultaneously, the increase in faecal Bifidobacterium and Lactobacillus showed that imbalances in intestinal flora might improve and maintain normal gastrointestinal function. Normal intestinal flora not only could improve IBS symptoms but also improve symptoms of other gastrointestinal diseases.
“In summary, probiotics as a safe treatment may be beneficial for improving IBS-C stool consistency and increasing the number of faecal Bifidobacteria and Lactobacilli. Obtaining information on which strains are most effective and which subtypes of IBS-C patients might benefit most from probiotic treatment can be used to determine the number and combination of strains for ideal probiotic supplements,” concluded the researchers.
The current research was funded by the National Natural Science Foundation of China, the Gansu Special Project of Soft Science and the Fundamental Research Funds for the Central Universities.
“Effectiveness and Safety of Probiotics for Patients with Constipation-Predominant Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of 10 Randomized Controlled Trials”
Authors: Xue Shang et al.
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