The efficacy of probiotics in the treatment of irritable bowel syndrome

A systematic review

P. Moayyedi, A. C. Ford, N. J. Talley, F. Cremonini, A. E. Foxx-Orenstein, Lawrence J. Brandt, E. M M Quigley

Research output: Contribution to journalArticle

455 Citations (Scopus)

Abstract

Introduction: Probiotics may benefit irritable bowel syndrome (IBS) symptoms, but randomised controlled trials (RCTs) have been conflicting; therefore a systematic review was conducted. Methods: MEDLINE (1966 to May 2008), EMBASE (1988 to May 2008) and the Cochrane Controlled Trials Register (2008) electronic databases were searched, as were abstracts from DDW (Digestive Diseases Week) and UEGW (United European Gastroenterology Week), and authors were contacted for extra information. Only parallel group RCTs with at least 1 week of treatment comparing probiotics with placebo or no treatment in adults with IBS according to any acceptable definition were included. Studies had to provide improvement in abdominal pain or global IBS symptoms as an outcome. Eligibility assessment and data extraction were performed by two independent researchers. Data were synthesised using relative risk (RR) of symptoms not improving for dichotomous data and standardised mean difference (SMD) for continuous data using random effects models. Results: 19 RCTs (18 papers) in 1650 patients with IBS were identified. Trial quality was generally good, with nine reporting adequate methods of randomisation and six a method of concealment of allocation. There were 10 RCTs involving 918 patients providing outcomes as a dichotomous variable. Probiotics were statistically significantly better than placebo (RR of IBS not improving = 0.71; 95% CI 0.57 to 0.88) with a number needed to treat (NNT) = 4 (95% CI 3 to 12.5). There was significant heterogeneity (χ2 = 28.3, p = 0.001, I2 = 68%) and possible funnel plot asymmetry. Fifteen trials assessing 1351 patients reported on improvement in IBS score as a continuous outcome (SMD = -0.34; 95% CI -0.60 to -0.07). There was statistically significant heterogeneity (χ2 = 67.04, p<0.001, I2 = 79%), but this was explained by one outlying trial. Conclusion: Probiotics appear to be efficacious in IBS, but the magnitude of benefit and the most effective species and strain are uncertain.

Original languageEnglish (US)
Pages (from-to)325-332
Number of pages8
JournalGut
Volume59
Issue number3
DOIs
StatePublished - Mar 2010

Fingerprint

Irritable Bowel Syndrome
Probiotics
Randomized Controlled Trials
Therapeutics
Placebos
Numbers Needed To Treat
Gastroenterology
Random Allocation
MEDLINE
Abdominal Pain
Research Personnel
Databases

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Moayyedi, P., Ford, A. C., Talley, N. J., Cremonini, F., Foxx-Orenstein, A. E., Brandt, L. J., & Quigley, E. M. M. (2010). The efficacy of probiotics in the treatment of irritable bowel syndrome: A systematic review. Gut, 59(3), 325-332. https://doi.org/10.1136/gut.2008.167270

The efficacy of probiotics in the treatment of irritable bowel syndrome : A systematic review. / Moayyedi, P.; Ford, A. C.; Talley, N. J.; Cremonini, F.; Foxx-Orenstein, A. E.; Brandt, Lawrence J.; Quigley, E. M M.

In: Gut, Vol. 59, No. 3, 03.2010, p. 325-332.

Research output: Contribution to journalArticle

Moayyedi, P, Ford, AC, Talley, NJ, Cremonini, F, Foxx-Orenstein, AE, Brandt, LJ & Quigley, EMM 2010, 'The efficacy of probiotics in the treatment of irritable bowel syndrome: A systematic review', Gut, vol. 59, no. 3, pp. 325-332. https://doi.org/10.1136/gut.2008.167270
Moayyedi P, Ford AC, Talley NJ, Cremonini F, Foxx-Orenstein AE, Brandt LJ et al. The efficacy of probiotics in the treatment of irritable bowel syndrome: A systematic review. Gut. 2010 Mar;59(3):325-332. https://doi.org/10.1136/gut.2008.167270
Moayyedi, P. ; Ford, A. C. ; Talley, N. J. ; Cremonini, F. ; Foxx-Orenstein, A. E. ; Brandt, Lawrence J. ; Quigley, E. M M. / The efficacy of probiotics in the treatment of irritable bowel syndrome : A systematic review. In: Gut. 2010 ; Vol. 59, No. 3. pp. 325-332.
@article{0d99b22c4022453aacf59a040b4a3ad5,
title = "The efficacy of probiotics in the treatment of irritable bowel syndrome: A systematic review",
abstract = "Introduction: Probiotics may benefit irritable bowel syndrome (IBS) symptoms, but randomised controlled trials (RCTs) have been conflicting; therefore a systematic review was conducted. Methods: MEDLINE (1966 to May 2008), EMBASE (1988 to May 2008) and the Cochrane Controlled Trials Register (2008) electronic databases were searched, as were abstracts from DDW (Digestive Diseases Week) and UEGW (United European Gastroenterology Week), and authors were contacted for extra information. Only parallel group RCTs with at least 1 week of treatment comparing probiotics with placebo or no treatment in adults with IBS according to any acceptable definition were included. Studies had to provide improvement in abdominal pain or global IBS symptoms as an outcome. Eligibility assessment and data extraction were performed by two independent researchers. Data were synthesised using relative risk (RR) of symptoms not improving for dichotomous data and standardised mean difference (SMD) for continuous data using random effects models. Results: 19 RCTs (18 papers) in 1650 patients with IBS were identified. Trial quality was generally good, with nine reporting adequate methods of randomisation and six a method of concealment of allocation. There were 10 RCTs involving 918 patients providing outcomes as a dichotomous variable. Probiotics were statistically significantly better than placebo (RR of IBS not improving = 0.71; 95{\%} CI 0.57 to 0.88) with a number needed to treat (NNT) = 4 (95{\%} CI 3 to 12.5). There was significant heterogeneity (χ2 = 28.3, p = 0.001, I2 = 68{\%}) and possible funnel plot asymmetry. Fifteen trials assessing 1351 patients reported on improvement in IBS score as a continuous outcome (SMD = -0.34; 95{\%} CI -0.60 to -0.07). There was statistically significant heterogeneity (χ2 = 67.04, p<0.001, I2 = 79{\%}), but this was explained by one outlying trial. Conclusion: Probiotics appear to be efficacious in IBS, but the magnitude of benefit and the most effective species and strain are uncertain.",
author = "P. Moayyedi and Ford, {A. C.} and Talley, {N. J.} and F. Cremonini and Foxx-Orenstein, {A. E.} and Brandt, {Lawrence J.} and Quigley, {E. M M}",
year = "2010",
month = "3",
doi = "10.1136/gut.2008.167270",
language = "English (US)",
volume = "59",
pages = "325--332",
journal = "Gut",
issn = "0017-5749",
publisher = "BMJ Publishing Group",
number = "3",

}

TY - JOUR

T1 - The efficacy of probiotics in the treatment of irritable bowel syndrome

T2 - A systematic review

AU - Moayyedi, P.

AU - Ford, A. C.

AU - Talley, N. J.

AU - Cremonini, F.

AU - Foxx-Orenstein, A. E.

AU - Brandt, Lawrence J.

AU - Quigley, E. M M

PY - 2010/3

Y1 - 2010/3

N2 - Introduction: Probiotics may benefit irritable bowel syndrome (IBS) symptoms, but randomised controlled trials (RCTs) have been conflicting; therefore a systematic review was conducted. Methods: MEDLINE (1966 to May 2008), EMBASE (1988 to May 2008) and the Cochrane Controlled Trials Register (2008) electronic databases were searched, as were abstracts from DDW (Digestive Diseases Week) and UEGW (United European Gastroenterology Week), and authors were contacted for extra information. Only parallel group RCTs with at least 1 week of treatment comparing probiotics with placebo or no treatment in adults with IBS according to any acceptable definition were included. Studies had to provide improvement in abdominal pain or global IBS symptoms as an outcome. Eligibility assessment and data extraction were performed by two independent researchers. Data were synthesised using relative risk (RR) of symptoms not improving for dichotomous data and standardised mean difference (SMD) for continuous data using random effects models. Results: 19 RCTs (18 papers) in 1650 patients with IBS were identified. Trial quality was generally good, with nine reporting adequate methods of randomisation and six a method of concealment of allocation. There were 10 RCTs involving 918 patients providing outcomes as a dichotomous variable. Probiotics were statistically significantly better than placebo (RR of IBS not improving = 0.71; 95% CI 0.57 to 0.88) with a number needed to treat (NNT) = 4 (95% CI 3 to 12.5). There was significant heterogeneity (χ2 = 28.3, p = 0.001, I2 = 68%) and possible funnel plot asymmetry. Fifteen trials assessing 1351 patients reported on improvement in IBS score as a continuous outcome (SMD = -0.34; 95% CI -0.60 to -0.07). There was statistically significant heterogeneity (χ2 = 67.04, p<0.001, I2 = 79%), but this was explained by one outlying trial. Conclusion: Probiotics appear to be efficacious in IBS, but the magnitude of benefit and the most effective species and strain are uncertain.

AB - Introduction: Probiotics may benefit irritable bowel syndrome (IBS) symptoms, but randomised controlled trials (RCTs) have been conflicting; therefore a systematic review was conducted. Methods: MEDLINE (1966 to May 2008), EMBASE (1988 to May 2008) and the Cochrane Controlled Trials Register (2008) electronic databases were searched, as were abstracts from DDW (Digestive Diseases Week) and UEGW (United European Gastroenterology Week), and authors were contacted for extra information. Only parallel group RCTs with at least 1 week of treatment comparing probiotics with placebo or no treatment in adults with IBS according to any acceptable definition were included. Studies had to provide improvement in abdominal pain or global IBS symptoms as an outcome. Eligibility assessment and data extraction were performed by two independent researchers. Data were synthesised using relative risk (RR) of symptoms not improving for dichotomous data and standardised mean difference (SMD) for continuous data using random effects models. Results: 19 RCTs (18 papers) in 1650 patients with IBS were identified. Trial quality was generally good, with nine reporting adequate methods of randomisation and six a method of concealment of allocation. There were 10 RCTs involving 918 patients providing outcomes as a dichotomous variable. Probiotics were statistically significantly better than placebo (RR of IBS not improving = 0.71; 95% CI 0.57 to 0.88) with a number needed to treat (NNT) = 4 (95% CI 3 to 12.5). There was significant heterogeneity (χ2 = 28.3, p = 0.001, I2 = 68%) and possible funnel plot asymmetry. Fifteen trials assessing 1351 patients reported on improvement in IBS score as a continuous outcome (SMD = -0.34; 95% CI -0.60 to -0.07). There was statistically significant heterogeneity (χ2 = 67.04, p<0.001, I2 = 79%), but this was explained by one outlying trial. Conclusion: Probiotics appear to be efficacious in IBS, but the magnitude of benefit and the most effective species and strain are uncertain.

UR - http://www.scopus.com/inward/record.url?scp=77749318556&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77749318556&partnerID=8YFLogxK

U2 - 10.1136/gut.2008.167270

DO - 10.1136/gut.2008.167270

M3 - Article

VL - 59

SP - 325

EP - 332

JO - Gut

JF - Gut

SN - 0017-5749

IS - 3

ER -