Probiotic Therapy of the Irritable Bowel Syndrome: Why Is the Evidence Still Poor and What Can Be Done About It?

Journal of Neurogastroenterology and Motility
Nazar MazurakPaul Enck

Abstract

Despite numerous randomized clinical trials and meta-analyses, there is no increased evidence for the efficacy of probiotics in the treatment of irritable bowel syndrome (IBS). We review this evidence, identify and analyse the reasons for this lack of evidence and propose methodological improvements for future studies. Based on a literature search, we identified 56 papers that matched the purpose of our analyses. Twenty-seven studies used multi-species bacterial preparations and 29 used single-strain probiotics. They were analysed regarding patients included, treatment duration, probiotic dosage, and outcome measures. Trials in both groups suffered from heterogeneity with respect to probiotic concentration, duration of treatment, and other methodological issues (crossover design and underpowered studies). This heterogeneity did not allow the application of a meta-analytic approach and a systematic review was therefore performed instead. Multi-strain preparations combined 2 to 8 different bacterial subspecies, mostly lactobacilli or bifidobacteria, and used variable lengths of treatments. Overall, more than 50% of trials presented negative outcomes. The majority of the single-strain probiotic trials employing lactobacilli or Sac...Continue Reading

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Citations

Jun 7, 2016·Journal of Human Nutrition and Dietetics : the Official Journal of the British Dietetic Association·Y A McKenzieUNKNOWN (IBS Dietetic Guideline Review Group on behalf of Gastroenterology Specialist Group of the British Dietetic Association)
Jun 9, 2016·Journal of Human Nutrition and Dietetics : the Official Journal of the British Dietetic Association·Y A McKenzieUNKNOWN (IBS Dietetic Guideline Review Group on behalf of Gastroenterology Specialist Group of the British Dietetic Association)
Jun 30, 2016·Journal of Neurogastroenterology and Motility·Fanny Pélerin, Pierre Desreumaux
Oct 6, 2016·Journal of Neurogastroenterology and Motility·Jung Hwan Oh
Jul 15, 2016·Journal of Neurogastroenterology and Motility·Huiying WangPaul Enck
Feb 2, 2017·European Child & Adolescent Psychiatry·Beate Herpertz-DahlmannJohn Baines
Apr 26, 2018·Annals of Nutrition & Metabolism·Paul Enck, Nazar Mazurak
Aug 14, 2018·The International Journal of Neuropsychopharmacology·Thomaz F S BastiaanssenJohn F Cryan
May 10, 2016·Nature Reviews. Disease Primers·Paul EnckRobin C Spiller
Jan 8, 2018·Psychotherapy and Psychosomatics·Peter HenningsenFrancis Creed
Dec 21, 2016·International Journal of Bacteriology·Claudia Beimfohr
Jan 8, 2020·Probiotics and Antimicrobial Proteins·Elizaveta A TrushVladimir T Ivashkin
May 2, 2018·Neurotherapeutics : the Journal of the American Society for Experimental NeuroTherapeutics·Huiying WangPaul Enck

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