AUTHOR=Zhang Tao , Zhang Cunzheng , Zhang Jindong , Sun Feng , Duan Liping 

TITLE=Efficacy of Probiotics for Irritable Bowel Syndrome: A Systematic Review and Network Meta-Analysis

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2022.859967

DOI=10.3389/fcimb.2022.859967

ISSN=2235-2988

ABSTRACT=Background: Irritable bowel syndrome (IBS) is a common gastrointestinal condition. Studies regarding the treatment of IBS with probiotics have not yielded consistent results, and the best probiotic species has not yet been confirmed. Therefore, we performed a network meta-analysis (NMA) to assess the relative rank order of different probiotic species for IBS.
Method: We searched for RCTs on the efficacy of probiotics for IBS until August 25, 2021. The primary outcome was the symptom relief rate, as well as global symptoms, abdominal pain, bloating, and straining scores. A network meta-analysis (NMA) was conducted using Stata 15.0. We also used meta-regression to explore whether the treatment length and dose influenced the efficacy.
Results: Forty-three RCTs, with 5,531 IBS patients, were eligible for present NMA. Interestingly, B.coagulans exhibited the highest probability to be the optimal probiotic specie in improving IBS symptom relief rate, as well as global symptom, abdominal pain, bloating, and straining scores. In regard to the secondary outcomes, L.plantarum ranked first in ameliorating the QOL of IBS patients, but unfortunately without any significant differences compared with other probiotics in standardized mean differences (SMD) estimates. Moreover, patients received L.acidophilus had lowest incidence of adverse events. The meta-regression showed that no significant differences were found between participants using different doses of probictics in all outcomes, while the treatment length, as a confounder, can significantly influence the efficacy of probiotics in ameliorating abdominal pain (Coef = -2.30; p = 0.035) and straining (Coef = -3.15; p = 0.020) in IBS patients. Thus, we performed the subgroup analysis on treatment length subsequently in these two outcomes, which showed that efficacy of B.coagulans using 8 weeks ranked first both in improving the abdominal pain and straining scores. Additionally, B. coagulans still had significant efficacy compared to different types of probiotic combinations in present study.
Conclusions: The findings of this NMA suggested that B.coagulans had prominent efficacy in treating IBS patients, and incorporating B. coagulans into a probiotic combination, or genetically engineering it to amplify its biological function may be a future research target to treat IBS patients.