Irritable bowel syndrome (IBS) is a most common gastrointestinal condition. Studies regarding the treatment of IBS with probiotics have not yielded consistent results over the past few decades, and the best probiotics is not yet hallmarked.

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Researchers in a recent study reveals that some combinations of probiotics or strains may be beneficial in IBS. However, certainty in the evidence for efficacy by GRADE criteria was low to very low. However, if gastroenterologists are to be able to recommend probiotics in patients with confidence, a better evidence base is needed suggested the authors. The findings of the study is published in journal Gastroentrology.

The researchers conducted a search in MEDLINE, EMBASE, and the Cochrane Controlled Trials Register up to March 2023. Randomized controlled trials (RCTs) recruiting adults with IBS, comparing probiotics with placebo were eligible. Dichotomous symptom data were pooled to obtain a relative risk of global symptoms, abdominal pain, or abdominal bloating or distension persisting after therapy, with a 95% confidence interval (CI). Continuous data were pooled using a standardized mean difference with a 95% CI. Adverse events data were also pooled.
The key findings of the study
• Researchers identified 82 eligible trials, containing 10,332 patients. Only 24 RCTs were at low risk of bias across all domains.
• For global symptoms, there was moderate certainty in the evidence for a benefit of Escherichia strains, low certainty for Lactobacillus strains and Lactobacillus plantarum 299V, and very low certainty for combination probiotics, LacClean Gold S, Duolac 7s, and Bacillus strains.
• For abdominal pain, there was low certainty in the evidence for a benefit of Saccharomyces cerevisae I-3856 and Bifidobacterium strains, and very low certainty for combination probiotics, Lactobacillus, Saccharomyces, and Bacillus strains.
• For abdominal bloating or distension there was very low certainty in the evidence for a benefit of combination probiotics and Bacillus strains.
• The relative risk of experiencing any adverse event, in 55 trials, including over 7000 patients, was not significantly higher with probiotics.
Researchers concluded that “Some combinations of probiotics or strains may be beneficial in IBS. However, certainty in the evidence for efficacy by GRADE criteria was low to very low across almost all our analyses.”
Reference: Vivek C. Goodoory, Mais Khasawneh, Christopher J. Black et al; Efficacy of Probiotics in Irritable Bowel Syndrome: Systematic Review and Meta-analysis; August 02, 2023; DOI:https://doi.org/10.1053/j.gastro.2023.07.018