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Comparing probiotic and drug interventions in irritable bowel syndrome: a meta-analysis of randomised controlled trials
Vrije Universiteit Amsterdam, Athena Institute, De Boelelaan, Amsterdam, the Netherlands.
Vrije Universiteit Amsterdam, Athena Institute, De Boelelaan, Amsterdam, the Netherlands.
Örebro University, School of Medical Sciences.ORCID iD: 0000-0002-0362-0008
Vrije Universiteit Amsterdam, Athena Institute, De Boelelaan, Amsterdam, the Netherlands.
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2022 (English)In: Beneficial Microbes, ISSN 1876-2883, E-ISSN 1876-2891, Vol. 13, no 3, p. 183-194Article, review/survey (Refereed) Published
Abstract [en]

Clinical decisions made by health professionals to recommend either drug or probiotic interventions for irritable bowel syndrome (IBS) should be supported by proper knowledge of the efficacy rates of both types of interventions. In this article, we performed a systematic review and meta-analysis to examine the efficacy of both probiotic- and drug interventions in IBS. Medline was searched between January 2015 - January 2021. Randomised controlled trials (RCT) recruiting participants > 18 years old with IBS and examining the effect of probiotics or drugs were eligible for inclusion. The data of the primary outcome, i.e. the persistence of IBS symptoms (dichotomous symptom data), were pooled to obtain a relative risk (RR), with a 95% confidence interval (CI). Secondary outcomes, abdominal pain- and bloating scores (continuous data), were pooled using a standardised mean difference with a 95% CI. The search identified 269 citations of which 32 RCTs were eligible. Our meta-analysis indicated that both probiotic and drug interventions are able to improve the persistence of IBS symptoms (RR 0.60 [0.51; 0.92] versus 0.87 [0.81; 0.92], respectively) and abdominal pain scores (standardised mean difference (SMD) -0.35 [-0.56; -0.14] versus -0.10 [-0.20; 0.00], respectively). However, determining the overall efficacy of both intervention types is inherently complex and such results should be interpreted with care, due to the large diversity of probiotic- and drug types and doses, which is also complicated by variety in IBS subtypes. Hence, as a first step, more large scale randomised double blind placebo-controlled trials focussing on a specific IBS subtype targeted with specific probiotic strains or specific pharmaceutical modalities should be executed, enabling a more proper comparison between trials.

Place, publisher, year, edition, pages
Wageningen Academic Publishers, 2022. Vol. 13, no 3, p. 183-194
Keywords [en]
Burden to benefit ratio, drugs, efficacy, probiotics
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-100579DOI: 10.3920/BM2021.0123ISI: 000837954700002PubMedID: 35848115Scopus ID: 2-s2.0-85135596470OAI: oai:DiVA.org:oru-100579DiVA, id: diva2:1687232
Available from: 2022-08-15 Created: 2022-08-15 Last updated: 2022-08-30Bibliographically approved

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Brummer, Robert Jan

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