Strain-specific and outcome-specific efficacy of probiotics for the treatment of irritable bowel syndrome: A systematic review and meta-analysis

BACKGROUND: Consistent guidance for choosing an appropriate probiotic for the treatment of irritable bowel syndrome is lacking. METHODS: Literature databases searched included: PubMed, Google Scholar and NIH registry of clinical trials from inception to June 2021. Inclusion criteria: randomized controlled trials (RCTs) enrolling adult or pediatric IBS patients comparing probiotics against controls and ≥ 2 RCTs with common IBS outcome measures within each type of probiotic. Five common measures of IBS symptoms (changes in global Irritable Bowel Syndrome Severity Scoring System or IBS-SSS scores, frequency of global responders, changes in bloating or abdominal pain scores and frequency of abdominal pain relief) were used. This study was registered at Prospero (#CRD42018109169). FINDINGS: We screened 521 studies and included 42 randomized controlled trials (45 treatment arms, N = 3856). Four probiotics demonstrated significant reduction in abdominal pain relief: B. coagulans MTCC5260 (RR= 4(.)9, 95% C.I. 3(.)3, 7(.)3), L. plantarum 299v (RR= 4(.)6, 95% CI 1(.)9, 11(.)0), S. boulardii CNCM I-745 (RR= 1(.)5, 95% C.I. 1(.)1, 2(.)1) and S. cerevisiae CNCM I-3856 (RR= 1(.)3, 95% C.I. 1(.)04, 1(.)6). Mild-moderate adverse events were reported in 51% of the trials, none were more associated with the probiotic compared to controls. INTERPRETATION: Although the analysis of probiotic efficacy was limited by the diversity of IBS outcomes used in trials and lack of confirmatory trials for some strains, six single-strain probiotics and three different types of probiotic mixtures showed significant efficacy for at least one IBS outcome measure. These results might be relevant to clinical practice and policy.