Meta analysis comes to the conclusion that probiotics effectively reduce IBS symptoms

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reference

Liang D, Longgui N, Guoqiang X. Effectiveness of different probiotic protocols in irritable bowel syndrome: a network meta analysis. Medicine (Baltimore) . 2019; 98 (27): E16068.

objective

A meta-analysis to assess the effectiveness of the different types of probiotic protocols to treat the symptoms of irritable bowel syndrome (IBS).

method

The authors searched various databases between January 2006 and April 2019, including Pubmed, Medline, Embase, Web of Science and Cochrane Central Register of Controlled Trials. They analyzed a total of 14 placebo -controlled randomized studies with 1,695 patients. In this analysis, the 2 primary multi-strain protocols were presented in the studies that showed the effectiveness:

duo = lactobacillus acidophilus, plantarum, lactobacillus rhamnosus, bifidobacterium breve, bifidobacterium lactis, bifidobacterium longum, and streptococcus Thermophilus

pro = bifidobacterium lactis bb12, lactobacillus acidophilus la5, lactobacillus delbruecki subsp bulgaricus lby-27, and streptococcus thermophilus sty-31

important knowledge

The researchers found that protocols with a daily dose of 10 10 colonie forming units (KBE) that were combined lactobacilli and bifidobacterium tribes were more effective than individual tribes or overdosing protocols. The Duo Protocol showed the greatest effectiveness in irritable bowel syndrome of diarrhea, while Pro was more effective in irritable bowel syndrome.

The researchers also considered the probiotic protocols to be safe, whereby the undesirable events did not differ statistically from placebo.

practice implications

ROM criteria are used to diagnose and classify functional gastrointestinal diseases such as IBS. ROM IV is the latest version of these criteria and has changed the concept of functional gastrointestinal disorders in disorders of the intestinal brain interaction (DGBI); Of these, IBS is most common worldwide. ^{1 Although the IBS prevalence has increased significantly, it may be more common than before due to self-diagnosis and self-management. Interestingly, an online survey from 2019, in which RDS was compared with a self-diagnosed RDS, was compared that almost 69 % of the respondents met the Rome IV criteria, but only visited a doctor because of their symptoms.}

In this meta-analysis, doses of more than 10 10 CFU were not more effective in the treatment of IBS symptoms. Some research results indicate that high-dose probiotics can actually promote bacterial proliferation that worsens GI symptoms.

Based on data of the international classification of diseases, tenth revision (ICD-10), IBS is classified as a functional disorder of the large intestine, which causes abdominal pain, cramps, inflation and changes in stool habits, diarrhea, constipation, or alternating diarrhea and constipation. ROM IV classification show different intestinal patterns: 4

1. diarrhea predominant (ibs-d)
2. constipation predominant (IBS-C)
3. Mixed diarrhea and constipation (IBS-M)
4. not classified and does not fit in any of the 3 subtypes (IBS-U)

The fact that this meta-analysis identified which probiotic main combinations were effective in relieving the symptoms of the various IBS classifications is clinically helpful. This analysis also confirms that probiotic formulations with several tribes are more effective than a single trunk that many clinicians have seen in their practice

The question of high doses is also important and refers to the intended clinical use of the probiotic wording. In this meta-analysis, doses of more than 10 10 CFU were not more effective in the treatment of IBS symptoms. Some research results indicate that high-dose probiotics can actually promote bacterial proliferation that worsens GI symptoms. This was the case in a study from 2018 with patients with bacterial overgrowth of the small intestine (SIBO), which found an increase in symptoms such as brain fog, flatulence and flatulence.

The results of this meta -analysis match another analysis that dale et al. 2019 published in the magazine nutrients . 6 In this analysis, 11 randomized placebo-controlled studies with probiotics were evaluated, with 7 of the studies to find a significant improvement in the IBS symptoms. This analysis also showed that dietary supplements were more effective than individual tribes with several strains. All studies that showed the use of multi-strain probiotics used 1 or both lactobacilli SPP and bifidobacterium SPP. The dosage was not addressed in this meta -analysis.

In addition to the meta -analysis by Liang et al. If other studies have found that probiotics with several tribes are safe, have no serious undesirable events and only have a limited number of light to moderate side effects.

In view of the fact that intestinal dysgies and intestinal permeability contribute to IBS symptoms, 8 It makes sense that probiotics are clinically effective in this frequent illness. ^{9 This latest meta-analysis provides information about which tribes could be effective for which subtype and in which dose could be effective. In addition, this analysis and other studies illustrate the cheap security profile of probiotic interventions for this disease.}

There is a large inter -individual variation in response to different probiotic formulas. This can be the previous status of the microbioma of a person, nutritional factors that support or disturb the therapeutic reaction to the administration of exogenous organisms, and the simultaneous use of medication that change the intestinal flora, as well as unique genetic factors that can determine the sensitivity of a person to introduce new biota. When it comes to probiotics for IBS, it can really be "different strokes for different people".

With this information, clinicists can safely select the many multi-strain probiotics available on the market for their patients who have to struggle with IBS.