Epocrates DocAlert Messages — Editor's Pick
Probiotics may improve irritable bowel syndrome
InfoPOEMs
January 2009
Clinical question: Are probiotics beneficial in the treatment of irritable bowel syndrome?
Bottom line: This systematic review/meta-analysis of randomized trials found a significant benefit of probiotics (number needed to treat [NNT] = 12) for improving symptoms of irritable bowel syndrome (IBS). Given the frequent difficulty in adequately treating this illness and the generally benign effects of probiotics, clinicians should strongly consider them for their patients with IBS. (LOE = 1a)
Reference: Nikfar S, Rahimi R, Rahimi F, Derakhshani S, Abdollahi M. Efficacy of probiotics in irritable bowel syndrome: A meta-analysis of randomized, controlled trials. Dis Colon Rectum 2008;51(12):1775-1780. [PubMed Abstract]
Study design: Meta-analysis (randomized controlled trials)
Setting: Various (meta-analysis)
Synopsis: These investigators thoroughly searched multiple databases, including PubMed, Embase, the Cochrane Register of Controlled Trials, reference lists from pertinent articles, and meeting abstracts, for randomized trials evaluating probiotics in the management of IBS. No language restrictions applied. Three reviewers independently evaluated articles for inclusion and methodologic quality (using standard Jadad criteria where 0 = lowest quality and 5 = highest quality) and no significant differences in assessments occurred between the reviewers. The diagnosis of IBS was determined according to standard Rome criteria; different doses and bacteria were used in the various studies. Eight studies (n = 1011 patients) met inclusion criteria; 6 had Jadad scores of 3 or better, and 2 studies had Jadad scores of 2. Treatment duration ranged from 4 weeks to 24 weeks, and the studies included mostly women. Clinical improvement, generally defined as a satisfactory improvement of symptoms, was significantly higher in the probiotic group than in the placebo group (53.1% vs 44.9%; NNT=12; 95% CI, 7-62). A funnel plot assessment found no evidence of publication bias and all studies met statistical criteria for homogeneity. A separate analysis using only the 6 highest quality studies found no difference in results.
Copyright © 2009 John Wiley & Sons, Inc. www.essentialevidence.com
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