IDDF2022-ABS-0208 Efficacy of probiotics for irritable bowel syndrome: a meta-analysis of randomized, double-blind, placebo-controlled trials

BackgroundThe therapeutic role of probiotics in irritable bowel syndrome (IBS) remains controversial. We aimed to assess the efficacy of probiotics in IBS by different genera, doses, and treatment duration.MethodsWe searched MEDLINE and EMBASE up to August 24, 2021 to identify randomized, double-blind, placebo-controlled trials investigating the effectiveness of probiotics among patients with IBS. Pooled analyses of the effects of probiotics in relieving IBS symptoms were calculated using a random-effects model. Further stratification was performed by different genera, doses and duration of probiotics treatment.ResultsOur final analysis included 39 trials reporting outcomes on 5079 IBS patients. Probiotics significantly increased the overall response rate (RR 1.66; P < 0.00001; IDDF2022-ABS-0208 Figure 1 Overall response rates), subjective relief rate (RR 1.55; P < 0.0001; IDDF2022-ABS-0208 Figure 2 Subjective relief rates) and abdominal pain relief rate (RR 1.74; P < 0.00001; IDDF2022-ABS-0208 Figure 3 Abdominal pain relief rates). As is shown in IDDF2022-ABS-0208 Figure 4 Response rates of different genera, mixed probiotics (RR 1.46; P <0.00001), Bifidobacterium (RR 1.68; P < 0.00001), Lactobacillus (RR 2.10; P =0.002) and Saccharomyces (RR 1.27; P =0.03) markedly relieved IBS symptoms. Mixed probiotics (RR 1.35; P = 0.001) and Bifidobacterium (RR 1.62; P < 0.0001) elevated patients’ subjective relief rate (IDDF2022-ABS-0208 Figure 2 Subjective relief rates). Lactobacillus (RR 1.83; P =0.006) and Saccharomyces (RR 1.27; P = 0.03) much improved abdominal pain (IDDF2022-ABS-0208 Figure 3 Abdominal pain relief rates). Probiotics appeared to show a remarkable beneficial role at a dose of 109 CFU/d or above (RR 1.72; P <0.0001; IDDF2022-ABS-0208 Figure 5 Response rates of different doses) and started to work within 4–8 weeks (RR 1.77; P <0.00001; IDDF2022-ABS-0208 Figure 6 Response rates of different treatment durations).ConclusionsProbiotics have a therapeutic role in IBS. However, the effect of different probiotics varies. The minimal effective dose of probiotics may be 109 CFU/d. With appropriate probiotic formula, the therapeutic effect can occur at 4 weeks. These data provide a basis for further research on the optimal probiotic therapy in IBS.