TY - JOUR
T1 - Probiotics and synbiotics in chronic constipation in adults: a systematic review and meta-analysis of randomized controlled trials
AU - Van Der Schoot, Alice
AU - Helander, Carina
AU - Whelan, Kevin
AU - Dimidi, Eirini
N1 - Funding Information:
This systematic review was part of a project funded by the General and Education Trust Fund, British Dietetic Association (grant ID: 19/14). Funders had no role in the design, conduct or publishment of this review.
Funding Information:
AvdS is currently funded by a grant from the Almond Board of California. CH has been funded by a grant from the Almond Board of California. ED has received an education grant from Alpro, research funding from the British Dietetic Association, Almond Board of California, the International Nut and Dried Fruit Council and Nestec Ltd and has served as a consultant for Puratos. KW has received research funding from government bodies including National Institute of Health Research and Medical Research Council, charities including Crohn's and Colitis UK, ForCrohns, The Leona M. and Harry B. Helmsley Charitable Trust, Kenneth Rainin Foundation, as well as from industrial sources including Almond Board of California, Clasado Biosciences, Danone and the International Dried Fruit and Nut Council. KW is the coinventor of a mobile application to support people following dietary restrictions and biomarkers to detect IBS and markers of response.
Publisher Copyright:
© 2022 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism
PY - 2022/12
Y1 - 2022/12
N2 - Background & aims: Probiotics and synbiotics have been increasingly investigated for the management of chronic constipation. We aimed to investigate the effect of probiotics and synbiotics on stool output, gut transit time, symptoms and quality of life in adults with chronic constipation via a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: Studies were identified using electronic databases, backward citation and hand-searching abstracts. The search date was 10 July 2022. RCTs reporting administration of probiotics or synbiotics in adults with chronic constipation were included. Risk of bias (RoB) was assessed with the Cochrane RoB 2.0 tool. Meta-analysis was conducted separately for probiotics and synbiotics. Results were synthesized using risk ratios (RRs), mean differences or standardized mean differences (SMDs) and 95% confidence intervals (CIs) using a random-effects model. Results: Thirty RCTs investigating probiotics and four RCTs investigating synbiotics were included. Overall, 369/647 (57%) responded to probiotic treatment and 252/567 (44%) to control (RR 1.28, 95% CI 1.07, 1.52, p = 0.007). Probiotics increased stool frequency (SMD 0.71, 95% CI 0.37, 1.04, p < 0.00001), with Bifidobacterium lactis having a significant effect, but not mixtures of probiotics, Bacillus coagulans Unique IS2 or Lactobacillus casei Shirota. Probiotics did not impact stool consistency (SMD 0.26, 95% CI −0.03, 0.54, p = 0.08). Probiotics improved integrative symptom scores compared to control (SMD -0.46, 95% CI −0.89, −0.04). Synbiotics did not impact stool output or integrative symptom scores compared to control. Conclusions: Certain probiotics may improve response to treatment, stool frequency and integrative constipation symptoms, providing cautious optimism for their use as a dietary management option. There is currently insufficient evidence to recommend synbiotics in the management of chronic constipation. Caution is needed when interpreting these results due to high heterogeneity and risk of bias amongst the studies.
AB - Background & aims: Probiotics and synbiotics have been increasingly investigated for the management of chronic constipation. We aimed to investigate the effect of probiotics and synbiotics on stool output, gut transit time, symptoms and quality of life in adults with chronic constipation via a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: Studies were identified using electronic databases, backward citation and hand-searching abstracts. The search date was 10 July 2022. RCTs reporting administration of probiotics or synbiotics in adults with chronic constipation were included. Risk of bias (RoB) was assessed with the Cochrane RoB 2.0 tool. Meta-analysis was conducted separately for probiotics and synbiotics. Results were synthesized using risk ratios (RRs), mean differences or standardized mean differences (SMDs) and 95% confidence intervals (CIs) using a random-effects model. Results: Thirty RCTs investigating probiotics and four RCTs investigating synbiotics were included. Overall, 369/647 (57%) responded to probiotic treatment and 252/567 (44%) to control (RR 1.28, 95% CI 1.07, 1.52, p = 0.007). Probiotics increased stool frequency (SMD 0.71, 95% CI 0.37, 1.04, p < 0.00001), with Bifidobacterium lactis having a significant effect, but not mixtures of probiotics, Bacillus coagulans Unique IS2 or Lactobacillus casei Shirota. Probiotics did not impact stool consistency (SMD 0.26, 95% CI −0.03, 0.54, p = 0.08). Probiotics improved integrative symptom scores compared to control (SMD -0.46, 95% CI −0.89, −0.04). Synbiotics did not impact stool output or integrative symptom scores compared to control. Conclusions: Certain probiotics may improve response to treatment, stool frequency and integrative constipation symptoms, providing cautious optimism for their use as a dietary management option. There is currently insufficient evidence to recommend synbiotics in the management of chronic constipation. Caution is needed when interpreting these results due to high heterogeneity and risk of bias amongst the studies.
UR - http://www.scopus.com/inward/record.url?scp=85141515094&partnerID=8YFLogxK
U2 - 10.1016/j.clnu.2022.10.015
DO - 10.1016/j.clnu.2022.10.015
M3 - Article
SN - 0261-5614
VL - 41
SP - 2759
EP - 2777
JO - CLINICAL NUTRITION
JF - CLINICAL NUTRITION
IS - 12
ER -