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 Console Bracket Assembly 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 Bundt Pans least one IBS outcome measure.These results might be relevant to clinical practice and policy.