Systematic review with meta‐analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome
Open accessAbstract
Summary: Background: Irritable bowel syndrome ( IBS ) is a chronic functional bowel disorder. Disturbances in the gastrointestinal microbiome may be involved in its aetiology. Aim: To perform a systematic review and meta‐analysis to examine the efficacy of prebiotics, probiotics, synbiotics and antibiotics in IBS . Methods: MEDLINE , EMBASE , and the Cochrane Controlled Trials Register were searched (up to July 2017). Randomised controlled trials ( RCT s) recruiting adults with IBS , comparing prebiotics, probiotics, synbiotics or antibiotics with placebo or no therapy were eligible. Dichotomous symptom data were pooled to obtain a relative risk ( RR ) of remaining symptomatic after therapy, with a 95% confidence interval ( CI ). Continuous data were pooled using a standardised mean difference with a 95% CI . Results: The search identified 4017 citations. Data for prebiotics and synbiotics were sparse. Fifty‐three RCT s of probiotics, involving 5545 patients, were eligible. Particular combinations of probiotics, or specific species and strains, appeared to have beneficial effects on global IBS symptoms and abdominal pain, but it was not possible to draw definitive conclusions about their efficacy. There were five trials of similar design that used rifaximin in non‐constipated IBS patients, which was more effective than placebo ( RR of symptoms persisting = 0.84; 95% CI 0.79‐0.90). Adverse events were no more common with probiotics or antibiotics. Conclusions: Which particular combination, species or strains of probiotics are effective for IBS remains, for the most part, unclear. Rifaximin has modest efficacy in improving symptoms in non‐constipated IBS .
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In previous meta-analyses, definitive conclusions about efficacy of specific probiotics could not be drawn because of small numbers of trials and lack of uniformity in reporting endpoints.
“In our previous meta-analyses, 22 -24 we were unable to draw de fi nitive conclusions about the ef fi cacy of speci fi c probiotics because of a small number of trials of some combinations, species, or strains, as well as a lack of uniformity in reporting of endpoints.”
From Efficacy of Probiotics in Irritable Bowel Syndrome: Systematic Review and Meta-analysis (2023) · cites this paper as [24]
The Discussion (page not available in our copy) says definitive conclusions about particular probiotics remain impossible and notes that some combinations were studied in only small numbers of RCTs. The paper discusses different outcome measures, but the passages found do not identify a lack of uniformity in endpoint reporting as a reason for that uncertainty. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe efficacy of probiotics and faecal microbiota transplantation is inconsistent.
“The efficacy of probiotics and faecal microbiota transplantation is inconsistent”
From Irritable bowel syndrome (2020) · cites this paper as [105]
The Discussion (page not provided) reports mixed results across probiotic combinations, species and strains, with heterogeneity between trials and no definitive conclusion about efficacy. That supports the probiotic portion of the claim. The paper does not report on the efficacy of faecal microbiota transplantation; searches for that term found no relevant passage. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSome probiotics may be beneficial in irritable bowel syndrome (IBS).
“Some probiotics may be bene fi cial in irritable bowel syndrome (IBS), but differences in species and strains used, as well as endpoints reported, have hampered attempts to make speci fi c recommendations as to which should be preferred.”
From Efficacy of Probiotics in Irritable Bowel Syndrome: Systematic Review and Meta-analysis (2023) · cites this paper as [24]
In prior evidence synthesis, for the most part, no recommendations concerning efficacy of particular combinations or strains could be made.
“where, for the most part, no recommendations concerning ef fi cacy of particular combinations of probiotics or strains could be made.”
From Efficacy of Probiotics in Irritable Bowel Syndrome: Systematic Review and Meta-analysis (2023) · cites this paper as [24]
We updated a prior meta-analysis of 37 RCTs, incorporating data from 8 new trials and randomising 6352 patients.
“We updated a prior meta-analysis of 37 RCTs, 158 incorporating data from 8 new trials [166][167][168][169][170][171][172][173] and randomising 6352 patients.”
From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [158]
A systematic review and meta-analysis of 15 RCTs, comprising 946 patients, demonstrated benefit of fibre in IBS (RR of symptoms persisting=0.87; 95% CI 0.80 to 0.94).
“With regard to fibre, a systematic review and meta-analysis of 15 RCTs, comprising 946 patients, demonstrated its benefit in IBS (RR of symptoms persisting=0.87;95% CI 0.80 to 0.94) (online supplemental figure 1).158”
From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [158]
The Abstract (page not available) identifies this as a review of prebiotics, probiotics, synbiotics and antibiotics. The 'Efficacy and Safety of Prebiotics in IBS' section (page not available) describes three eligible prebiotic RCTs, not a 15-trial fibre analysis. Searches for fibre, 946 patients and the stated risk estimate found no passage in our copy reporting the claimed result. (LLM, conf=0.75)
Experimental — accuracy not yet measuredThe effect of fibre in IBS was limited to soluble fibre, such as ispaghula (RR 0.83; 95% CI 0.73 to 0.94), but not insoluble fibre, like wheat bran, which may exacerbate abdominal pain and bloating.
“However, this effect was limited to soluble fibre, such as ispaghula (RR 0.83; 95% CI 0.73 to 0.94), but not insoluble fibre, like wheat bran, which may exacerbate abdominal pain and bloating.”
From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [158]
The ‘Efficacy and Safety of Prebiotics in IBS’ section (page unavailable) discusses fructooligosaccharides and trans-galactooligosaccharides, not a comparison of soluble and insoluble fibre. Searches for ispaghula, wheat bran, soluble fibre, and the stated RR and confidence interval found no passage supporting the claim or its statement about worsened pain and bloating. (LLM, conf=0.77)
Experimental — accuracy not yet measuredInsoluble fibre (eg, wheat bran) may exacerbate symptoms in IBS.
“Soluble fibre, such as ispaghula, is an effective treatment for global symptoms and abdominal pain in IBS, but insoluble fibre (eg, wheat bran) should be avoided as it may exacerbate symptoms.”
From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [158]
The ‘Efficacy and Safety of Prebiotics in IBS’ section discusses oligosaccharide trials, not insoluble fibre or wheat bran. Searches for wheat bran, insoluble fibre, and ispaghula found no passage in our copy addressing whether bran exacerbates IBS symptoms or should be avoided. Page numbers were not available. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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- Authors
- Ford, A. C., Harris, L. A., Lacy, B. E., Quigley, E. M. M., & Moayyedi, P.
- Affiliations
- University of Leeds (GB)
- Mayo Clinic in Arizona (US)
- Mayo Clinic (US)
- Houston Methodist (US)
- McMaster University (CA)
- Corresponding author
- Ford, Alexander C.
- Venue
- Alimentary Pharmacology & Therapeutics
- Publisher
- Wiley
- Published
- 2018-10-08
- Volume
- 48
- Issue
- 10
- Pages
- 1044-1060
- ISSN
- 0269-2813 (ISSN-L)
- 1365-2036
- OpenAlex
- W2896437365
- Cited by
- 619
- References
- 102
- Citations by year
- 2026: 45 · 2025: 59 · 2024: 79 · 2023: 85 · 2022: 87 · 2021: 77 · 2020: 127 · 2019: 52 · 2018: 4 · 2017: 2
- FWCI
- 11.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Alimentary Pharmacology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Funders
- American College of Gastroenterology
- Health Research
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Keywords
- irritable bowel syndrome, probiotics, prebiotics, synbiotics, antibiotics, rifaximin, gastrointestinal microbiome, abdominal pain, symptom relief, functional bowel disorders
- MeSH terms
- Gastrointestinal Microbiome, Rifaximin, Adult, Anti-Bacterial Agents, Gastrointestinal Agents, Humans, Abdominal Pain, Randomized Controlled Trials as Topic, Treatment Outcome, Probiotics, Irritable Bowel Syndrome, Prebiotics, Synbiotics
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