Effects of probiotic-containing products on stool frequency and intestinal transit in constipated adults: systematic review and meta-analysis of randomized controlled trials
Open accessAbstract
Background Probiotics are commonly recommended for the alleviation of constipation symptoms.The aim of this research was to determine the effects of probiotic-containing products on stool frequency and intestinal transit time (ITT) in constipated adults and to determine the factors that influence the efficacy of these products. MethodsWe conducted a systematic review of randomized controlled trials that measured weekly stool frequency or ITT in constipated adults receiving probiotic-containing supplements.A random effects meta-analysis was performed; stool frequency was summarized by the mean difference statistic and ITT was summarized by the standardized mean difference (SMD) statistic.Meta-regression and diagnostic model performance testing were used to identify publication bias and sources of heterogeneity.Results A total of 21 studies (23 comparisons) comprising 2656 subjects were included.All studies utilized probiotics containing Lactobacillus or Bifidobacterium species.Probiotic-containing products resulted in a mean increase in weekly stool frequency of 0.83 (95% confidence interval [CI] 0.53-1.14,P<0.001).There was high heterogeneity among the studies (I 2 =85%, P<0.001) and evidence of significant publication bias (Egger's P-value <0.01).After adjustment for publication bias, the mean difference in weekly stool frequency was reduced from 0.83 to 0.30.The effects on stool frequency were greater in studies where functional constipation was diagnosed using Rome III (P<0.01), or Rome II or III criteria (P<0.05),compared to non-Rome diagnosis techniques.Probiotic-containing products were also efficacious in reducing ITT (SMD=0.65,95%CI 0.33-0.97,P<0.001).There was high heterogeneity among studies (I 2 =66%, P<0.01), but no evidence of publication bias (Egger's P-value=0.52).A larger total sample size was associated with greater efficacy as regards ITT (P=0.03).The probiotic species, the number of probiotic strains and the daily probiotic dosage had no influence on the outcomes.Conclusion Supplementation with products containing Lactobacillus or Bifidobacterium species increases stool frequency and reduces ITT in constipated adults.However, since significant heterogeneity in outcomes was detected among the studies analyzed, the results should be interpreted with caution.
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Treatment containing both Lactobacillus and Bifidobacterium had significantly higher improvement than treatment containing only Lactobacillus or Bifidobacterium.
“while Miller et al found, by subgroup analysis, that treatment containing Lactobacillus and Bifidobacterium had significant higher improvement than treatment containing Lactobacillus or Bifidobacterium only.35”
From Efficacy in bowel movement and change of gut microbiota on adult functional constipation patients treated with probiotics-containing products: a systematic review and meta-analysis (2024) · cites this paper as [35]
In the Results sections on stool frequency and intestinal transit (page unavailable), the combined-product subgroup has numerically larger improvements than either single-genus subgroup. But the paper explicitly says probiotic species did not statistically influence either outcome; it does not find a significant advantage for the combination over the single-genus products. (LLM, conf=0.88)
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Experimental — accuracy not yet measuredThe sample size was estimated at 178 evaluable participants (89 per group), and accounting for 20% attrition, 224 randomized participants (112 per group) were needed.
“The power calculation was based on a 2-sample t test assuming equal variance using a meta-analysis on the effects of probiotics for total bowel movements per week, which was the only available and reliable reference.12”
From Eight-Week Supplementation With <i>Bifidobacterium lactis</i> HN019 and Functional Constipation: A Randomized Clinical Trial (2024) · cites this paper as [12]
The Results section (Probiotic effects on stool frequency; page not provided) reports a meta-analysis of weekly bowel movements, supporting the cited sentence’s identification of the reference used for the power calculation. The paper does not report the claimed calculation of 178 evaluable or 224 randomized participants, or the 20% attrition assumption; those figures cannot be attributed to it. (LLM, conf=0.84)
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- Authors
- Miller, L. E.
- Corresponding author
- Miller, Larry E.
- ORCID
- Miller, Larry E.
- Venue
- Annals of Gastroenterology
- Publisher
- Hellenic Society of Gastroenterology
- Published
- 2017
- Volume
- 30
- Issue
- 6
- Pages
- 629-639
- ISSN
- 1108-7471 (ISSN-L)
- 1792-7463
- PMC
- PMC5670282
- OpenAlex
- W2760230265
- Cited by
- 79
- References
- 42
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 4 · 2023: 12 · 2022: 15 · 2021: 11 · 2020: 12 · 2019: 9 · 2018: 6 · 2017: 1
- FWCI
- 1.29
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- other-oa
- Locations
- Annals of Gastroenterology (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Keywords
- probiotics, constipation, stool frequency, intestinal transit time, Lactobacillus, Bifidobacterium, functional constipation, Rome criteria, probiotic supplementation, adults, publication bias, meta-regression
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