The effect of probiotics on functional constipation in adults: a systematic review and meta-analysis of randomized controlled trials
Open accessAbstract
Background Functional constipation is a prevalent, burdensome gastrointestinal disorder whose treatment remains challenging. Probiotics have been increasingly investigated in its management.Objective The aim was to investigate the effect of probiotics on gut transit time, stool output, and constipation symptoms in adults with functional constipation via a systematic review and meta-analysis of randomized controlled trials (RCTs).Design Studies were identified by searching 4 electronic databases, back-searching reference lists, contacting authors, and hand-searching abstracts. RCTs that reported administration of probiotics in adults with functional constipation were included. Two reviewers independently performed the screening, data extraction, and bias assessment. Outcome data were synthesized by using weighted mean differences (WMDs) or standardized mean differences (SMDs) with the use of a random-effects model.Results A total of 660 records were identified of which 14 were eligible (1182 patients). Overall, probiotics significantly reduced whole gut transit time by 12.4 h (95% CI: -22.3, -2.5 h) and increased stool frequency by 1.3 bowel movements/wk (95% CI: 0.7, 1.9 bowel movements/wk), and this was significant for Bifidobacterium lactis (WMD: 1.5 bowel movements/wk; 95% CI: 0.7, 2.3 bowel movements/wk) but not for Lactobacillus casei Shirota (WMD: -0.2 bowel movements/wk; 95% CI: -0.8, 0.9 bowel movements/wk). Probiotics improved stool consistency (SMD: +0.55; 95% CI: 0.27, 0.82), and this was significant for B. lactis (SMD: +0.46; 95% CI: 0.08, 0.85) but not for L. casei Shirota (SMD: +0.26; 95% CI: -0.30, 0.82). No serious adverse events were reported. Attrition and reporting bias were high, whereas selection bias was unclear due to inadequate reporting.Conclusions Probiotics may improve whole gut transit time, stool frequency, and stool consistency, with subgroup analysis indicating beneficial effects of B. lactis in particular. However, caution is needed with the interpretation of these data due to their high heterogeneity and risk of bias. Adequately powered RCTs are required to better determine the species or strains, doses, and duration of use of probiotics that are most efficacious.
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Maltodextrin has been successfully used as a placebo in numerous trials in constipation, with a meta-analysis showing no change on whole gut transit time.
“maltodextrin has been successfully used 9 as a placebo in numerous trials in constipation, with a meta-analysis showing no change on WGTT 8 .”
From Randomised clinical trial: <i>Bifidobacterium lactis</i> NCC2818 probiotic vs placebo, and impact on gut transit time, symptoms, and gut microbiology in chronic constipation (2019) · cites this paper as [8]
The citation to this paper is attached to the claim that the meta-analysis showed no change in whole gut transit time. The GTT section instead reports that probiotics significantly reduced whole gut transit time by 12.4 hours overall. The separate claim about maltodextrin carries a different citation and is not assessed here. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredTwo systematic reviews and meta-analyses showed that probiotic consumption significantly decreased whole gut transit time, with B. lactis strains HN019 and DN-173010 conferring the largest treatment effects, particularly in constipated individuals compared to healthy people.
“Similarly, two systematic reviews and meta-analyses - that investigated the effect of various probiotics on WGTT in healthy and constipated individuals - showed that probiotic consumption significantly decreased WGTT, with B. lactis strains HN019 and DN-173010 conferring the largest treatment effects, particularly in constipated individuals compared to healthy people 8 26 .”
From Randomised clinical trial: <i>Bifidobacterium lactis</i> NCC2818 probiotic vs placebo, and impact on gut transit time, symptoms, and gut microbiology in chronic constipation (2019) · cites this paper as [8]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredOther B. lactis strains significantly increased stool frequency by an average of 1.5 bowel movements per week, and improved stool consistency and other constipation-related symptoms.
“which showed that other B. 18 lactis strains significantly increased stool frequency by an average of 1.5 bowel movements per week, and 19 improved stool consistency and other constipation-related symptoms 8 .”
From Randomised clinical trial: <i>Bifidobacterium lactis</i> NCC2818 probiotic vs placebo, and impact on gut transit time, symptoms, and gut microbiology in chronic constipation (2019) · cites this paper as [8]
The Stool output section reports that B. lactis increased stool frequency by 1.5 bowel movements per week and significantly improved stool consistency. The Discussion also reports reduced flatulence, but the Constipation-related symptoms section found no significant B. lactis effect on incomplete evacuation or ease of stool expulsion. Thus, the claim overgeneralizes the improvement in other symptoms; the paper also cautions that the findings were heterogeneous. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe current study's results differ from the findings of the meta-analysis on other B. lactis strains.
“while differing with the findings of the aforementioned meta-analysis,”
Bifidobacterium lactis reduced whole gut transit time and increased stool frequency in constipated patients in a meta-analysis of randomized controlled trials.
“a recent meta analysis of randomized controlled trials have revealed that Bifidobacterium lactis, but not for Lactobacillus casei Shirota, reduced whole gut transit time and increased stool frequency in constipated patients”
From Gut microbiota role in irritable bowel syndrome: New therapeutic strategies (2016) · cites this paper as [210]
Lactobacillus casei Shirota did not reduce whole gut transit time or increase stool frequency in constipated patients in a meta-analysis of randomized controlled trials.
“Bifidobacterium lactis, but not for Lactobacillus casei Shirota, reduced whole gut transit time and increased stool frequency in constipated patients”
From Gut microbiota role in irritable bowel syndrome: New therapeutic strategies (2016) · cites this paper as [210]
An earlier systemic review and meta-analysis of randomized-controlled trials indicated that probiotics may improve whole-gut transit time, stool frequency, and stool consistency, and that Bifidobacterium lactis showed better efficacies than Lactobacillus casei Shirota.
“an earlier systemic review and meta-analysis of randomized–controlled trials indicated that probiotics may improve the whole-gut transit time, stool frequency, and stool consistency; Bifidobacterium lactis showed better efficacies than Lactobacillus casei Shirota [ 81 ].”
From Role of gut microbiota in functional constipation (2021) · cites this paper as [81]
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- Authors
- Dimidi, E., Christodoulides, S., Fragkos, K. C., Scott, S. M., & Whelan, K.
- Affiliations
- Queen Mary University of London (GB)
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2014-10
- Volume
- 100
- Issue
- 4
- Pages
- 1075-1084
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2012951812
- Cited by
- 316
- References
- 63
- Citations by year
- 2026: 21 · 2025: 26 · 2024: 21 · 2023: 34 · 2022: 29 · 2021: 28 · 2020: 32 · 2019: 28 · 2018: 32 · 2017: 33 · 2016: 13 · 2015: 18 · 2014: 1
- FWCI
- 3.55
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Nestec
- 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
- probiotics, functional constipation, gut transit time, stool frequency, stool consistency, Bifidobacterium animalis subsp. lactis, Lactobacillus casei Shirota, adults, constipation treatment, adverse events, reporting bias, attrition bias, selection bias, subgroup analysis, quality of evidence, gut microbiota, dietary fat, dietary fiber intake
- MeSH terms
- Constipation, Defecation, Humans, Randomized Controlled Trials as Topic, Probiotics
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