Efficacy and safety of probiotics in irritable bowel syndrome: A systematic review and meta-analysis
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BACKGROUND/AIM: Irritable Bowel Syndrome (IBS) is a common chronic functional bowel disorder and the evidence shows most drug therapies in the treatment of IBS are weak. Recently, some studies showed probiotics may have a positive effect in IBS and they are widely used to improve the symptom of IBS, which indicate probiotics may play an important role in the treatment of IBS. However, the exact effectiveness and safety of probiotics are largely unknown. This systematic review focuses on identifying the efficacy and safety of probiotics in the treatment of IBS. MATERIALS AND METHODS: Data sources were searched up to February 2019. Databases included MEDLINE, CENTRAL, CINAHL, and Embase. Randomized controlled trials (RCTs) comparing probiotics including complex or individual probiotics with placebo or no therapy were screened, extracted, and appraised by two independent reviewers. The data were pooled using a random-effects model. The methodological quality of all RCTs was assessed using the Cochrane risk of bias and Jadad scale. Outcomes included symptom-relevant and patient-relevant characteristics, such as symptom relief, abdominal pain, bloating, flatulence, quality of life, and adverse event. RESULTS: This review includes 28 studies with a total of 3606 participants. Particular combinations of probiotics, or specific species and strains, showed probiotics have beneficial effect on overall IBS symptoms (22 studies, n = 3144, RR of improvement in overall IBS symptoms = 1.5, CI 1.23 to 1.83) or overall IBS symptom and abdominal pain scores (18 studies, n = 2766, SMD = -0.31, CI -0.45 to -0.17). In addition, adverse events were not significantly higher with probiotics (8 studies, n = 923, RR = 1.05; 95% CI 0.85-1.31). However, there was no significant benefit on individual IBS symptom scores and quality of life. CONCLUSION: Current evidence shows particular combinations, species or strains of probiotics are effective for overall IBS symptoms. However, it is hard to derive a definite conclusion due to high heterogeneity and unclear risk of bias of some trials. Large well-designed and rigorous trials are warranted.
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Gastrointestinal flora disorder, mild mucosal inflammation, chronic immune activation, changes in intestinal permeability, and psychosocial factors are implicated in IBS.
“Yet, gastrointestinal flora disorder, mild mucosal inflammation, chronic immune activation, changes in intestinal permeability, and psychosocial factors are implicated in IBS [4,15,16,17].”
From Effectiveness and Safety of Probiotics for Patients with Constipation-Predominant Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of 10 Randomized Controlled Trials (2022) · cites this paper as [16]
The Introduction links altered gut microbiota and psychological conditions to IBS. It does not address mild mucosal inflammation, chronic immune activation, or changes in intestinal permeability as implicated factors. Page numbers are unavailable in our copy. (LLM, conf=0.86)
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Soman, R. J., Gorantla, S. C., & Swamy, M. V. (2022) · International Journal of Basic & Clinical Pharmacology · doi:10.18203/2319-2003.ijbcp20222353 · Cited by 3 · see citing works
Probiotics: To Use or Not to Use? That Is the Question
Schmulson, M. J. (2021) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000001299 · Cited by 2 · see citing works
Síndrome do Intestino Irritável: uma revisão de literatura
Weber, J. B., Weber, C. D. S. B., & Ferraz, A. R. (2022) · Revista Eletrônica Acervo Médico · doi:10.25248/reamed.e11009.2022 · Cited by 1 · see citing works
Ballena-Caicedo, J., Zuzunaga-Montoya, F. E., Acosta-Porzoliz, R. P. E., García-Ahumada, F. S., Rivera-Lozada, O., Valladares-Garrido, M. J., & Vera-Ponce, V. J. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15051727 · Cited by 1 · see citing works
The role of probiotics in current algorithms for the treatment of irritable bowel syndrome: A review
Андреев, Д. Н., & Maev, I. V. (2023) · Consilium Medicum · doi:10.26442/20751753.2023.5.202131 · Cited by 1 · see citing works
Post-Covid-19 irritable bowel syndrome – importance of diet therapy and probiotic therapy
Grońska, D., & Drzewowska, K. (2022) · Medycyna Ogólna i Nauki o Zdrowiu · doi:10.26444/monz/155260 · Cited by 1 · see citing works
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Mechanism of Lactobacillus rhamnosus in treatment of irritable bowel syndrome
Su, S., Zhang, Z., Wang, X., Wang, Y., & Wang, B. (2021) · World Chinese Journal of Digestology · doi:10.11569/wcjd.v29.i7.366
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Adjuvant nutraceuticals in the management of gastrointestinal diseases
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Modulation of microbiota as a target in the management of patients with irritable bowel syndrome
Livzan, M., & Gaus, O. (2023) · Meditsinskiy sovet = Medical Council · doi:10.21518/ms2023-366
Saccharomyces cerevisiae for abdominal pain and discomfort in irritable bowel syndrome patients
Siyal, M., Abbas, Z., Amir, M. R., & Qadeer, M. A. (2023) · Pakistan Journal of Medical Sciences · doi:10.12669/pjms.40.3.8349
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Ivashkin, V. T., Livzan, M. A., Abdulganieva, D., Alekseeva, O. P., Alekseenko, S. A., Бакулина, Н. В., Baranovsky, A. Y., Bordin, D. S., Volel, B. A., Zolnikova, O. Y., et al. (2026) · Russian Journal of Gastroenterology Hepatology Coloproctology · doi:10.22416/1382-4376-2026-36-2-7-24
- Authors
- Jia, L.-Q., Sun, J.-R., Kong, C.-F., Qu, X.-K., Deng, C., & Lou, Y.-N.
- Affiliations
- Beijing University of Chinese Medicine (CN)
- China-Japan Friendship Hospital (CN)
- Venue
- Saudi Journal of Gastroenterology
- Published
- 2020
- Volume
- 26
- Issue
- 2
- Pages
- 66
- ISSN
- 1319-3767 (ISSN-L)
- PMC
- PMC7279071
- OpenAlex
- W2997095744
- Cited by
- 40
- References
- 60
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 3 · 2023: 8 · 2022: 11 · 2021: 9 · 2020: 2
- FWCI
- 1.00
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc-sa
- Locations
- Saudi Journal of Gastroenterology (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- 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, irritable bowel syndrome, abdominal pain, bloating, flatulence, quality of life, adverse events, probiotic strains, functional bowel disorders
- MeSH terms
- Humans, Quality of Life, Abdominal Pain, Probiotics, Irritable Bowel Syndrome
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