Table 1.
Probiotics, prebiotics, synbiotics, fibre and herbal medicinal products in irritable bowel syndrome
| Reference | Study type | Disease | Intervention | Number of patients | Results |
|---|---|---|---|---|---|
| Probiotics, prebiotics and synbiotics | |||||
| Hoveyda et al., 2009 | Meta‐analysis (14 RCTs) | IBS (no restriction for subtypes) | Probiotics | 1225 | Probiotics may have a role in alleviating some symptoms of IBS. OR was 1.6 for dichotomous data from seven trials; SMD was 0.23 for continuous data from six trials. |
| Moayyedi et al., 2010 | Meta‐analysis (19 RCTs) | IBS (no restriction for subtypes) | Probiotics | 1650 | Probiotics were significantly better than placebo (RR of IBS not improving =0.71) with NNT = 4. |
| Ford et al., 2014b | Meta‐analysis (probiotics, 35 RCTs; synbiotics, two RCTs) | IBS (no restriction for subtypes) | Probiotics and synbiotics | 3452 (probiotics) and 198 (synbiotics) | The significant RR of IBS symptoms persisting with probiotics versus placebo was 0.79. There were no significant effects of synbiotic in reducing symptoms. |
| Didari et al., 2015 | Meta‐analysis (24 RCTs) | IBS (no restriction for subtypes) | Probiotics | 1793 | Probiotics improved abdominal pain (two trials, RR 1.96), global symptom score (two trials, RR 2.43), general symptoms (seven trials, RR 2.14), and an IBS severity score evaluating distension, bloating and flatulence (three trials, SMD 2.57). |
| Horvath et al., 2011 | Meta‐analysis (three RCTs) | Children with abdominal pain‐related functional gastrointestinal disorders | L. rhamnosus GG | 290 | L. rhamnosus GG supplementation was associated with a significantly higher rate of treatment responders (RR 1.31, NNT 7) |
| Tiequn et al., 2015 | Meta‐analysis (six RCTs) | IBS (no restriction for subtypes) | Lactobacillus spp. | 440 (273 adults and 167 children) | Lactobacilli induced therapeutic benefit with a significant RR of 7.69 (adults, 17.62; children, 3.71). |
| Fibre | |||||
| Ford et al., 2008 | Meta‐analysis (12 RCTs) | IBS (no restriction for subtypes) | Fibre (bran or psyllium) | 591 | Fibre induced no clinical improvement with respect to placebo or a low fibre diet (RR 0.87).
Bran had no significant effect (RR of persistent symptoms 1.02). Psyllium was significantly effective (RR of persistent or unimproved symptoms 0.78). |
| Ruepert et al., 2011 | Meta‐analysis (12 RCTs) | IBS (no restriction for subtypes) | Fibre | 621 | No beneficial effect of fibre over placebo for improvement of abdominal pain (SMD 0.03), global assessment of symptoms (RR 1.10), or symptom score (SMD −0.00). Subgroup analyses for insoluble and soluble fibres also showed no significant benefit. |
| Moayyedi et al., 2014 | Meta‐analysis (14 RCTs) | IBS (no restriction for subtypes) | Fibre (soluble and insoluble) | 921 | Significant clinical benefit of fibre (RR = 0.86), that was confirmed in RCTs on soluble fibre (RR = 0.83, NNT = 7), but not in those on bran (RR = 0.90) |
| Everitt et al., 2013 | RCT | IBS (no restriction for subtypes) | Mebeverine versus methylcellulose versus placebo or self‐management website for 6 weeks | 135 | No significant difference in IBS symptom severity scale or IBS‐QOL scores between medication or website groups at 12 weeks, or in medication groups at 6 weeks, or IBS‐QOL in website groups at 6 weeks |
| Toskes et al., 1993 | Crossover study | IBS (no restriction for subtypes) | Polycarbophil 6 g per day versus placebo for 6 months | 23 | 15 patients chose polycarbophil over placebo for relief of the symptoms (71%) |
| Herbal medicinal products | |||||
| Liu et al., 2006 | Systematic review (75 trials) | IBS (no restriction for subtypes) | Herbal medicines were compared with placebo or conventional pharmacological therapy | 7957 | Improvement of symptoms with 6 and 22 herbal medicines compared with placebo or conventional therapy respectively; 29 herbal medicines were not significantly different from conventional therapy. |
| Madisch et al., 2004 | RCT | IBS (no restriction for subtypes) | STW 5 (iberogast), STW 5‐II, bitter candytuft mono‐extract or placebo for 4 weeks | 208 | STW 5 and STW 5‐II were significantly better than placebo in reducing the total abdominal pain score and IBS symptom score. |
| Ford et al., 2008 | Meta‐analysis (four RCTs) | IBS (no restriction for subtypes) | Peppermint oil | 392 | 26% of patients randomized to peppermint oil had persistent symptoms compared with 65% of those receiving placebo (RR 0.43) |
| Khanna et al., 2014 | Meta‐analysis (nine studies) | IBS (no restriction for subtypes) | Peppermint oil | 726 | Improvement of global symptoms (RR 2.23) and abdominal pain (RR 2.14) with peppermint oil with respect to placebo |
IBS‐QOL, IBS quality of life; SMD, standardized mean differences