Table 2.
Characteristics of studies assessing the effects of probiotics on children with constipation.
| References | Year | Country | Age (yr) | n (intervention/control) | Intervention Protocol (intervention, control, duration) | Clinical Response Criteria | Treatment Effect (intervention vs. control) |
|---|---|---|---|---|---|---|---|
| Banaszkiewicz et al. (71) | 2005 | Poland | 2–16 | 84 (43/41) |
Lactobacillus rhamnosus GG, + lactulose Placebo + lactulose 12 wk, 24 wk |
≥3 spontaneous BM per week, decreased episodes of fecal incontinence | ≥3 spontaneous BM frequency NS, 12 wk ≥3 spontaneous BM frequency NS, 24 wk |
| Bu et al. (64) | 2007 | Taiwan | <10 | 45 (18/18/9) |
Lactobacillus casei rhamnosus Lcr35 Magnesium oxide Placebo 4 wk |
≥3 spontaneous BM per week, decreased episodes of fecal incontinence in the fourth week | Achieved ≥3 spontaneous BM frequency (0.57 ± 0.17 vs. 0.55 ± 0.13 vs. 0.37 ± 0.10; P = 0.03) |
| Hannah et al. (72) | 2008 | Indonesia | 0.5–14 | 43 (23/20) | Synbiotic mixturea Placebo + saccharin 1 wk |
Increased BM frequency, improvement in BM consistency, decrease in pain with defecation, no treatment side effects | Increased BM frequency, improved BM consistency, improvement in pain with defecation, side effects NS |
| Coccorullo et al. (73) | 2010 | Italy | >0.5 | 44 (22/22) |
Lactobacillus reuteri DSM 17938 Placebo 8 wk |
≥3 spontaneous BM per week | Achieved ≥3 spontaneous BM frequency (P = 0.008) |
| Khodadad et al. (74) | 2010 | Iran | 4–12 | 102 (37/33/32) | Synbiotic mixture (Protexin)b + liquid paraffin Synbiotic mixture (Protextin)b + placebo Liquid paraffin + placebo 4 wk |
≥3 spontaneous BM per week, ≤ 2 fecal soiling per month, decrease in abdominal pain | Achieved ≥3 spontaneous BM all groups (P <0.001, highest in symbiotic + liquid paraffin group), fecal soiling and abdominal pain NS |
| Guerra et al. (75) | 2011 | Brazil | 5–15 | 60 (30/30) | Goat yogurt with probiotic culturesc Placebo (goat yogurt without probiotic cultures) 10 wk (crossover at 5 wk) |
Increased BM frequency, improvement in BM consistency, decrease in abdominal, decrease in pain with defecation | Increased BM frequency (P = 0.012), BM consistency NS, improvement in abdominal pain (P = 0.015), improvement in pain with defecation (P = 0.046) |
| Tabbers et al. (76) | 2011 | Netherlands and Poland | 3–16 | 159 (79/80) | Activia with probiotic culturesd Placebo (yogurt without probiotic cultures + low lactose content) 3 wk |
≥3 spontaneous BM per week, <1 fecal incontinence in the last 2 weeks | ≥3 spontaneous BM NS |
| Sadeghzadeh et al. (77) | 2014 | Iran | 4–12 | 56 (28/28) | Probiotic mixture (Protexin)e + lactulose Placebo + lactulose 4 wk |
Increased BM frequency, improvement in BM consistency | Increased BM frequency all groups (2.08 ± 0.65 and 1.54 ± 0.98 P = 0.042), improved BM consistency (0.88 ± 0.45 vs. 0.63 ± 0.50, P = 0.049) |
| Hashemi et al.* (78) | 2015 | Iran | 2–16 | 120 (40/40/40) | Synbiotic mixture (Kidilact)b + PEG Placebo + synbiotic mixture (Kidilact)b Placebo + PEG 6 wk |
Not available | Significant improvement in constipation symptoms with synbiotic mixture + PEG. |
| Abediny et al.* (79) | 2016 | Iran | 4–12 | 90 (45/45) | Synbiotic mixture (Kidilact)b + PEG PEG 4 wk |
Increased BM frequency, decrease in abdominal pain, decrease in painful defecation | BM frequency and painful defecation NS; improved abdominal pain (P < 0.05) |
| Wojtyniak et al. (65) | 2017 | Poland | <5 | 94 (48/46) |
Lactobacillus casei rhamnosus Lcr35 Placebo, 99% milk powder + 1% magnesium stearate 4 wk |
≥3 spontaneous BM per week, decreased episodes of fecal incontinence in the last week of intervention | ≥3 spontaneous BM NS |
| Mahdavi et al. (80) | 2017 | Iran | 2–10 | 94 (48/46) | Synbiotic mixture (Kidilact)b + PEG PEG 4 wk |
Increased BM frequency, improvement in stool consistency, decrease in pain with defecation, decrease in number of withholding episodes per week, decreased episodes of fecal incontinence per week, no treatment adverse events | BM frequency, stool consistency, pain, and withholding NS; improvement in fecal incontinence (0.289 vs. 0.02, P = 0.005) |
| Russo et al. (81) | 2017 | Italy | 4–12 | 55 (27/28) | Probiotic mixture (Tribif)f + PEG PEG 8 wk |
≥3 spontaneous BM per week, increased BM frequency, improvement in BM consistency Bristol ≥ grade 3, decrease in abdominal pain, decreased episodes of fecal incontinence, decreased rectal bleeding with defecation | ≥3 spontaneous BM, BM frequency, BM consistency, abdominal pain, fecal incontinence and rectal bleeding NS |
| Bastürk et al. (82) | 2017 | Turkey | 4–18 | 155 (77/78) | Synbiotic mixtureg + prebioticsh Placebo 4 wk |
Increased BM frequency, improvement in BM consistency (Bristol type), decrease in abdominal pain, decrease in pain with defecation | Increased BM frequency (p ≤ 0.001), improvement in BM consistency (p ≤ 0.001), improvement in abdominal pain (p ≤ 0.001), improvement in pain with defecation (p ≤ 0.001) |
| Jose et al. (83) | 201 | India | <18 | 60 (30/30) | Probiotic mixture (Protexin)b + lactulose Placebo + lactulose 4 wk |
Increased BM frequency, improvement in BM consistency, decrease in abdominal pain, decreased episodes of fecal incontinence, no treatment side effects | Increased BM frequency, improvement in BM consistency; abdominal pain and fecal incontinence NS |
| Wegner et al. (84) | 2018 | Poland | 3–7 | 129 (65/64) |
Lactobacillus reuteri DSM 17938 + PEG Placebo + PEG 8 wk |
≥3 spontaneous BM per week, increased BM frequency, improvement in BM consistency, decrease in pain with defecation, decreased episodes of fecal incontinence | ≥3 spontaneous BM, BM frequency, BM consistency, painful defecation and fecal incontinence NS |
| Jadrešin et al. (95) | 2018 | Croatia | 2–18 | 33 (18/15) |
L. reuteri DSM 17938 + lactulose Placebo + lactulose 12 wk |
Increased BM frequency, improvement in BM consistency, improvement in symptoms at the end of the study, decreased dose of the lactulose needed, and decreased episodes of fecal incontinence | BM frequency, BM consistency, presence of symptoms, lactulose and fecal incontinence NS |
Data extracted from systematic review and meta-analysis by Harris et al. (70) BM, bowel movement; NS, not significant; PEG, polyethylene glycol; RR, relative risk.
a
Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactobacillus casei, Lactobacillus bulgaricus, Bifidobacterium infantis, Bifidobacterium breve, Streptococcus thermophiles.
b
Lactobacillus casei, Lactobacillus rhamnosus, Streptococcus thermophilus, Bifidobacterium breve, Lactobacillus acidophilus, Bifidobacterium infantis, fructooligosaccharide.
c
Bifidobacterium longum, Lactobacillus delbrueckii subsp. bulgaricus, Streptococcus thermophiles.
d
Bifidobacterium lactis DN-173010, Lactobacillus delbrueckii subsp. bulgaricus, Streptococcus thermophiles.
e
Lactobacillus casei PXN 37, Lactobacillus rhamnosus PXN 54, Streptococcus thermophiles PXN 66, Bifidobacterium breve PXN 25, Lactobacillus acidophilus PXN 35, Bifidobacterium infantis (child specific) PXN 27, and Lactobacillus bulgaricus PXN 39.
f
Bifidobacterium breve M-16 V, Bifidobacterium infantis M-63, Bifidobacterium longum BB536.
g
Lactobacillus casei, Lactobacillus rhamnosus, Lactobacillus plantarum, Bifidobacterium lactis.
h
Fiber, polydextrose, fructo-oligosaccharides, galacto-oligosaccharides.
*
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