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Abstract：
Background: Probiotic and low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) diet are two commonly used management approaches for patients with irritable bowel syndrome (IBS). We aimed to evaluate the most effective combinations and components among different probiotics or low FODMAP diet through component network meta-analysis (NMA). Methods: We searched Embase, Ovid Medline, and Web of Science from inception to 21 January 2021. Randomized controlled trials (RCTs) examining the efficacy of probiotics and low FODMAP diet for IBS were included, with placebo, sham diet, or conventional treatments as controls. Binary outcomes were compared among treatments using the relative ratio (RR). A minimally contextualized framework recommended by the GRADE group was used to evaluate the certainty of evidence. The primary efficacy outcome was the relief of global IBS symptoms, and the secondary efficacy outcome was the reduction in IBS symptom scores or abdominal pain scores. Key Results: We included 76 RCTs (n = 8058) after screening 1940 articles. Eight RCTs were classified as low risk of bias. Standard network meta-analysis (NMA) showed that Lactobacillus (RR 1.74, 95% CI 1.22-2.48) and Bifidobacterium (RR 1.76, 95% CI 1.01-3.07) were the most effective for the primary efficacy outcome (high certainty evidence); component NMA showed that Bacillus (RR 5.67, 95% CI 1.88 to 17.08, p = 0.002) and Lactobacillus (RR 1.42, 95% CI 1.07 to 1.91, p = 0.017) were among the most effective components. The results of standard NMA and CNMA analysis of the improvement of overall IBS symptom scores or abdominal pain scores were consistent with this finding. Conclusion: Lactobacillus was the most effective component for the relief of IBS symptoms; Bifidobacterium and Bacillus were possibly effective and need further verification. Systematic Review Registration: website, identifier registration number.
摘要：
背景：益生菌和低可发酵寡糖，二糖，单糖，和多元醇（FODMAP）饮食是肠易激综合征（IBS）患者的两种常用管理方法。我们旨在通过成分网络荟萃分析（NMA）评估不同益生菌或低FODMAP饮食中最有效的组合和成分。方法：我们搜索了Embase，OvidMedline,和WebofScience从成立到2021年1月21日。纳入了研究益生菌和低FODMAP饮食对IBS疗效的随机对照试验(RCT)。安慰剂，假饮食，或常规治疗作为对照。使用相对比率（RR）比较治疗之间的二元结果。使用GRADE小组推荐的最低语境框架来评估证据的确定性。主要疗效结果是整体IBS症状的缓解，次要疗效结局是IBS症状评分或腹痛评分降低.主要结果：在筛选1940篇文章后，我们纳入了76项随机对照试验(n=8058)。8项随机对照试验被归类为低偏倚风险。标准网络荟萃分析（NMA）显示，乳杆菌（RR1.74，95％CI1.22-2.48）和双歧杆菌（RR1.76，95％CI1.01-3.07）对主要疗效结局最有效（高确定性证据）；NMA成分显示，芽孢杆菌（RR5.67，95％CI1.88至17.08，p=0.002）和乳杆菌（1.42至95％CI=1.07）的最有效总体IBS症状评分或腹痛评分改善的标准NMA和CNMA分析结果与该发现一致。结论:乳酸菌是缓解IBS症状最有效的成分;双歧杆菌和芽孢杆菌可能是有效的,需要进一步验证。系统审查注册：网站，标识符注册号。
