Abstract：
Some probiotics may be beneficial in irritable bowel syndrome (IBS), but differences in species and strains used, as well as endpoints reported, have hampered attempts to make specific recommendations as to which should be preferred. We updated our previous meta-analysis examining this issue.
MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (up to March 2023). Randomized controlled trials (RCTs) recruiting adults with IBS, comparing probiotics with placebo were eligible. Dichotomous symptom data were pooled to obtain a relative risk of global symptoms, abdominal pain, or abdominal bloating or distension persisting after therapy, with a 95% confidence interval (CI). Continuous data were pooled using a standardized mean difference with a 95% CI. Adverse events data were also pooled.
We identified 82 eligible trials, containing 10,332 patients. Only 24 RCTs were at low risk of bias across all domains. For global symptoms, there was moderate certainty in the evidence for a benefit of Escherichia strains, low certainty for Lactobacillus strains and Lactobacillus plantarum 299V, and very low certainty for combination probiotics, LacClean Gold S, Duolac 7s, and Bacillus strains. For abdominal pain, there was low certainty in the evidence for a benefit of Saccharomyces cerevisae I-3856 and Bifidobacterium strains, and very low certainty for combination probiotics, Lactobacillus, Saccharomyces, and Bacillus strains. For abdominal bloating or distension there was very low certainty in the evidence for a benefit of combination probiotics and Bacillus strains. The relative risk of experiencing any adverse event, in 55 trials, including more than 7000 patients, was not significantly higher with probiotics.
Some combinations of probiotics or strains may be beneficial in IBS. However, certainty in the evidence for efficacy by GRADE criteria was low to very low across almost all of our analyses.
MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (up to March 2023). Randomized controlled trials (RCTs) recruiting adults with IBS, comparing probiotics with placebo were eligible. Dichotomous symptom data were pooled to obtain a relative risk of global symptoms, abdominal pain, or abdominal bloating or distension persisting after therapy, with a 95% confidence interval (CI). Continuous data were pooled using a standardized mean difference with a 95% CI. Adverse events data were also pooled.
We identified 82 eligible trials, containing 10,332 patients. Only 24 RCTs were at low risk of bias across all domains. For global symptoms, there was moderate certainty in the evidence for a benefit of Escherichia strains, low certainty for Lactobacillus strains and Lactobacillus plantarum 299V, and very low certainty for combination probiotics, LacClean Gold S, Duolac 7s, and Bacillus strains. For abdominal pain, there was low certainty in the evidence for a benefit of Saccharomyces cerevisae I-3856 and Bifidobacterium strains, and very low certainty for combination probiotics, Lactobacillus, Saccharomyces, and Bacillus strains. For abdominal bloating or distension there was very low certainty in the evidence for a benefit of combination probiotics and Bacillus strains. The relative risk of experiencing any adverse event, in 55 trials, including more than 7000 patients, was not significantly higher with probiotics.
Some combinations of probiotics or strains may be beneficial in IBS. However, certainty in the evidence for efficacy by GRADE criteria was low to very low across almost all of our analyses.
摘要：
目的：某些益生菌可能对肠易激综合征（IBS）有益，但是使用的物种和菌株的差异，以及报告的端点，阻碍了就哪一个应该是首选的具体建议的尝试。我们更新了以前的荟萃分析，检查了这个问题。
方法：MEDLINE，EMBASE,并搜索了Cochrane控制试验登记册（截至2023年3月）。随机对照试验（RCT）招募成人IBS，比较益生菌和安慰剂符合资格.合并二分症状数据以获得整体症状的相对风险，腹痛,或治疗后持续腹胀或腹胀，95%置信区间(CI)。使用具有95%CI的标准化平均差汇集连续数据。也汇集了不良事件数据。
结果：我们确定了82项符合条件的试验，包括10332名患者。在所有领域中，只有24个随机对照试验的偏倚风险较低。对于整体症状，有证据表明埃希氏菌菌株有益，低确定性的乳杆菌菌株和植物乳杆菌299V，组合益生菌的确定性非常低，LacCleanGoldS,Duolac7s,和芽孢杆菌菌株。对于腹痛，酿酒酵母I-3856和双歧杆菌菌株获益的证据确定性较低，组合益生菌的确定性非常低，乳酸菌,酵母菌,和芽孢杆菌菌株。对于腹胀或腹胀，益生菌和芽孢杆菌菌株组合有益的证据的确定性非常低。经历任何不良事件的相对风险，在55项试验中，包括7000多名患者，益生菌并没有显着升高。
结论：一些益生菌或菌株的组合可能对IBS有益。然而,在我们几乎所有的分析中,GRADE标准对疗效证据的确定性都很低,甚至很低.
方法：MEDLINE，EMBASE,并搜索了Cochrane控制试验登记册（截至2023年3月）。随机对照试验（RCT）招募成人IBS，比较益生菌和安慰剂符合资格.合并二分症状数据以获得整体症状的相对风险，腹痛,或治疗后持续腹胀或腹胀，95%置信区间(CI)。使用具有95%CI的标准化平均差汇集连续数据。也汇集了不良事件数据。
结果：我们确定了82项符合条件的试验，包括10332名患者。在所有领域中，只有24个随机对照试验的偏倚风险较低。对于整体症状，有证据表明埃希氏菌菌株有益，低确定性的乳杆菌菌株和植物乳杆菌299V，组合益生菌的确定性非常低，LacCleanGoldS,Duolac7s,和芽孢杆菌菌株。对于腹痛，酿酒酵母I-3856和双歧杆菌菌株获益的证据确定性较低，组合益生菌的确定性非常低，乳酸菌,酵母菌,和芽孢杆菌菌株。对于腹胀或腹胀，益生菌和芽孢杆菌菌株组合有益的证据的确定性非常低。经历任何不良事件的相对风险，在55项试验中，包括7000多名患者，益生菌并没有显着升高。
结论：一些益生菌或菌株的组合可能对IBS有益。然而,在我们几乎所有的分析中,GRADE标准对疗效证据的确定性都很低,甚至很低.
