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Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome
Meta-analysis (53 probiotic RCTs, n=5545) found heterogeneous but generally favourable signals for some probiotic combinations/strains on global IBS symptoms and abdominal pain; five similar-design rifaximin trials in non-constipated IBS showed reduced symptom persistence versus placebo (RR 0.84, 95% CI 0.79–0.90).
Design
- SR + MA; searches to July 2017
- Eligible: adult IBS RCTs vs placebo / no therapy for prebiotics, probiotics, synbiotics, antibiotics
Probiotics corpus
- 53 probiotic RCTs (n = 5545)
- Abstract: particular combinations / species / strains appeared beneficial for global symptoms and abdominal pain, but authors caution definitive strain ranking is not possible from the pooled literature.
Antibiotic (rifaximin) bundle
- 5 trials, similar design, non-constipated IBS
- RR of symptoms persisting = 0.84 (95% CI 0.79–0.90)
- Adverse events: not more common than placebo for probiotics or rifaximin in abstract framing
Evidence hygiene
This row supports ‘some probiotics help some IBS phenotypes’ while underscoring strain/comparator heterogeneity—pair with newer network meta-analyses if users need rank-order language.
Publication
Ford AC, et al. Aliment Pharmacol Ther. 2018 Nov;48(9):872-883. PMID 30294792.
Outcomes
- Rifaximin vs placebo in non-constipated IBS (5 similar-design trials): RR of symptoms persisting = 0.84 (95% CI 0.79-0.90).
- 53 probiotic RCTs (n=5545): strain/combination-dependent signals on global IBS symptoms and abdominal pain; authors caution definitive strain ranking is not possible from this pooled literature.