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02.05.2024 | Review

Network meta-analysis of probiotics, prebiotics, and synbiotics for the treatment of chronic constipation in adults

verfasst von: Xinxin Deng, Cui Liang, Liying Zhou, Xue Shang, Xu Hui, Liangying Hou, Yongsheng Wang, Wendi Liu, Shanshan Liang, Liang Yao, Kehu Yang, Xiuxia Li

Erschienen in: European Journal of Nutrition

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Abstract

Objective

To compare the outcomes associated with the use of probiotics, prebiotics, and synbiotics for the treatment of chronic constipation in adults.

Methods

We searched eight electronic databases from database inception to July 11, 2023, to identify randomized controlled trials (RCTs) that report efficacy and safety for the treatment of chronic constipation. The risk of bias in the included RCTs was evaluated according to the Cochrane tool, and the certainty of the evidence was assessed using the Confidence in Network Meta-Analysis framework. The analysis was conducted using R version 4.3.0.

Results

Out of the 37 RCTs, a total of 21 different types of interventions were reported, involving 3,903 patients. This NMA demonstrated that both prebiotics and synbiotics resulted in an increase in frequency of stool movements per week. Compared to placebo, lactulose (Mean difference [MD] = 3.39, 95% Confdence interval [CI] [1.13, 5.65], moderate certainty), mix2 (consisting of Lactulose and Bacillus coagulans) (MD = 3.63, 95% CI [1.37, 5.89], moderate certainty), mix6 (consisting of Lactulose and Bifidobacterium coagulans) (MD = 4.30, 95% CI [1.04, 7.54], low certainty), and mix7 (consisting of Lactulose, Bifidobacterium subtilis, and Enterococcus faecium) (MD = 4.58, 95% CI [1.35, 7.78], moderate certainty) exhibited a significant effect. Notably, mix7 demonstrated the highest probability of being the most effective intervention (94.8%). Furthermore, when compared to L. plantarum, four probiotics and two synbiotics showed significant advantages in the Patient Assessment of Constipation Symptoms (PAC-SYM) score. L. reuteri (MD = -13.74, 95% CI [-22.20, -4.66], very low certainty) exhibited a significant effect in improving the Patient Assessment of Constipation Quality of Life (PAC-QoL) score. In terms of safety, there were no statistically significant differences between the intervention and control groups in all adverse event analyses.

Conclusions

Moderate to very low evidence supports the use of lactulose and synbiotics to increase the number of weekly stool movements in patients, particularly highlighting the significant impact of synbiotics in increasing the number of weekly stool movements in patients with constipation. The use of L. paracasei showed improvements in PAC-SYM scores, while L. reuteri demonstrated enhancements in PAC-QoL scores.

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Titel: Network meta-analysis of probiotics, prebiotics, and synbiotics for the treatment of chronic constipation in adults
verfasst von: Xinxin Deng
Cui Liang
Liying Zhou
Xue Shang
Xu Hui
Liangying Hou
Yongsheng Wang
Wendi Liu
Shanshan Liang
Liang Yao
Kehu Yang
Xiuxia Li
Publikationsdatum: 02.05.2024
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Nutrition
Print ISSN: 1436-6207
Elektronische ISSN: 1436-6215
DOI: https://doi.org/10.1007/s00394-024-03410-1

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Network meta-analysis of probiotics, prebiotics, and synbiotics for the treatment of chronic constipation in adults

Abstract

Objective

Methods

Results

Conclusions

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