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

  • 2024-05-02
  • European journal of nutrition 63(6)
    • Xinxin Deng
    • Cui Liang
    • Liying Zhou
    • Xue Shang
    • Xu Hui
    • Liangying Hou
    • Yongsheng Wang
    • Wendi Liu
    • Shanshan Liang
    • Liang Yao
    • Kehu Yang
    • Xiuxia Li

Study Design

Type
Systematic Review
Sample size
n = 903
Population
3,903 adults with chronic constipation
Methods
Network meta-analysis of 37 randomized controlled trials; searched eight databases from inception to July 11, 2023
Funding
Unclear
  • Rigorous Journal

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.

Research Insights

Adverse Events Reported

  • Lactobacillus paracasei→Overall tolerability

    In terms of safety, there were no statistically significant differences between the intervention and control groups in all adverse event analyses.

    Finding
    Reported
  • Bacillus coagulans→Overall tolerability

    In terms of safety, there were no statistically significant differences between the intervention and control groups in all adverse event analyses.

    Finding
    Reported
  • Lactobacillus reuteri→Overall tolerability

    In terms of safety, there were no statistically significant differences between the intervention and control groups in all adverse event analyses.

    Finding
    Reported
  • Enterococcus faecium→Overall tolerability

    In terms of safety, there were no statistically significant differences between the intervention and control groups in all adverse event analyses.

    Finding
    Reported
  • Lactobacillus plantarum→Overall tolerability

    In terms of safety, there were no statistically significant differences between the intervention and control groups in all adverse event analyses.

    Finding
    Reported
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