Probiotics for Preventing and Treating Small Intestinal Bacterial Overgrowth: A Meta-Analysis and Systematic Review of Current Evidence.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of clinical intervention studies
PubMed 28267052 · doi:10.1097/MCG.0000000000000814
What was done
A systematic review and meta-analysis of studies from PubMed, Embase, and the Cochrane Central Register of Controlled Trials (up to May 2016) was conducted to evaluate probiotics for SIBO prevention and treatment. Prevention was evaluated by SIBO incidence, and treatment was evaluated by SIBO decontamination rate, reduction in breath H2 concentration, abdominal pain scores, and daily stool frequency. Random-effects meta-analysis was performed using relative risks (RR) and weighted mean differences (WMD).
What was found
A total of 14 full-text articles and 8 abstracts were included, with 18 studies included in data synthesis: - SIBO incidence prevention showed an insignificant decrease with probiotics (RR=0.54; 95% CI, 0.19-1.52; P=0.24). - The pooled SIBO decontamination rate was 62.8% (95% CI, 51.5%-72.8%). Probiotics significantly increased decontamination compared to control (RR=1.61; 95% CI, 1.19-2.17; P<0.05). - Breath H2 concentration significantly decreased with probiotics (WMD=-36.35 ppm; 95% CI, -44.23 to -28.47 ppm; P<0.05). - Abdominal pain scores decreased significantly (WMD=-1.17; 95% CI, -2.30 to -0.04; P<0.05). - Daily stool frequency did not significantly change (WMD=-0.09; 95% CI, -0.47 to 0.29).
Why it matters
This review shows that probiotics can enhance SIBO decontamination rates, lower breath hydrogen levels, and reduce abdominal pain, though they were not shown to prevent SIBO occurrence.
Limits
The total number of participants, baseline patient characteristics, and specific probiotic species, doses, or treatment durations were not reported in the abstract. Eight of the 22 included records were conference abstracts rather than full peer-reviewed publications. The prevention finding was imprecise with wide confidence intervals.
Cited by
- contradicts Probiotics can worsen symptoms in people with ulcers who also have small intestinal bacterial overgrowth (SIBO).