Systematic review with meta-analysis: the efficacy of probiotics in inflammatory bowel disease.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 28653751 · doi:10.1111/apt.14203
What was done
Authors conducted a systematic review and meta-analysis searching MEDLINE, EMBASE, and the Cochrane Controlled Trials Register through November 2016. They evaluated randomized controlled trials in adults with ulcerative colitis (UC) or Crohn's disease (CD) comparing probiotics against placebo or 5-aminosalicylates (5-ASAs). The primary outcomes were relative risk (RR) of failure to achieve remission in active disease and RR of relapse in quiescent disease.
What was found
Twenty-two RCTs were included. For active UC, overall probiotics were not significantly better than placebo in inducing remission (RR of failure to achieve remission = 0.86; 95% CI = 0.68–1.08), though VSL#3 specifically reduced failure to achieve remission (RR = 0.74; 95% CI = 0.63–0.87). In quiescent UC, probiotics were equivalent to 5-ASAs in preventing relapse (RR = 1.02; 95% CI = 0.85–1.23). For CD, probiotics showed no benefit in inducing remission, preventing relapse in quiescent disease, or preventing relapse after surgically induced remission (numerical estimates for CD were not reported in the abstract).
Why it matters
The findings clarify that probiotics do not show efficacy across all inflammatory bowel disease subtypes, but specific formulations such as VSL#3 may aid active ulcerative colitis and match 5-ASAs for maintenance.
Limits
The abstract does not provide the total participant count or numerical data for Crohn's disease outcomes. Probiotic strain heterogeneity limits class-wide conclusions, and safety and long-term tolerability were not reported.
Cited by
- supports Clinical and animal studies have reported therapeutic benefits of high-dose probiotic formulations (such as VSL#3 or Visbiome at 400 to 800 billion CFUs) for colitis and irritable bowel syndrome.