Efficacy and safety of probiotics in IBD: an overview of systematic reviews and updated meta-analysis of randomized controlled trials

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dc.contributor.authorEstevinho, Maria Manuela
dc.contributor.authorYuan, Yuhong
dc.contributor.authorRodríguez Lago, Iago
dc.contributor.authorPimenta, Mário Sousa
dc.contributor.authorDias, Cláudia Camila
dc.contributor.authorAcosta, Manuel Barreiro de
dc.contributor.authorJairath, Vipul
dc.contributor.authorMagro, Fernando
dc.date.accessioned2025-03-07T12:12:45Z
dc.date.available2025-03-07T12:12:45Z
dc.date.issued2024-09
dc.date.updated2025-03-07T12:12:45Z
dc.description.abstractBackground and objective: Probiotics show promise in inflammatory bowel disease (IBD), yet knowledge gaps persist. We performed an overview of systematic reviews and an updated metanalysis of randomized controlled trials (RCT) assessing the effect of probiotics on Crohn's disease (CD) and ulcerative colitis (UC). Methods: MEDLINE, Web of Science, and the Cochrane Central Register of Controlled Trials were searched up to September 2023. Primary outcomes were clinical remission and recurrence; secondary outcomes included endoscopic response and remission, and adverse events. We calculated odds ratios (OR) using a random-effects model in R. The quality of systematic reviews was assessed using the AMSTAR-2; the trials' risk of bias was evaluated using the Cochrane Collaboration tool. Evidence certainty was rated using the GRADE framework. Results: Out of 2613 results, 67 studies (22 systematic reviews and 45 RCTs) met the eligibility criteria. In the updated meta-analysis, the OR for clinical remission in UC and CD was 2.00 (95% CI 1.28–3.11) and 1.61 (95% CI 0.21–12.50), respectively. The subgroup analysis suggested that combining 5-ASA and probiotics may be beneficial for inducing remission in mild-to-moderate UC (OR 2.35, 95% CI 1.29–4.28). Probiotics decreased the odds of recurrence in relapsing pouchitis (OR 0.03, 95% CI 0.00–0.25) and trended toward reducing clinical recurrence in inactive UC (OR 0.65, 95% CI 0.42–1.01). No protective effect against recurrence was identified for CD. Multi-strain formulations appear superior in achieving remission and preventing recurrence in UC. The use of probiotics was not associated with better endoscopic outcomes. Adverse events were similar to control. However, the overall certainty of evidence was low. Conclusion: Probiotics, particularly multi-strain formulations, appear efficacious for the induction of clinical remission and the prevention of relapse in UC patients as well as for relapsing pouchitis. Notwithstanding, no significant effect was identified for CD. The favorable safety profile of probiotics was also highlighted.en
dc.identifier.citationEstevinho, M. M., Yuan, Y., Rodríguez-Lago, I., Sousa-Pimenta, M., Dias, C. C., Barreiro-de Acosta, M., Jairath, V., & Magro, F. (2024). Efficacy and safety of probiotics in IBD: An overview of systematic reviews and updated meta-analysis of randomized controlled trials. United European Gastroenterology Journal, 12(7), 960-981. https://doi.org/10.1002/UEG2.12636
dc.identifier.doi10.1002/UEG2.12636
dc.identifier.eissn2050-6414
dc.identifier.issn2050-6406
dc.identifier.urihttp://hdl.handle.net/20.500.14454/2489
dc.language.isoeng
dc.publisherJohn Wiley and Sons Inc
dc.rights© The Author(s)
dc.subject.otherClinical outcomes
dc.subject.otherClinical remission
dc.subject.otherCrohn's disease
dc.subject.otherEndoscopic response
dc.subject.otherInflammatory bowel disease
dc.subject.otherMicrobiome modulation
dc.subject.otherProbiotic
dc.subject.otherRCT
dc.subject.otherRecurrence
dc.subject.otherUlcerative colitis
dc.titleEfficacy and safety of probiotics in IBD: an overview of systematic reviews and updated meta-analysis of randomized controlled trialsen
dc.typejournal article
dcterms.accessRightsopen access
oaire.citation.endPage981
oaire.citation.issue7
oaire.citation.startPage960
oaire.citation.titleUnited European Gastroenterology Journal
oaire.citation.volume12
oaire.licenseConditionhttps://creativecommons.org/licenses/by-nc-nd/4.0/
oaire.versionVoR
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