Maria Manuela Estevinho, Yuhong Yuan, Iago Rodríguez-Lago, Mário Sousa-Pimenta, Cláudia Camila Dias, Manuel Barreiro-de Acosta, Vipul Jairath, Fernando Magro
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引用次数: 0
Abstract
Background 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.
背景和目的：益生菌有望治疗炎症性肠病（IBD），但目前仍存在知识空白。我们对评估益生菌对克罗恩病（CD）和溃疡性结肠炎（UC）影响的随机对照试验（RCT）进行了系统综述和最新荟萃分析：方法：检索了截至 2023 年 9 月的 MEDLINE、Web of Science 和 Cochrane Central Register of Controlled Trials。主要结果是临床缓解和复发；次要结果包括内镜反应和缓解以及不良事件。我们使用 R 中的随机效应模型计算了几率比（OR）。系统综述的质量使用 AMSTAR-2 进行评估；试验的偏倚风险使用 Cochrane 协作工具进行评估。证据确定性采用 GRADE 框架进行评定：在 2613 项结果中，有 67 项研究（22 项系统综述和 45 项研究性试验）符合资格标准。在更新的荟萃分析中，UC 和 CD 临床缓解的 OR 分别为 2.00（95% CI 1.28-3.11）和 1.61（95% CI 0.21-12.50）。亚组分析表明，结合使用5-ASA和益生菌可能有利于轻度至中度UC的缓解（OR 2.35，95% CI 1.29-4.28）。益生菌可降低复发性脓袋炎的复发几率（OR 0.03，95% CI 0.00-0.25），并有减少非活动性 UC 临床复发的趋势（OR 0.65，95% CI 0.42-1.01）。CD 未发现对复发有保护作用。多菌株配方在实现 UC 缓解和预防复发方面似乎更具优势。使用益生菌与更好的内镜效果无关。不良反应与对照组相似。然而，证据的总体确定性较低：益生菌，尤其是多菌株制剂，对于诱导 UC 患者临床缓解、预防复发以及复发性胃袋炎似乎具有疗效。尽管如此，益生菌对 CD 没有明显效果。此外，益生菌还具有良好的安全性。
期刊介绍：
United European Gastroenterology Journal (UEG Journal) is the official Journal of the United European Gastroenterology (UEG), a professional non-profit organisation combining all the leading European societies concerned with digestive disease. UEG’s member societies represent over 22,000 specialists working across medicine, surgery, paediatrics, GI oncology and endoscopy, which makes UEG a unique platform for collaboration and the exchange of knowledge.
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