P0618 - Probing Probiotics: A Systematic Review and Meta-analysis on the Efficacy of Various Probiotic Regimens in the Management of Irritable Bowel Syndrome

Sreeja Cherukuru, MBBS¹, Sree Maneesha Sunkara, MBBS, MPH.², Mahek Fatima, MBBS³, Archana Priyadarsini, MBBS⁴, Ashwith Reddy Gaddam, MD⁵, Binay K. Panjiyar, MBBS^6
1Sri Venkateswara Medical College, Tirupati, Andhra Pradesh, India; ²Malla Reddy Institute of Medical Sciences, Ashland, MA; ³Osmania General Hospital and Medical College, Hyderabad, Telangana, India; ⁴Dr Somervell Memorial CSI Medical College, Missouri City, TX; ⁵University of Kansas Medical Center, Kamareddy, Telangana, India; ⁶Harvard Medical School, Boston, MA

Introduction: A key modulator of Irritable Bowel Syndrome (IBS) is the microbiota-gut-brain axis, involving the role of gut flora in altering biochemical signaling between the gut and CNS neurotransmitters. Probiotics can improve IBS symptoms by altering gut flora but efficacy of various genera remains controversial. Our study investigates outcome-specific and strain-level effectiveness of various probiotic regimens in managing IBS.

Methods: We searched PubMed, ScienceDirect, Google Scholar, PLOS ONE, and ClinicalTrials.gov (January 2013 to March 2024) for Randomized Control Trials (RCTs) recruiting adult IBS patients to compare treatment with probiotics versus controls. Two major outcomes were analyzed: Irritable Bowel Syndrome-Symptom Severity Score (IBS-SSS) and Irritable Bowel Syndrome-Quality of Life (IBS-QOL) score. Each of the five domains of the IBS-SSS (abdominal pain severity and frequency, severity of flatulence, dissatisfaction of bowel habits, and effect on quality of life) were further evaluated. We used RevMan 5.4.1 to perform a random-effects meta-analysis using mean difference (MD) with a 95% confidence interval (CI). Subgroup and sensitivity analyses were performed based on the duration of intervention.

Results: 18 RCTs evaluating 26 probiotic strains, either singularly or in combination with other genera, were included in this study. Probiotics showed a significant improvement in global IBS-SSS [MD -37.10; 95%CI -54.99, -19.22; P < 0.00001; I² = 92%]. 13 different regimens (7 mixtures and 6 strains) were noted to be beneficial. All the domains of IBS-SSS including abdominal pain severity [MD -10.15; 95% CI -14.34, -5.97; P< 0.00001] and frequency [MD -2.59; 95%CI -3.93, -1.26; P< 0.00001], flatulence [MD -9.49; 95% CI -13.99, -4.98; P< 0.00001] and effect on QOL [MD -8.49; 95% CI -12.47, -4.51; P< 0.00001] improved with probiotics, except satisfaction of bowel habits [MD 105.29; 95%CI -120.24, 330.82; P = 0.36]. Probiotics also improved overall quality of life as seen by an improvement in IBS-QOL [MD 8.60; 95%CI 3.02, 14.19; P < 0.00001; I² = 96%]. 6 probiotic regimens (3 mixtures and 3 strains) showed a significant improvement in IBS-QOL.

Discussion: 15 probiotic regimens, predominantly comprising bifidobacteria, lactobacilli, and bacilli, showed an improvement in at least one of the scores assessed. Future research on standardized IBS outcomes, including a global improvement metric and more RCTs evaluating strain-specific probiotic effectiveness in different IBS subtypes is needed.



Disclosures:


Sreeja Cherukuru, MBBS¹, Sree Maneesha Sunkara, MBBS, MPH.², Mahek Fatima, MBBS³, Archana Priyadarsini, MBBS⁴, Ashwith Reddy Gaddam, MD⁵, Binay K. Panjiyar, MBBS⁶. P0618 - Probing Probiotics: A Systematic Review and Meta-analysis on the Efficacy of Various Probiotic Regimens in the Management of Irritable Bowel Syndrome, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.