TREATING IRRITABLE

BOWEL SYNDROME: A
META ANALYSIS
Bian Tiequn, Chao Guanqun, and Zhang Shuo
Interna Medicine
2015 The Japanese Society of Internal Medicine

Ika Krastanaya
I11109002
SMF Penyakit Dalam
RS Abdul Aziz Singkawang

INTRODUCTION
Irritable

bowel syndrome (IBS)

is a functional disorder of the
digestive tract that causes
chronic symptoms, such as
abdominal pain and discomfort,
and
abnormal
bowel
movements, including diarrhea
and constipation, with no
organic abnormalities.

INTRODUCTION
most

frequent digestive tract

disorders
encountered
by
general
practitioners
and
gastroenterologists.
its etiology remains unknown.
a combination
of
The
most
popular
dysregulated gastrointestinal
pathogenetic
theory involves :
(GI) motility and heightened
visceral sensitivity in the
context of chronic life
stressors

INTRODUCTION

constipation can be acute or chronic, with chronic constipation

defined as that with a duration greater than three months.

The Rome III criteria for chronic constipation include the presence of
two or more of six symptoms for at least 12 weeks within the
preceding six months

a. straining at defecation on at least 1/4 occasions;

b. lumpy/hard stools on at least 1/4 occasions;
c. the sensation of incomplete evacuation on at least
1/4 occasions;
d. the need for manual maneuvers to facilitate
defecation on at least 25% of occasions;
e. the sensation of anorectal obstruction/blockage on
at least 25% of occasions;
f. fewer than three bowel movements a week

there is currently no universally accepted satisfactory treatment protocol

for this condition.

INTRODUCTION
PROBIOTIC
Recently, the administration of probiotics,
defined as live microorganisms. That, when
administered in adequate amounts, confer a
health benefit on the host has been proposed
as
a
treatment
for
functional
gastrointestinal disorders.
Probiotics have been shown to have beneficial
effects on various aspects of human
health, as well as several gastrointestinal
disorders, including adult and pediatric
diarrhea, antibiotic associated diarrhea and
pouchitis.

INTRODUCTION
Four

meta-analyses have previously evaluated

the effects of probiotics for the treatment of
IBS different conclusions.
Currently, Lactobacilli and Bifidobacteria
are among the most commonly studied
probiotics in patients with IBS.
a Cochrane systematic review concluded that
there is no evidence that Lactobacillus
supplementation is effective in managing
children with recurrent abdominal pain.

MATERIALS AND METHODS

SEARCH STRATEGY

MATERIALS AND METHODS

METHODOLOGY QUALITY ASSESSMENT

RESULT
Article

Selection

RESULT

Jadad score
assessment

RESULT
Table 2. All subtypes of IBS
(diarrhea predominant,
constipation-predominant and
alternating) were incorporated in
the included studies.
The meta-analysis included 440
IBS patients (273 adults and 167
children) randomized to receive
either Lactobacillus or a placebo.

RESULT

RESULT
Heterogeneity test
We performed the heterogeneity analysis using the
2test and found heterogeneity in the metaanalysis.
Therefore, a random-effects model was used for
the meta-analysis. The cause of heterogeneity the
limited number of studies and small sample sizes.

RESULT
Publication

bias assessment
We performed Beggs test and
Eggers test , both of which
showed no publication bias in the
meta-analysis (Beggs test, p=
1.000; Eggers test, p=0.932).
Merging and meta-analysis
The meta-analysis showed that
the heterogeneity among the six
studies
was
statistically

RESULT
In

the forest plot, the diamond was on the

right, OR was 7.69 (95%CI: 2.33-25.43,
z=3.35, p=0.0008) indicated that
Lactobacillus supplementation had an
effect on irritable bowel syndrome

RESULT
We

used the random effects model for the

meta-analysis (p=0.10), the OR was 17.62
(95%CI: 5.12-60.65, z=4.55, p<0.00001)

indicated
that
Lactobacillus
treatment had an effect in the adult
irritable bowel syndrome patients.

RESULT
We

applied the random-effects model

for the meta-analysis (p=0.04) and
found an OR of 3.71 (95%CI: 1.0513.11, z=2.04, p=0.04) indicated
that Lactobacillus therapy had an
effect in the pediatric irritable
bowel syndrome patients.

DISCUSSION

functional
bowel
disorder
characterized by chronic and relapsing
abdominal pain or discomfort associated
with altered bowel habits.
The primary aim of treatment to
relieve abdominal pain.
Affected patients experience recurrent
abdominal pain and/or discomfort with
alterations in bowel habits in addition to a
range of other features, including bloating,
distension, flatulence, borborygmi and
disturbances in the defecatory function

IBS

DISCUSSION
The

therapeutic efficacy of IBS

treatment is likely impacted by
the heterogeneous
pathogenesis of the disease,
intestinal motility,
which includes altered
visceral hypersensitivity,
abnormal brain-gut
interactions,
food intolerance,
altered intestinal
permeability

DISCUSSION
Due

to its obscure pathophysiology,

treating IBS difficult prompting
interest in the identification of new and
safe treatment options.
According to published guidelines, the
primary
treatment
options
for
abdominal
pain
include
antispasmodics or antidepressants
at low doses, while anti-diarrheal and/or
laxative drugs are given to improve
transit disturbances .

DISCUSSION
composed of normal
gut flora, and adverse events
associated with these agents are
very rare.
probiotics are good candidates
for controlling the symptoms
associated with IBS, especially
when
treatment
safety
is
paramount
in
non-lethal
disorders, such as IBS .
While the exact mechanisms by
probiotics

DISCUSSION
In

our research, we found six

articles that met the inclusion
criteria, including three articles
about
children
and
three
articles about adults.
According to the results of the
manalysis,
Lactobacillus
treatment has an effect in both
children and adults with IBS,
without any side effects.

DISCUSSION
Furthermore,

this metaanalysis showed that

Lactobacillus therapy is beneficial in IBS
patients.
While
IBS is likely multifactorial in
etiology,
recent
findings
in
both
experimental animal and clinical studies
suggest that disturbances in gut flora, as
observed in the setting of smallintestinal bacterial overgrowth, occur in
patients with irritable bowel syndrome
and that such abnormalities contribute to the
development of IBS-type symptoms.

Physiologic Benefits of Probiotics in Irritable

Bowel Syndrome

Probiotics have a beneficial effect on

intestinal mucosa via several proposed
mechanisms that include:
suppression of the growth and binding of
pathogenic bacteria
improvement of the barrier function of the
epithelium, and alteration of the immune
activity of the host.
secrete short chain fatty acids, an action
that results in decreased luminal pH and
production of bactericidal proteins.29
The DNA of probiotic organisms has also
been shown to inhibit apoptosis of epithelial

CONCLUSION
Lactobacillus

is a good candidate for

assessment in a large multicenter
trial of IBS patients, including both
adults and children.
With respect to the limitations of this
metaanalysis, there is a strong need
for further research to confirm the
effects of probiotic treatment. As the
exact mechanism of action of Lactobacillus
supplementation is not known, further
experimental studies are needed.