AUTHOR=Xie Chao-Rong , Tang Bin , Shi Yun-Zhou , Peng Wen-Yan , Ye Kun , Tao Qing-Feng , Yu Shu-Guang , Zheng Hui , Chen Min 

TITLE=Low FODMAP Diet and Probiotics in Irritable Bowel Syndrome: A Systematic Review With Network Meta-analysis

JOURNAL=Frontiers in Pharmacology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.853011

DOI=10.3389/fphar.2022.853011

ISSN=1663-9812

ABSTRACT=<p><bold>Background:</bold> Probiotic and low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) diet are two commonly used management approaches for patients with irritable bowel syndrome (IBS). We aimed to evaluate the most effective combinations and components among different probiotics or low FODMAP diet through component network meta-analysis (NMA).</p><p><bold>Methods:</bold> We searched Embase, Ovid Medline, and Web of Science from inception to 21 January 2021. Randomized controlled trials (RCTs) examining the efficacy of probiotics and low FODMAP diet for IBS were included, with placebo, sham diet, or conventional treatments as controls. Binary outcomes were compared among treatments using the relative ratio (RR). A minimally contextualized framework recommended by the GRADE group was used to evaluate the certainty of evidence. The primary efficacy outcome was the relief of global IBS symptoms, and the secondary efficacy outcome was the reduction in IBS symptom scores or abdominal pain scores.</p><p><bold>Key Results:</bold> We included 76 RCTs (n = 8058) after screening 1940 articles. Eight RCTs were classified as low risk of bias. Standard network meta-analysis (NMA) showed that <italic>Lactobacillus</italic> (RR 1.74, 95% CI 1.22–2.48) and <italic>Bifidobacterium</italic> (RR 1.76, 95% CI 1.01–3.07) were the most effective for the primary efficacy outcome (high certainty evidence); component NMA showed that <italic>Bacillus</italic> (RR 5.67, 95% CI 1.88 to 17.08, <italic>p</italic> = 0.002) and <italic>Lactobacillus</italic> (RR 1.42, 95% CI 1.07 to 1.91, <italic>p</italic> = 0.017) were among the most effective components. The results of standard NMA and CNMA analysis of the improvement of overall IBS symptom scores or abdominal pain scores were consistent with this finding.</p><p><bold>Conclusion:</bold><italic>Lactobacillus</italic> was the most effective component for the relief of IBS symptoms; <italic>Bifidobacterium</italic> and <italic>Bacillus</italic> were possibly effective and need further verification.</p><p><bold>Systematic Review Registration:</bold> website, identifier registration number.</p>