Systematic review with meta‐analysis: the efficacy of probiotics in inflammatory bowel disease

Summary Background Ulcerative colitis ( UC ) and Crohn's disease ( CD ) are inflammatory bowel diseases ( IBD ). Evidence implicates disturbances of the gastrointestinal microbiota in their pathogenesis. Aim To perform a systematic review and meta‐analysis to examine the efficacy of probiotics in IBD . Methods MEDLINE , EMBASE , and the Cochrane Controlled Trials Register were searched (until November 2016). Eligible randomised controlled trials ( RCT s) recruited adults with UC or CD , and compared probiotics with 5‐aminosalicylates (5‐ ASA s) or placebo. Dichotomous symptom data were pooled to obtain a relative risk ( RR ) of failure to achieve remission in active IBD , or RR of relapse of disease activity in quiescent IBD , with 95% confidence intervals ( CI s). Results The search identified 12 253 citations. Twenty‐two RCT s were eligible. There was no benefit of probiotics over placebo in inducing remission in active UC ( RR of failure to achieve remission=0.86; 95% CI =0.68‐1.08). However, when only trials of VSL #3 were considered there appeared to be a benefit ( RR =0.74; 95% CI =0.63‐0.87). Probiotics appeared equivalent to 5‐ ASA s in preventing UC relapse ( RR =1.02; 95% CI =0.85‐1.23). There was no benefit of probiotics in inducing remission of active CD , in preventing relapse of quiescent CD , or in preventing relapse of CD after surgically induced remission. Conclusions VSL #3 may be effective in inducing remission in active UC . Probiotics may be as effective as 5‐ ASA s in preventing relapse of quiescent UC . The efficacy of probiotics in CD remains uncertain, and more evidence from RCT s is required before their utility is known.