The paper, published in European Journal of Pediatrics, said that most probiotic products, when combined with laxatives, were associated with significantly greater improvements in bowel movement or stool frequency as compared to placebo.
However, when no laxative was used, the probiotic strain Lactobacillus casei rhamnosus Lcr35 showed the most improvements.
The meta-analysis was conducted by researchers from Taiwan, including Ping An Medical Clinic, E-Da Cancer Hospital, and National Defense Medical Center.
Results of nine randomised controlled trials (RCTs) involving 710 participants aged 5.5 on average were included in this network meta-analysis (NMA). A network meta-analysis compares the effects of multiple interventions at the same time.
The intervention period of the nine RCTs ranged from three to 12 weeks.
Findings found that combining probiotics and laxatives could significantly improve bowel movement or stool frequency.
The probiotics that worked effectively with laxatives include 1) Lactobacillus rhamnosus GG ATCC 53103, 2) Lactobacillus reuteri DSM 17938, 3) the combination of Bifidobacteria breve M-16V and Bifidobacteria longum BB536, 4) synbiotics, and 5) protexin – a blend of seven probiotics strains.
Using protexin and laxatives produced the most improvements, based on Surface Under the Cumulative RAnking curve (SUCRA). The higher the score, the greater the improvement in bowel movement or stool frequency.
In this case, protexin plus laxative yielded a score of 93.3.
However, when no laxatives were used, Lactobacillus casei rhamnosus Lcr35 made the most significant improvements to bowel movement and stool frequency.
The probiotic yielded a SUCRA score of 61.7 – ranking number five out of the nine types of interventions studied.
“Another important finding was that LacCRh Lcr35 provided significantly better improvement in bowel movement or stool frequency than the placebo/control treatment in the subgroup analysis of the treatment arm with only probiotics vs. placebo or laxatives,” said the researchers.
They explained that the efficacy of LacCRh Lcr35 could come from its ability to adhere to human intestinal cell lines, maintain colonisation in the gut, and its antibacterial activity against pathogens.
“Although it has been commercially used to manage acute diarrhoea for more than 20 years, the optimal dosage of LacCRh Lcr35 to manage paediatric functional constipation remains unclear. Therefore, future large-scale RCTs addressing the optimal dosage of LacCRh Lcr35 are warranted,” the researchers added.
The interventions with the second to fourth highest SUCRA score were Lactobacillus rhamnosus GG ATCC 53103 with laxatives at 78.9, synbiotics plus laxatives at 68.5, and Lactobacillus reuteri DSM 17938 plus laxatives at 62.5.
The SUCRA score for laxative use alone was 46.2.
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“Our NMA showed that the most investigated probiotic products, especially when used in combination with laxatives, provided significantly better improvement in bowel movement/ stool frequency than the placebo/control treatments.
“Protexin + lax exerted the most improvement in bowel movement/stool frequency among all the investigated probiotic products.
“However, if we focused on treatment arms with a single probiotic intervention, only LacCRh Lcr35 was considered to be an intervention with significant efficacy,” said the researchers.
On the other hand, two probiotics strains did not show statistically significant improvements, namely the combination of Bifidobacteria lactis DN-173 010 and Lactococcus cremoris.
While probiotics and laxatives have produced greater improvements as compared to laxative use alone, the researchers said that the additive effect of probiotics to laxatives was considered “relatively small”.
“Although the probiotics plus laxatives provided significantly better improvement in the primary outcome than the placebo/control group, the additive effect of probiotics to the laxatives was relatively small...
“Based on the aforementioned results, we might recommend the application of an advanced combination of probiotics and laxatives for paediatric functional constipation if there is no concurrent contraindication,” said the researchers.
The role of probiotics
Probiotics are tested on constipation as it is believed that it could alleviate the condition by addressing gut dysbiosis.
For instance, children suffering from functional constipation might have a lower Lactobacillus spp., Alistipes spp., and Ruminococcus spp., but an increased Bacteroides spp., Parabacteroides spp., and Bifidobacterium longum.
Also, probiotic supplementation could have improved short-chain fatty acid production, enhanced colon motility and colonic transit time.
Source: European Journal of Pediatrics
Efficacy and acceptability of different probiotic products plus laxatives for pediatric functional constipation: a network meta-analysis of randomized controlled trials.
https://doi.org/10.1007/s00431-024-05568-6
Authors: Yang, WC., Zeng, BS., Liang, CS. et al.
