Probiotics improve GI symptoms in coeliac disease

Use of probiotics for treating coeliac disease (CD) results in improved gastrointestinal (GI) symptoms, results of a meta-analysis have shown.

“Many patients with CD experience persistent symptoms despite adhering to the gluten-free diet,” the authors said. “Different studies have assessed the use of probiotics as an adjuvant treatment for CD.”

The databases of Embase, Medline, Cinahl, Web of Science, Central and Dare were searched up to February 2019 for randomized controlled trials (RCTs) evaluating probiotics compared with placebo for treating CD. Data on GI symptoms, quality of life (QoL), adverse events, serum tumour necrosis factor-α, intestinal permeability, and microbiota composition were collected.

Of the 2,831 records screened, only seven articles describing six RCTs (n=5,279 participants) met the eligibility criteria for quantitative analysis.

Assessment by the GI Symptoms Rating Scale showed that probiotics improved GI symptoms (mean difference symptom reduction, 228.7 percent, 95 percent confidence interval [CI], 243.96–213.52; p=0.0002). No difference in GI symptoms after probiotics was found after pooling different questionnaires.

Treatment with probiotics also increased the levels of Bifidobacteria (mean difference, 0.85 log colony-forming units [CFU] per gram, 95 percent confidence interval [CI], 0.38–1.32; p=0.0003).

Data on tumour necrosis factor-α levels or QoL for probiotics compared with placebo were insufficient. In addition, there was no difference in adverse events between probiotics and placebo. Notably, the overall certainty of the evidence ranged from very low to low.

“High-quality clinical trials are needed to improve the certainty in the evidence,” the authors said.