Review
Copyright ©The Author(s) 2021.
World J Gastrointest Surg. Sep 27, 2021; 13(9): 923-940
Published online Sep 27, 2021. doi: 10.4240/wjgs.v13.i9.923
Table 1 Summary of diagnostic criteria used to define irritable bowel syndrome
Diagnostic criteria
Symptoms included in criteria
Rome 1 (1990)Abdominal pain or discomfort relived with defecation; Abdominal pain or discomfort associated with a change in stool frequency or consistency; In addition, two or more of the following on at least 5% of occasions or days for 3 mo: (1) Altered stool frequency and form; (2) Altered stool passage; (3) Passage of mucus; and (4) Bloating or distension
Rome II (1999)Abdominal discomfort or pain that has two or three features for 1 wk (need to be consecutive) in the last year; Relieved with defecation; Onset associated with a change in the frequency of stools; Onset associated with a change in the form of stools
Rome III (2006)Recurrent abdominal pain or discomfort three days per month in the last 3 mo associated with two or more of: (1) Improvement in defecation; (2) Onset associated with a change in the frequency of stools; and (3) Onset associated with a change in the form of stools
Rome IV (2016)Recurrent abdominal pain on average at least 1 d/wk in the last 3 mo, associated with 2 or more of the following1: (1) Related to defecation (i.e., either increasing or improving pain); (2) Associated with a change in stool frequency; and (3) Associated with a change in stool form (appearance)
1Criteria fulfilled for the last 3 mo with symptom onset at least 6 mo before diagnosis.
Table 2 Outcomes of randomized controlled trials of probiotics versus placebo in different type of irritable bowel syndrome
Ref.Type of IBS (%)Sample sizeProbioticOutcome by the type of IBS (probiotic group)Common outcome (probiotic group)
Sinn et al[71], 2008D: 20; C: 27; M: 62.540L.acidophillus SDC 2012, 2013Not specifiedReduction of abdominal pain (28%), bowel habit satisfaction (18.2%), reduction of straining at stool (25.4%)
Hong et al[72], 2009D: 45.7; C: 20; M: 8.6; Non classified: 25.770Bifidobacterium bifidum BGN4, B. lactis AD011, Lactobacillus acidophilus AD031, L. casei IBS041Not specifiedReduction of pain score (-31.9), defecation and discomfort (-29.2), no significant change in QOL and bowel habits (defecation frequency and stoll consistency)
Guglielmetti et al[73], 2011D: 21.3; C: 19.7; M: 58.2; NC: 0.8122Bifidobacterium bifidum MIMBb75Not specifiedImproved global IBS symptoms by -0.88 points, reduction in pain/discomfort by -0.82 points, distention/bloating by -0.92 points, urgency by -0.76 points (Likert scale)
Cui and Hu[74], 2012D: 48.3; C: 20; M: 11.7; NC: 1060Bifidobacterium longum and Lactobacillus acidophilusNot specifiedImprovement in frequency of abdominal pain (23% vs 6%), abdominal distension (27% vs 7%), bowel habits (26% vs 8%), dissatisfaction with defecation (20% vs 10%).
Dapoigny et al[75], 2012D: 30; C: 22; M: 34; NC: 1450Lactobacillus casei rhamnosus LCR35D: significant reduction in abdominal pain; M: no relevant difference between groupsNo clinicaly relevant changes overall
Ducrottéet al[76], 2012All types214Lactobacillus plantarum 299vNot specifiedMean frequency of abdominal pain was reduced significantly by 51.9%, reductions in stool frequency, bloating and feeling of incomplete emptying, significant reduction of the daily number of stools
Amirimani et al[77], 2013All types102Lactobacillus reuteriNot specifiedIncreased frequency of defecation, no significat difference in bloating, urgency,abdominal pain, stool shape. Study did not clasiffy between D and C subtype
Begtrup et al[78], 2013D: 40; C: 19; M: 38; NC: 2131L. paracasei ssp paracasei F19, L. Acidophilus; La5 and Bifidobacterium Bb12Not specifiedAdequate relief of symptoms at least 50% of the time (52% vs 41%), No difference in diarrhea, bloating and satiety
Roberts et al[79], 2013D and C179Bifidobacterium lactis CNCM I-2494, S.thermophilus, L.bulgarisNot specifiedImprovements in symptoms scores, bloating, flatulence, ease of bowel movement and quality of life (48% vs 33%)
Jafari et al[80], 2014All types108Probio-Tec® Quatro-cap-4Not specifiedDecrease in VAS score for abdominal pain and bloating, decrease in feeling incomplete defecation
Ludidi et al[81], 2014All types40Bifidobacterium lactis W52, Lactobacillus casei W56, L. salivarius W57, Lactococcus lactis W58, L. acidophilus NCFM, and L. rhamnosus W71Not specifiedDecrease in visceral hypersensitivity in both groups,decreased pain in both groups, no significat difference in overal symptom improval
Pedersen et al[82], 2014D: 38; C: 17.3; M: 40.7; NC: 481Lactobacillus rhamnosus GGNot specifiedImprovement in IBS-SSS score nad QOL score. Low FODMAP diet showed efficient in IBS-C, and probiotic in IBC-D
Sisson et al[83], 2014D: 37.6; C: 21.5; M: 35.5; NC: 5.4186Lactobacillus rhamnosus NCIMB 30174, L. plantarum NCIMB 30173, L. Acidophilus NCIMB 30175, Enterococcus faecium NCIMB 30176Not specifiedReduction in IBS-SSS score (abdominal paion, bloating, bowel habit satisfaction)-63.3 vs -28.3. No difference in QOL score
Yoon et al[84], 2014D: 53.1; C: 40.8; M: 6.149Bifidobacterium bifidum (KCTC 12199BP), B. lactis (KCTC 11904BP), B. longum (KCTC 12200BP), L. acidophilus (KCTC 11906BP), L. rhamnosus (KCTC 12202BP) and Streptococcus thermophilus (KCTC 11870BP)Not specifiedGlobal relief of IBS symptoms (68% vs 37.5%), reduced abdominal pain and discomfort. No difference in stool consistency. Changes in the fecal microbiota genome (detected by PCR test)
Pineton de Chambrun et al[85], 2015D: 28.5; C: 46.9; M: 24.6179Saccharomyces cerevisiae CNCM I-3856Not specifiedSame results regarding abdominal pain and discomfort in both groups, but probiotic group showed improvement in during the second month of use
Yoon et al[86],2015D: 48.1; C: 18.5; M: 21; NC: 12.480Bifidobacterium bifidum (KCTC 12199BP), B. lactis (KCTC11904BP), B. longum (KCTC 12200BP), Lactobacillus acidophilus (KCTC 11906BP), L. rhamnosus (KCTC 12202BP), StreptococcusthermophilusNot specifiedIncrease in probiotic strains in stool samples, higher adequate symptom relief (but not statisticaly relevant), improvement in the diarhea symptom score
Lyra et al[87], 2016D: 38.9; C: 16.6; M: 44; NC: 0.5391Lactobacillus acidophilus NCFM (ATCC 700396)Not specifiedNo difference in both groups in IBS-SSS score
Spiller et al[88], 2016D: 20.8; C: 47.4; M: 31.7379Saccharomyces cerevisiase I-3856Reduced abdominal pain and bloating in IBS-CNo overall benefit in all subtypes, but significant improvement in C subtype
Preston et al[89], 2018D: 46.4; C: 35.7; M: 18.6113Lactobacillus acidophilus CL1285, L. casei LBC80R, L. rhamnosus CLR2Improvement of IBS-SSS score for female D subtype by 50% to 144%. Better satisfation with bowel habits in C subtype. Better QOL in IBS-D females. Impruvment in number of days without pain M subtypeNo improvement in IBS-SSS score overall or QOL overall
IBS: Irritable bowel syndrome; IBS-SSS: Irritable Bowel Syndrome Severity Scoring System; NC: Non classified irritable bowel syndrome; D: Diarrhea irritable bowel syndrome; C: Constipation irritable bowel syndrome; M: Mixed irritable bowel syndrome; QOL: Quality of life.
Table 3 Outcomes of randomized controlled trials of probiotics versus placebo in the C and D type of irritable bowel syndrome
Ref.Type of IBSSample sizeProbioticOutcome by the type of IBS (probiotic group)
Agrawal et al[102], 2009C34Bifidobacterium lactis DN-173 010Reduction in bloating and distension (-1.52 cm), reduction of orocaecal (-1.2 h) and colonic (-12.2 h) transit times, reduction of pain and discomfort (-0.5)
Michail et al[105], 2011D24VSL#3: Lactobacillus acidophilus, L. plantarum, L. casei, and L. delbrueckii ssp. bulgaricus, Bifidobacterium breve, B. longum, and B. infantis and Streptococcus salivarius ssp. thermophilusSignificant decreases in the bloating, diarrhea, satiety and QOL in both groups (placebo and probiotic)
Ki Cha et al[106], 2012D50Lactobacillus acidophilus, L. plantarum, L. rhamnosus, Bifidobacterium breve, B. lactis, B. longum and Streptococcus thermophilusSymptoms (abdominal pain, abdominal discomfort, loose/watery stool, urgency, mucus in stool, bloating, and passage of gas) relief was higher (> 50%), improved stool consistency
Abbas et al[50], 2014D72Saccharomyces boulardiiDecrease in the blood and tissue levels of proinflammatory cytokines IL-8 and TNF-a and and increase in the anti-inflammatory IL-10, improvement in body image and food avoidance
Lorenzo-Zúñiga et al[93], 2014D84Lactobacillus plantarum (CECT7484 and CECT7485), Pediococcus acidilactici (CECT7483)Improved QOL score, improvement in gut-related anxiety (VSI scale)
Majeed et al[107], 2016D36Bacillus coagulans MTCC 5856Decrase in bloating, diarhea, vomiting, abdominal pain, improvement in Bristol stool score
Mezzasalma et al[108],2019C150Lactobacillus acidophilus, L. reuteri, L.s plantarum, L.s rhamnosus, Bifidobacterium animalis subps. lactisQOL improved in probiotic group, incresead healthier characteristic in stool samples
Hod et al[109],2017D107Lactobacillus rhamnosus LR5, L. casei LC5, L. paracasei LPC5, L. plantarum LP3, L. acidophilus LA1, Bifidobacterium bifidum, BF3, B. longum BG7, B. breve BR3, B. infantis BT1, Streptococcus thermophilus ST3, L. bulgaricus LG1, Lactococcus lactisNo difference between groups overall, no CRP and fecal calprotectin levels difference
Ishaque et al[110],2018D360Bio-Kult®Reduced overal IBS-SSS score by 145 point in 30 d, reduced number of bowel movements, symptom free patients (33.7% vs 12.8%)
Khodadoostan et al[111],2018D67Lactobacillus casei, L. acidophilus, L. rhamnosus, L. bulgaricus, Bifidobacterium breve, B. longum, and Streptococcus thermophilus with prebiotic of ructooligosaccharidesImprovement in stool consistency adn defecation rate after 3 mo, decrease in abdominal pain after 6 mo
Sun et al[112], 2018D200Clostridium butyricumReduction in IBS-SSS score (-62.12 vs -40.74), no difference in abdominal pain and bloating, improvement in QOL, no change in Bristol stool scale.
IBS: Irritable bowel syndrome; IBS-SSS: Irritable Bowel Syndrome Severity Scoring System; D: Diarrhea irritable bowel syndrome; C: Constipation irritable bowel syndrome; QOL: Quality of life.