PROBIOTICS FOR TREATMENT OF CHRONIC CONSTIPATION IN CHILDREN: A COCHRANE SYSTEMATIC REVIEW

Abstract

Background Chronic constipation is one of the most common paediatric problems seen within primary, secondary and tertiary care. It is hypothesised that the use of probiotics might alter the growth of bacteria in the bowel, promote normal gut physiology and reduce constipation symptoms. Given the recent growth in published studies in this area it is necessary to produce a new and focussed synthesis of this evidence by deploying a robust methodology to ensure that there can be a contemporaneous impact on clinical practice.

Methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL and the Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Group Specialised Trial Register were searched (Inception – July 2015). Manufacturers of probiotics were contacted to identify unpublished trials. References of trials were also searched. Abstracts were considered for inclusion if full details to judge inclusion were offered or available from the authors. Randomised controlled trials (RCTs) were eligible for inclusion. Data extraction and assessment of methodological quality of included studies were independently performed by two authors. Analysis was completed in accordance with the intention to treat approach.

Results The search yielded 1529 results. Seven placebo controlled studies (n = 496) met the inclusion criteria and were included in the review. All studies compared probiotics with placebo, but two gave all participants lactulose as concomitant therapy. The studies ranged in length from 3 to 12 weeks. Metaanalysis of four studies (n = 312, patients not on concomitant lactulose) found a statistical significant increase in the frequency of defecation using probiotics compared to placebo (MD 1.09; 95% CI 0.17 to 2.01, Figure 1). This result did not change on sensitivity analysis using a fixed effects model. Meta-analysis of these four studies found no statistical significant difference in adverse events between probiotics and placebo (OR 0.33; 95% CI 0.03 to 3.23).

Conclusions The evidence from the published suggests superior efficacy of probiotics for chronic constipation in children when compared with placebo. There is no difference in adverse events, suggesting safety. The evidence base is of moderate quality and relatively small. Further research to investigate the long term impact of probiotic therapy on chronic constipation is suggested.