1.
Systematic Review with Meta-Analysis: Lactobacillus reuteri DSM 17938 for Treating Acute Gastroenteritis in Children. An Update.
Patro-Gołąb, B, Szajewska, H
Nutrients. 2019;11(11)
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Acute gastroenteritis (AGE) is a common health problem in children and, globally, diarrhoea is one of the leading causes of death in children younger than the age of 5 years. Probiotics have been extensively studied as a supportive treatment regimen in children with AGE and shown to be effective in reducing both diarrhoea duration and severity, and potentially reducing the duration of hospitalization. The aim of this systematic review and meta-analysis of four randomised controlled trials including 347 children was to provide an update on the research into a particular strain of Lactobacillus reuteri for the treatment of AGE. The meta-analysis showed a significantly reduced duration of illness and hospitalisation, as well as increased cure rate on day 1 and 2, but not 3, 4 or 5. Based on two of the four trials there was no difference in number of watery stools on day 1, 2, 3 or 4. The authors note that the clinical relevance of the findings was limited due to the small effect size and methodological limitations of the included studies.
Abstract
The effectiveness of Lactobacillus reuteri DSM 17938 (L. reuteri) for the management of acute gastroenteritis (AGE) has been recently questioned. We performed a systematic review to update evidence on L. reuteri for treating AGE in children. We searched MEDLINE, EMBASE, the Cochrane Library databases, and additional data sources from January 2016 (end of search for our 2016 systematic review) to August 2019. The primary outcomes were stool volume and duration of diarrhea. Four RCTs were included. None of them evaluated stool volume. Compared with placebo or no treatment, L. reuteri reduced diarrhea duration (four RCTs, n = 347, mean difference, MD -0.87 days, 95% CI [-1.43, -0.31]). L. reuteri use was also associated with a reduced duration of hospitalization (three RCTs, n = 284, MD -0.54 days, 95% CI [-1.09, 0.0]). The small effect sizes of limited clinical relevance and methodological limitations of the included trials should be noted when interpreting these findings.
2.
Systematic review: probiotics for functional constipation in children.
Wojtyniak, K, Szajewska, H
European journal of pediatrics. 2017;176(9):1155-1162
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Functional constipation is common in children with a prevalence ranging between 0.7 to 29.6%. Data have shown that 10% of children with functional constipation take laxatives for longer than 12months, and 40% are still symptomatic despite use of laxatives. The aim of the study is to find out the efficacy and safety of probiotics use in the management of functional constipation in children. The study is a systemic review and meta-analysis of seven double-blind randomized control trials (515 participants) that examined the effects of probiotics in patients aged 0 – 18 years with functional constipation. The study shows that probiotics are ineffective for the management of functional constipation in children in terms of treatment success, defecation frequency, frequency of faecal incontinence, and frequency of abdominal pain. Authors conclude that current evidence does not support the use of probiotics in the treatment of functional constipation in children.
Abstract
We updated our 2010 systematic review on the efficacy of probiotics in the treatment of constipation in children. The MEDLINE, EMBASE, and Cochrane Library databases; clinical trial registries; and reference lists of included studies were searched to February 2017 for randomized controlled trials (RCTs) performed in children, with no language restriction. The primary outcome measure was treatment success, as defined by the investigators. We included seven RCTs with a total of 515 participants. Included trials were heterogeneous with respect to study population, probiotic strains, dosages, study duration, and follow-up. Pooled results of two RCTs showed no significant difference between the Lactobacillus rhamnosus casei Lcr35 and placebo groups with respect to treatment success. Other probiotics were studied in single trials only. There was no significant difference between the probiotic and control groups with respect to treatment success. While some probiotic strains showed some effects on defecation frequency, none of the probiotics had beneficial effects on frequency of fecal incontinence or frequency of abdominal pain. Adverse events were rare and not serious. CONCLUSION Limited evidence does not support the use of any of currently evaluated probiotics in the treatment of functional constipation in children. What is Known: • Conventional treatment for functional constipation in children does not always provide satisfying improvement. • Probiotics have been suggested as potential treatment modalities for this condition. What is New: • Probiotics are ineffective for the management of functional constipation in children in terms of treatment success, frequency of fecal incontinence, and frequency of abdominal pain.