Efficacy of Probiotics Compared With Pharmacological Treatments for Maintenance Therapy for Functional Constipation in Children: A Systematic Review and Network Meta-analysis

Rebecca G Harris; Elizabeth P Neale; Marijka Batterham

doi:10.1093/nutrit/nuae119

Efficacy of Probiotics Compared With Pharmacological Treatments for Maintenance Therapy for Functional Constipation in Children: A Systematic Review and Network Meta-analysis

Nutr Rev. 2024 Sep 30:nuae119. doi: 10.1093/nutrit/nuae119. Online ahead of print.

Authors

Rebecca G Harris^{1

2}, Elizabeth P Neale^{1

2}, Marijka Batterham^{2

3}

Affiliations

¹ School of Medical Indigenous and Health Science, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong, New South Wales 2522, Australia.
² Illawarra Health and Medical Research Institute, Wollongong, New South Wales 2522, Australia.
³ Statistical Consulting Centre, School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales 2522, Australia.

PMID: 39348282
DOI: 10.1093/nutrit/nuae119

Abstract

Context: There has been an increase in randomized controlled trials (RCTs) comparing probiotics with various maintenance therapies, such as polyethylene glycol, lactulose, and mineral oil, to treat functional constipation in children.

Objective: The aim was to compare probiotics with all other oral maintenance therapies for functional constipation in children and rank all treatments in terms of effectiveness in a network meta-analysis.

Methods: RCTs were identified through systematically searching the MEDLINE, Scopus, EMBASE, and Cochrane Library databases, trial registries, and forward and backward citation searching. Within-study risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and confidence in the estimates was assessed using the CINeMA (Confidence in Network Meta-Analysis) framework. Random-effects network meta-analyses were conducted.

Results: Data were pooled from 41 and 29 RCTs for network meta-analysis of defecation frequency and treatment success, respectively. Probiotics did not significantly increase the number of bowel movements per week when compared with any conventional treatment or placebo. A combination of mineral oil and probiotics was the most effective treatment for increasing defecation frequency (mean difference: 3.13; 95% confidence interval [CI]: 0.64, 5.63). The most effective treatments for increasing the risk of treatment success as compared with placebo were mineral oil (relative risk [RR]: 2.41; 95% CI: 1.53, 3.81) and a combined treatment of polyethylene glycol and lactulose (RR: 2.45; 95% CI: 1.21, 4.97). Confidence in the estimates ranged from very low to moderate.

Conclusion: Currently, there is no evidence to suggest that probiotics should be used as a standalone treatment for functional constipation in children. More high-quality studies are needed to evaluate different strains of probiotics and their potential benefit as an additional treatment component to conventional treatments. Mineral oil and polyethylene glycol were the most effective treatments to increase defecation frequency and treatment success rates and should remain the first line of treatment for children with functional constipation.

Systematic review registration: PROSPERO registration no.

CRD42022360977 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=360977).

Keywords: children; functional constipation; laxatives; maintenance therapy; network meta-analysis; probiotics; randomized controlled trials; systematic review.

Grants and funding

Australian Government Research Training Program