Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 7, 2013; 19(29): 4718-4725
Published online Aug 7, 2013. doi: 10.3748/wjg.v19.i29.4718
Probiotic supplementation decreases intestinal transit time: Meta-analysis of randomized controlled trials
Larry E Miller, Arthur C Ouwehand
Larry E Miller, Miller Scientific Consulting, Inc., Arden, NC 28704, United States
Arthur C Ouwehand, DuPont Nutrition and Health, FIN-02460 Kantvik, Finland
Author contributions: Miller LE and Ouwehand AC contributed equally to this work; Miller LE designed the research; Miller LE analyzed the data; Miller LE and Ouwehand AC performed the research, wrote the paper, and approved the final draft of the paper.
Correspondence to: Larry E Miller, PhD, Miller Scientific Consulting, Inc., 26 Portobello Road, Arden, NC 28704, United States. larry@millerscientific.com
Telephone: +1-928-6079657 Fax: +1-928-2683563
Received: January 31, 2013
Revised: March 20, 2013
Accepted: April 10, 2013
Published online: August 7, 2013
Abstract

AIM: To determine the efficacy of probiotic supplementation on intestinal transit time (ITT) and to identify factors that influence these outcomes.

METHODS: A systematic review of randomized controlled trials (RCTs) of probiotic supplementation that measured ITT in adults was conducted by searching MEDLINE and EMBASE using relevant key word combinations. Main search limits included RCTs of probiotic supplementation in healthy or constipated adults that measured ITT. Study quality was assessed using the Jadad scale. A random effects meta-analysis was performed with standardized mean difference (SMD) of ITT between probiotic and control groups as the primary outcome. Meta-regression and subgroup analyses were conducted to examine the impact of moderator variables on ITT SMD.

RESULTS: A total of 11 clinical trials with 13 treatment effects representing 464 subjects were included in this analysis. Probiotic supplementation was associated with decreased ITT in relation to controls, with an SMD of 0.40 (95%CI: 0.20-0.59, P < 0.001). Constipation (r2 = 39%, P = 0.01), higher mean age (r2 = 27%, P = 0.03), and higher percentage of female subjects (r2 = 23%, P < 0.05) were predictive of decreased ITT with probiotics in meta-regression. Subgroup analyses demonstrated statistically greater reductions in ITT with probiotics in subjects with vs without constipation and in older vs younger subjects [both SMD: 0.59 (95%CI: 0.39-0.79) vs 0.17 (95%CI: -0.08-0.42), P = 0.01]. Medium to large treatment effects were identified with Bifidobacterium Lactis (B. lactis) HN019 (SMD: 0.72, 95%CI: 0.27-1.18, P < 0.01) and B. lactis DN-173 010 (SMD: 0.54, 95%CI: 0.15-0.94, P < 0.01) while other single strains and combination products yielded small treatment effects.

CONCLUSION: Overall, short-term probiotic supplementation decreases ITT with consistently greater treatment effects identified in constipated or older adults and with certain probiotic strains.

Keywords: Constipation, Gastrointestinal, Intestinal transit time, Meta-analysis, Probiotics

Core tip: Clinical trials of probiotics for gut health often utilize intestinal transit time (ITT) as a measure of clinical success although treatment effects are not consistent across studies. We performed the first systematic review and meta-analysis of randomized controlled trials to investigate the efficacy of probiotic supplementation on ITT in adults and to identify factors that influence these outcomes. Overall, short-term probiotic supplementation decreases ITT with consistently greater treatment effects identified in constipated or older adults and with certain probiotic strains.