New therapeutic perspectives in irritable bowel syndrome: Targeting low-grade inflammation, immuno-neuroendocrine axis, motility, secretion and beyond

Table 2 Summary of the literature findings about therapies restoring intestinal permeability in irritable bowel syndrome

Drug	Ref.	No. of patients	Study design	Outcome
Probiotics	Ford et al[61]	Forty-three RCTs were eligible for inclusion	Metanalysis	Probiotics had beneficial effects on global IBS, abdominal pain, bloating, and flatulence scores. Data for prebiotics and synbiotics in IBS were sparse. Probiotics appeared to have beneficial effects in CIC (mean increase in number of stools per week = 1.49; 95%CI: 1.02-1.96), but there were only two RCTs. Synbiotics also appeared beneficial (RR of failure to respond to therapy = 0.78; 95%CI: 0.67-0.92). Again, trials for prebiotics were few in number, and no definite conclusions could be drawn
	Mazurak et al[67]	Fifty-six papers	Metanalysis	The heterogeneity of the studies of probiotics in IBS questions the value of meta-analyses and the use of different bacterial strains and different mixtures of these strains, as well as different dosages, are the main contributors to this heterogeneity
Glutamine	Akobeng et al[73]	Two randomized trial	Cochrane analysis	Not significant difference in the permeability and no effect in the clinical remission
Larazotide acetate	Leffler et al[78]	342 adults with celiac disease who had been on a gluten free diet (GFD) for 12 mo or longer and maintained their current GFD during the study	Randomized, double-blind, placebo-controlled study assessed larazotide acetate 0.5, 1, or 2 mg 3 times daily	Reduce signs and symptoms in celiac disease patients on a GFD better than a GFD alone