Copyright ©2010 Baishideng. All rights reserved
World J Gastroenterol. May 14, 2010; 16(18): 2202-2222
Published online May 14, 2010. doi: 10.3748/wjg.v16.i18.2202
Systematic review and meta-analysis of Saccharomyces boulardii in adult patients
Lynne V McFarland
Lynne V McFarland, Department of Health Services Research and Development, Puget Sound Veterans Administration Healthcare System, Seattle, WA 98101, United States; Department of Medicinal Chemistry, Box 357610, School of Pharmacy, University of Washington, Seattle, WA 98195, United States
Author contributions: McFarland LV wrote this paper.
Correspondence to: Lynne V McFarland, PhD, Department of Health Services Research and Development, Puget Sound Veterans Administration Healthcare System, S-152, 1100 Olive Way #1400, Seattle, WA 98101, United States. lynne.mcfarland@va.gov
Telephone: +1-206-2771095 Fax: +1-206-7642935
Received: January 20, 2010
Revised: February 13, 2010
Accepted: February 20, 2010
Published online: May 14, 2010

This article reviews the evidence for efficacy and safety of Saccharomyces boulardii (S. boulardii) for various disease indications in adults based on the peer-reviewed, randomized clinical trials and pre-clinical studies from the published medical literature (Medline, Clinical Trial websites and meeting abstracts) between 1976 and 2009. For meta-analysis, only randomized, blinded controlled trials unrestricted by language were included. Pre-clinical studies, volunteer studies and uncontrolled studies were excluded from the review of efficacy and meta-analysis, but included in the systematic review. Of 31 randomized, placebo-controlled treatment arms in 27 trials (encompassing 5029 study patients), S. boulardii was found to be significantly efficacious and safe in 84% of those treatment arms. A meta-analysis found a significant therapeutic efficacy for S. boulardii in the prevention of antibiotic-associated diarrhea (AAD) (RR = 0.47, 95% CI: 0.35-0.63, P < 0.001). In adults, S. boulardii can be strongly recommended for the prevention of AAD and the traveler’s diarrhea. Randomized trials also support the use of this yeast probiotic for prevention of enteral nutrition-related diarrhea and reduction of Heliobacter pylori treatment-related symptoms. S. boulardii shows promise for the prevention of C. difficile disease recurrences; treatment of irritable bowel syndrome, acute adult diarrhea, Crohn’s disease, giardiasis, human immunodeficiency virus-related diarrhea; but more supporting evidence is recommended for these indications. The use of S. boulardii as a therapeutic probiotic is evidence-based for both efficacy and safety for several types of diarrhea.

Keywords: Probiotic, Diarrhea, Saccharomyces boulardii, Adult patients, Meta-analysis