A systematic review and meta-analysis of probiotics for the management of radiation induced bowel disease

Clin Nutr. 2013 Jun;32(3):353-60. doi: 10.1016/j.clnu.2013.02.004. Epub 2013 Feb 18.


Background & aims: A meta-analysis to estimate the efficacy of probiotics in prevention of radiation-induced bowel disease after pelvic radiotherapy has been performed. Previous attempts have arguably failed to provide a comprehensive analysis of clinical trials and their outcomes.

Methods: We searched for studies indexed in Medline, EMBASE, Cochrane Library, and on-line clinical trials registers. There was no language or time limit. Each study was evaluated for methodological quality and outcomes. We identified four outcomes on which to perform meta-analysis: incidence of diarrhoea, loperamide use, watery, and soft stools (Bristol Stool Chart). Odds ratio (OR) was used to compare efficacy, and the pooled OR was estimated using a random effects model; heterogeneity was assessed with Cochran's Q and Higgins I(2) test. Analyses were performed using Review Manager 5.2.

Results: Ten studies were included in our systematic review, of which six were subjected to meta-analysis to compare probiotics against placebo. Quality assessment showed an unclear risk due to incomplete outcome data and lack of performance of intention-to-treat analysis, while blinding and randomization issues were present in certain studies. Pooled results showed heterogeneity (Cochran's Q: p < 0.05; I(2): high). However the pooled OR for the incidence of diarrhoea, synthesized from 6 studies, significantly favoured the use of probiotics over control (OR = 0.44, 95% CI 0.21-0.92). Numerically, but not statistically, probiotics seem to decrease loperamide use (OR = 0.29, 95% CI 0.01-6.80) and the incidence of watery stools (OR = 0.36, 95% CI 0.05-2.81).

Conclusions: In conclusion, probiotic supplementation shows a probable beneficial effect in the prevention, and possible benefit in the treatment, of radiation-induced diarrhoea.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Diarrhea / etiology
  • Diarrhea / prevention & control
  • Diarrhea / therapy
  • Dietary Supplements*
  • Humans
  • Inflammatory Bowel Diseases / etiology
  • Inflammatory Bowel Diseases / prevention & control*
  • Inflammatory Bowel Diseases / therapy*
  • Pelvis / physiopathology
  • Pelvis / radiation effects
  • Probiotics / administration & dosage*
  • Radiation Injuries / therapy*
  • Randomized Controlled Trials as Topic
  • Treatment Outcome