Limited data on probiotics for treating patients with celiac disease

Reference

Seiler CL, Kiflen M, Stefanolo JP, et al. Probiotics for celiac disease: a systematic review and meta-analysis of randomized controlled trials. Am J Gastroenterol. 2020;115(10):1584-1595.

Synopsis

These authors searched multiple databases and a clinical trials registry to identify randomized trials of probiotics for treating patients with celiac disease. Additionally, they hand-searched the bibliographies of the included studies. The authors identified 8 unique publications, 7 of which (N = 5279 participants) could provide data for pooling. All the studies took place in tertiary medical centers outside of North America; 78% of the participants were women. Only 2 studies used the same probiotic strain and dose. So, if there is no class effect of probiotics, then there is a high probability of selective publication. The authors also describe variability in the inclusion and diagnostic criteria of the participants. The overall methodologic quality of the studies was low. The included studies used a variety of different means to assess response. Although, overall, there was no improvement in symptoms, the 2 studies that used the Gastrointestinal Symptoms Rating Scale reported marked symptom reduction. The authors also looked at largely irrelevant outcomes, such as changes in gut flora and tumor necrosis factor-alpha levels. There were insufficient data on quality of life. All of the studies reported on adverse events and only 7 events occurred, so not much can be concluded about that.