Efficacy and Safety of Probiotics, Prebiotics and Synbiotics for the Treatment of Functional Constipation in Children: Systematic Review and Network Meta-analysis.

Several studies have demonstrated that beneficial gut microorganisms, such as probiotics, can treat functional constipation in children. We aim to evaluate the effectiveness of probiotics, prebiotics, and synbiotics in treating childhood functional constipation. We conducted a comprehensive search of eight electronic databases, dating from their inception up to July 11, 2024. The eligibility criteria were randomized controlled trials (RCTs) that reported on the use of probiotics, prebiotics, or synbiotics for treating childhood functional constipation. The RCTs were evaluated using the Cochrane Risk of Bias tool, and a random effects network meta-analysis was performed under a frequentist framework. Fifteen RCTs involving 1087 participants were identified. Seventeen types of interventions were investigated. With low or very low confidence in the evidence, no significant differences in bowel movements per week were detected between the intervention and placebo groups. Based on very low-certainty evidence, when Mixed was compared with S. boulardii, Mixed (SMD = 0.86, 95% CI [0.48, 1.23], P < 0.001) had positive effects on stool consistency, and synbiotics were supported by low-quality evidence. Compared with S. boulardii, Lactulose (SMD = 0.62, 95% CI [0.25, 0.99], P < 0.001, low certainty) was more efficacious in improving stool consistency. Synbiotics appeared to reduce abdominal pain. In particular, compared with Lcr35, Mixed (SMD = -1.44, 95% CI [-2.67, -0.22], P = 0.021) showed significant benefits in alleviating abdominal pain, although the certainty of evidence was very low. Prebiotics and synbiotics may have potential benefits in stool consistency and reducing abdominal pain. However, the certainty of the evidence is very low to low. Future research should conduct larger-scale, well-designed RCTs to verify these preliminary findings.