A Systematic Review of Probiotics for Cystic Fibrosis Patients: Moving Forward

Background: Cystic fibrosis (CF) is associated with chronic respiratory disease and pancreatic insufficiency and results in the malabsorption of nutrients and intestinal inflammation. There is evidence that probiotic supplementation may impact the gastrointestinal and respiratory microbiota. This study aimed to categorize current evidence regarding the effects of supplementing with probiotics in CF patients on gastrointestinal and respiratory outcomes according to the type of intervention. Methods: The initial database search included all identified studies according to the recommendations of the Cochrane Collaboration, regardless of language, publication date or design. Studies were categorized by probiotic strain (Lactobacillus reuteri; Lactobacillus rhamnosus GG or a mix of strains); dosage (low dosage if 109 CFU); and duration of intervention (one, three, six or twelve months). Assessment of quality was performed based on the Cochrane risk of bias criteria and the Downs & Black checklist. Results: A total of 205 studies were identified; however, only nine met the criteria for inclusion. The studies were considered to have a high risk of bias, hampering the possibility of performing a meta-analysis. Eighty percent of the studies (4 of 5) reported a positive result for intestinal inflammation, and another 4 studies (4 of 5) reported a positive result for pulmonary exacerbation frequency, regardless of the treatment approach. Conclusion: The present data indicate a promising future for probiotic use in cystic fibrosis, which has an impact on exacerbations and intestinal inflammation; however, further studies of standardized therapeutic interventions are required. Address correspondence and reprint requests to Lenycia de Cassya Lopes Neri, M.Sc., Rua Albina Barbosa, 273, Aclimação São Paulo SP Brasil. CEP 01530-020 (e-mail: lenycia@gmail.com). Received 27 April, 2018 Accepted 1 October, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). Financial support: None Potential conflicts of interest: None Lenycia de Cassya Lopes Neri: Conception and design of the work; acquisition, analysis, and interpretation of data for the work; Revising it critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Monica Taminato: Substantial contributions to the conception and design of the work; interpretation of data for the work; revising it critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Luiz Vicente Ribeiro Ferreira da Silva Filho: Substantial contributions to the conception and design of the work; the acquisition, analysis, or interpretation of data for the work; Revising it critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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