Effectiveness of Saccharomyces boulardii on diarrhea, a systematic review and meta-analysis

Jose Ronilo  G. Juangco,; Maribel Emma  C. Hidalgo,; Riezel Vanessa  Abdon,; Nanette  Y. Ramilo-Cruz,; Raymond Oliver  A. Cruz,; Kathryn  Floro-Cruz,; Ma. Leyhl Ann  Nierves,; Shalemar  Kasan,

Effectiveness of Saccharomyces boulardii on diarrhea, a systematic review and meta-analysis

Abstract:

Introduction Probiotics such as Saccharomyces boulardii are now advocated for the treatment of diarrhea. The objective of this systematic review and meta-analysis was to determine the effectiveness of Saccharomyces boulardii in the treatment of diarrhea. Methods MEDLINE, EBSCO, Clinical Key, and the Cochrane Library were searched for clinical trials which used Saccharomyces boulardii as primary or adjuvant treatment for diarrhea. Outcomes included were treatment success in the form of cessation of diarrhea, decrease in the duration of diarrhea, decrease in hospital days, and improvement of dehydration. The Centre for Evidence-Based Medicine Critical Appraisal tool together with the Cochrane Collaboration tool was used to assess the risk of bias, RevMan 5.4 for encoding, and the Mantel-Haenszel method for analysis to compute a pooled result. Results Eleven clinical trials involving 1,541 participants were included in the systematic review and meta-analysis. Seven studies showed a non-significant overall decrease in the duration of diarrhea of 1.65 days (p = 0.25), five studies showed an overall significant beneficial response (RR = 1.68, p < 0.001) in the cessation of diarrhea. There was a statistically significant mean decrease (1.01 days, p < 0.001) in duration of hospitalization; and a statistically significant decrease (0.18 days or 4.32 hours, p = 0.04) in the duration of vomiting. Conclusion A systematic review and meta-analysis of 11 clinical trials favors the use of Saccharomyces boulardii in the treatment of diarrhea in terms of cessation of diarrhea, decrease in the duration of hospitalization and duration of vomiting.

References:

1. McFarland LV. Common organisms and probiotics: Saccharomyces boulardii. In: Floch MH, Ringel Y, Walker WA (Eds). The Microbiota in Gastrointestinal Pathophysiology Implications for Human Health, Prebiotics, Probiotics, and Dysbiosis [Internet]. 2017; 145-64. Available from: https://doi.org/10.1016/B978-0-12-804024-9.00018-5

2. Cochrane Handbook for Systematic Reviews of Interventions. [Internet]. Available from: https://training.cochrane.org/handbook/current

3. PRISMA Transparent Re por ting of Systematic Reviews and Meta-Analysis. PRISMA checklist [Internet]. Available from: http://prisma-statement.org/PRISMAStatement/Checklist.aspx [Cited 2020 Oct 11].

4. Cochrane Handbook: Identifying and measuring heterogeneity [Internet]. Available from: https://h a n d b o o k - 5 - 1 . c o c h r a n e. o r g / c h a p t e r _ 9 / 9 _ 5 _ 2 _identifying_and_measuring_heterogeneity.htm Effectiveness of Saccharomyces boulardii on diarrhea

5. Higgins PT, Green S, Altman GD, et al. Identifying and measuring heterogeneity. In: Green S, Higgins JPT (Eds). Handbook for Systematic Reviews of Interventions Version 5.1.0 [Internet]. The Cochrane Collaboration, 2011. Available from: https://training.cochrane.org/handbook/current

6. Corrêa NB, Penna FJ, Lima FM, Nicoli JR, Filho LA. Treatment of acute diarrhea with Saccharomyces boulardii in infants. J Pediatr Gastroenterol Nutr [Internet]. 2011 Nov; 53(5): 497-501. doi: 10.1097/MPG.0b013e31822b7ab0

7. Asmat S, Shaukat F, Asmat R, Bakhat HFSG, Asmat TM. Clinical efficacy comparison of Saccharomyces boulardii and lactic acid as probiotics in acute pediatric diarrhea. J Coll Phys Surg Pak [Internet]. 2018 Mar; 28(3): 214-7. doi: 10.29271/jcpsp.2018.03.214

8. Htwe K, Yee KS, Tin M, Vandenplas Y. Effect of Saccharomyces boulardii in the treatment of acute watery diarrhea in Myanmar children: A randomized controlled study. Am J Trop Med Hyg [Internet]. 2008 Feb; 78(2):214-6.

9. Dinleyici EC, Kara A, Dalgic N, et al. Saccharomyces boulardii CNCM I-745 reduces the duration of diarrhoea, length of emergency care and hospital stay in children with acute diarrhoea. Benef Microbes [Internet]. 2015;6(4): 415-21. doi: 10.3920/BM2014.0086

10. Vandenplas Y, Brunser O, Szajewska H. Saccharomyces boulardii in childhood. Eur J Pediatr [Internet]. 2009 Mar; 168(3): 253-65. doi: 10.1007/s00431-008-0879-7. Erratum in: Eur J Pediatr [Internet]. 2009 May; 168(5):637.

11. Kurugöl Z, Koturoglu G. Effects of Saccharomyces boulardii in children with acute diarrhoea. Acta Paediatr [Internet]. 2005 Jan; 94(1): 44-7. doi: 10.1111/j.1651-2227.2005. tb01786.x

12. Das S, Gupta PK, Das RR. Efficacy and safety of Saccharomyces boulardii in acute rotavirus diarrhea: Double blind randomized controlled trial from a developing country. J Trop Pediatr [Internet]. 2016 Dec; 62(6): 464-70. doi: 10.1093/tropej/fmw032

13. Riaz M, Alam S, Malik A, Ali SM. Efficacy and safety of Saccharomyces boulardii in acute childhood diarrhea: A double blind randomised controlled trial. Indian J Pediatr [Internet]. 2012 Apr; 79(4): 478-82. doi: 10.1007/s12098-011-0573-z

14. Shan LS, Hou P, Wang ZJ, et al. Prevention and treatment of diarrhoea with Saccharomyces boulardii in children with acute lower respiratory tract infections. Benef Microbes [Internet]. 2013 Dec; 4(4): 329-34. doi: 10.3920/BM2013.0008

15. Canani RB, Cirillo P, Terrin G, et al. Probiotics for treatment of acute diarrhoea in children: Randomised clinical trial of five different preparations. BMJ [Internet]. 2007 Aug; 335(7615): 340. doi: 10.1136/bmj.39272.581736.55

16. Grandy G, Medina M, Soria R, Terán CG, Araya M. Probiotics in the treatment of acute rotavirus diarrhoea. A randomized, double-blind, controlled trial using two different probiotic preparations in Bolivian children. BMC Infect Dis [Internet]. 2010 Aug; 10:253. doi:10.1186/1471-2334-10-253

17. G ua r ne r F, Kha n AG, G a risc h J, e t a l . Wor ld Gastroenterology Organisation Global Guidelines: Probiotics and Prebiotics October 2011. J Clin Gastroenterol [Internet]. 2012 Jul; 46(6): 468-81. doi:10.1097/MCG.0b013e3182549092

18. Drug search for Saccharomyces boulardii Philippines. [Internet]. Available from: https://www.mims.com/philippines/drug/search?q=saccharomyces+boulardii

19. Herbrecht R, Nivoix Y. Saccharomyces cerevisiae fungemia: An adverse effect of Saccharomyces boulardii probiotic administration. Clin Infect Dis [Internet]. 2005 Jun;40(11): 1635-7. doi: 10.1086/429926

20. Hennequin C, Kauffmann-Lacroix C, Jobert A, et al. Possible role of catheters in Saccharomyces boulardii fungemia. Eur J Clin Microbiol Infect Dis [Internet]. 2000 Jan; 19(1): 16-20. doi: 10.1007/s100960050003

21. Szajewska H, Skórka A, Dylag M. Meta-analysis: Saccharomyces boulardii for treating acute diarrhoea inchildren. Aliment Pharmacol Ther [Internet]. 2007 Feb;25(3): 257-64. doi: 10.1111/j.1365-2036.2006.03202.x

22. Feizizadeh S, Salehi-Abargouei A, Akbari V. Efficacy and safety of Saccharomyces boulardii for acute diarrhea. Pediatrics [Internet]. 2014 Jul; 134(1): e176-e191. doi: 10.1542/peds.2013-3950

23. Billoo AG, Memon MA, Khaskheli SA, et al. Role of a probiotic (Saccharomyces boulardii) in management and prevention of diarrhea. World J Gastroenterol [Internet]. 2006 Jul 28; 12(28): 4557-60. doi: 10.3748/wjg.v12.i28.4557

24. Villarruel G, Rubio DM, Lopez F, et al. Saccharomyces boulardii in acute childhood diarrhoea: A randomized,placebo-controlled study. Acta Paediatr [Internet]. 2 0 0 7 A p r ; 9 6 ( 4 ) : 5 3 8 - 4 1 . d o i : 1 0 . 1 1 1 1 / j . 1 6 5 1 -2227.2007.00191.x

25. Sheele J, Cartowski J, Dart A, et al. Saccharomyces boulardii and bismuth subsalicylate as low-cost interventions to reduce the duration and severity of cholera. Pathog Glob Health [Internet]. 2015 Sep; 109(6): 275-82. doi: 10.1179/2047773215Y.0000000028

26. Blehaut H, Massot J, Elmer GW, Levy RH. Disposition kinetics of Saccharomyces boulardii in man and rat. Biopharm Drug Dispos [Internet]. 1989 Jul-Aug;10(4):353-64. doi: 10.1002/bdd.2510100403

27. Zbinden R. Inhibition of Saccharomyces boulardii (nom. inval.) on cell invasion of Salmonella typhimurium and Yersinia enterocolitica. Microb Ecol Health Dis 1999; 11(3): 158–62.

28. Czerucka D, Nano JL, Bernasconi P, Rampal P. Ré ponse a` la toxine chole rique de deux ligne es de cellules e pithe liales intestinales. Effet de Saccharomyces boulardii. Gastroenterol Clin Biol 1989; 13: 383–7.

29. Pothoulakis C, Kelly CP, Joshi MA, et al. Saccharomyces boulardii inhibits Clostridium difficile toxin A binding and enterotoxicity in rat ileum. Gastroenterology [Internet]. 1993 Apr; 104(4): 1108-15. doi: 10.1016/0016-5085(93)90280-p

30. Czer ucka D, Rampal P. Experimental effects of Saccharomyces boulardii on diarrhoeal pathogens. Microbes Infect [Internet]. 2002 Jun; 4(7): 733-9. doi: 10.1016/s1286-4579(02)01592-7́́́́ Effectiveness of Saccharomyces boulardii on diarrhea

31. Czerucka D, Dahan S, Mograbi B, Rossi B, Rampal P. Saccharomyces boulardii preserves the barrier function and modulates the signal transduction pathway induced in enteropathogenic Escherichia coli-infected T84 cells. Infect Immun [Internet]. 2000 Oct; 68(10): 5998-6004. doi: 10.1128/IAI.68.10.5998-6004.2000

32. Geyik MF, Aldemir M, Hosoglu S, et al. The effects of Saccharomyces boulardii on bacterial translocation in rats with obstructive jaundice. Ann R Coll Surg Engl [Internet]. 2006 Mar; 88(2): 176–80. doi: 10.1308/003588406X94986

33. Buts JP, Bernasconi P, Vaerman JP, Dive C. Stimulation o f s e c r e t o r y I g A a n d s e c r e t o r y c o m p o n e n t o f immunoglobulins in small intestine of rats treated with Saccharomyces boulardii. Dig Dis Sci [Internet]. 1990 Feb;35(2): 251-6. doi: 10.1007/BF01536771

34. Buts JP, De Keyser N, De Raedemaeker L. Saccharomyces boulardii enhances rat intestinal enzyme expression by endoluminal release of polyamines. Pediatr Res [Internet]. 1994 Oct; 36(4): 522-7. doi: 10.1203/00006450-199410000-00019

35. Sougioultzis S, Simeonidis S, Bhaskar KR, et al. Saccharomyces boulardii produces a soluble anti- inflammatory factor that inhibits NF-kappa B-mediated IL-8 gene expression. Biochem Biophys Res Commun [Internet]. 2006 Apr 28; 343(1): 69-76. doi: 10.1016/j.bbrc.2006.02.080 Effectiveness of Saccharomyces boulardii on diarrhea