Efficacy of synbiotic, probiotic, and prebiotic treatments for irritable bowel syndrome in children: A systematic review and meta-analysis

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder in children, characterized by recurrent abdominal pain and altered bowel habits. It is associated with impaired quality of life and school performance. Increasing evidence suggests that gut microbiota dysbiosis plays an important role in the pathophysiology of pediatric IBS, leading to growing interest in microbiome-targeted therapies such as probiotics, prebiotics, and synbiotics. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of these interventions in children and adolescents with IBS. A comprehensive search of PubMed and Google Scholar was conducted for studies published up to 2024, including randomized controlled trials (RCTs) and other controlled studies involving participants aged 1–18 years diagnosed with IBS. The primary outcome was improvement in abdominal pain severity and frequency, while secondary outcomes included changes in bowel habits, bloating, quality of life, and adverse events. Thirteen studies involving 1169 participants met the inclusion criteria, comprising ten RCTs and three controlled clinical studies. Probiotic interventions, particularly Lactobacillus rhamnosus GG, Lactobacillus reuteri DSM 17938, and multistrain formulations such as VSL#3, showed modest to significant improvements in abdominal pain and stool consistency. Prebiotic therapies, including galacto-oligosaccharides and partially hydrolyzed guar gum, were mainly associated with improved stool regularity and reduced bloating, with limited effects on pain reduction. Synbiotic interventions consistently demonstrated the most favorable outcomes, improving multiple symptom domains and quality-of-life measures. Meta-analysis of eight studies revealed a significant pooled effect favoring microbiome-targeted interventions over placebo, despite substantial heterogeneity across studies.