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.
Saccharomyces boulardii ; Probiotics ; Diarrhea

OBJECTIVE: To study the effectiveness of Saccharomyces boulardii combined with phototherapy in the treatment of hyperbilirubinemia in neonates. METHODS: The neonates with hyperbilirubinemia who were hospitalized from January to December 2018 were enrolled and randomly divided into an observation group (n=61) and a control group (n=63). The neonates in the observation group were treated with phototherapy combined with Saccharomyces boulardii, and those in the control group were treated with phototherapy combined with placebo. Treatment outcomes were compared between the two groups. Fecal samples were collected 72 hours after treatment and 16s rRNA high-throughput sequencing was used to compare the features of gut microbiota between the two groups. RESULTS: There was no significant difference in the total serum bilirubin level between the two groups before treatment (P>0.05). At 24, 48, and 72 hours after treatment, the observation group had a significantly lower level of total serum bilirubin than the control group (P<0.05). Compared with the control group, the observation group had a significantly lower proportion of neonates requiring phototherapy again [20% (12/61) vs 75% (47/63), P<0.05]. Compared with the control group, the observation group had a significantly higher abundance of Bacteroides (P<0.05) and a significantly lower abundance of Escherichia coli and Staphylococcus in the intestine at 72 hours after treatment (P<0.05). CONCLUSIONS In neonates with hyperbilirubinemia, phototherapy combined with Saccharomyces boulardii can effectively reduce bilirubin level and prevent the recurrence of jaundice. Saccharomyces boulardii can favour the treatment outcome by regulating the gut microbiota of neonates.
Humans ; Hyperbilirubinemia ; Hyperbilirubinemia, Neonatal/therapy* ; Infant, Newborn ; Phototherapy ; Prospective Studies ; RNA, Ribosomal, 16S ; Saccharomyces boulardii