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Tutti Psyllium Husk Bifidobacterium lactis Fructooligosaccharides (FOS) Lactobacillus plantarum Peppermint Oil Pancreatic Enzymes (Pancrelipase) Curcumin Vitamin A Medium-Chain Triglycerides (MCT Oil) Galactooligosaccharides (GOS) Lactobacillus gasseri Aloe Vera (Inner Leaf Gel) Alpha-Galactosidase Vitamin D L-Glutamine Inulin Ginger Lactase Berberine Omega-3 Fatty Acids (EPA/DHA) Bovine Colostrum Zinc Bifidobacterium bifidum Butyrate (Sodium/Calcium Butyrate) Bacillus coagulans Saccharomyces boulardii Lactobacillus acidophilus N-Acetyl Cysteine (NAC) Bifidobacterium longum
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Figure 3
Figure 3 Chart

Beta diversity analysis using principal coordinates reveals shifts in overall microbiota community structure following butyrate supplementation. Separation between pre- and post-treatment samples suggests reproducible compositional changes.

Microbiota changes induced by microencapsulated sodium butyrate in patients with inflammatory bowel …

Figure 2
Figure 2 Forest Plot

Forest plot of pooled H. pylori eradication rates demonstrates a modest but statistically significant improvement when probiotics are added to standard antibiotic therapy. Effect sizes vary across individual studies depending on probiotic strains used.

The effect of probiotics supplementation on Helicobacter pylori eradication rates and side …

Figure 3
Figure 3 Forest Plot

Subgroup analysis by probiotic species reveals that Lactobacillus-based preparations and multi-strain combinations show the most consistent benefit for improving eradication rates. Single-strain Saccharomyces boulardii also demonstrates efficacy.

The effect of probiotics supplementation on Helicobacter pylori eradication rates and side …

Figure 4
Figure 4 Forest Plot

Overall side effect incidence is significantly reduced in patients receiving adjunctive probiotic supplementation during H. pylori eradication therapy. Diarrhea, nausea, and abdominal pain are the adverse events most consistently ameliorated.

The effect of probiotics supplementation on Helicobacter pylori eradication rates and side …

Figure 5
Figure 5 Chart

Funnel plot assessment for publication bias in the meta-analysis shows relatively symmetric distribution of studies, suggesting minimal publication bias in the included eradication rate trials.

The effect of probiotics supplementation on Helicobacter pylori eradication rates and side …

Figure 6
Figure 6 Chart

Sensitivity analyses confirm the robustness of the pooled treatment effect, with no single study disproportionately influencing the overall result. Risk of bias assessment across included trials indicates moderate quality evidence.

The effect of probiotics supplementation on Helicobacter pylori eradication rates and side …

Figure 1
Figure 1

The Canadian Association of Gastroenterology clinical practice guideline provides an evidence-based framework for managing irritable bowel syndrome, covering diagnosis, dietary modifications, pharmacological treatments, and psychological interventions.

Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable …

Figure 2
Figure 2 Flowchart

Diagnostic criteria for IBS rely on symptom-based assessment using Rome IV criteria, with limited use of diagnostic tests. Serological screening for celiac disease is recommended as part of the initial evaluation.

Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable …

The consensus group concluded that while studies suggest benefits with probiotic therapies overall, and with combination
Figure 3

Evidence evaluation for probiotic therapies in IBS suggests overall benefit, particularly with combination probiotic preparations. Strain-specific recommendations remain difficult due to heterogeneity in study designs and products evaluated.

Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable …

Figure 4
Figure 4

Dietary interventions for IBS include the low-FODMAP diet, which has demonstrated efficacy in reducing bloating, abdominal pain, and altered bowel habits. A dietitian-guided three-phase approach (restriction, reintroduction, personalization) is recommended.

Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable …

Key evidence: Two RCTs that fulfilled inclusion criteria for this consensus, compared polyethylene glycol 3350 (PEG) and placebo in a total of 181 patients with Rome (II or III) diagnosed IBS-C (165, 166). Compared with placebo, there was a statistically
Figure 5 Chart

Polyethylene glycol 3350 is evaluated for IBS with constipation based on two RCTs totaling 181 patients. Evidence supports its use for improving stool consistency, though effects on abdominal pain are less consistent.

Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable …

Figure 6
Figure 6

Antispasmodic agents including peppermint oil, pinaverium, and trimebutine receive conditional recommendations for IBS symptom management. Evidence quality varies across specific agents.

Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable …

IBS is diagnosed based on symptoms, with limited use of diagnostic tests; however, serological testing is suggested to exclude celiac disease.
Figure 7 Flowchart

An algorithmic approach to IBS management stratifies treatment by predominant bowel habit (IBS-C, IBS-D, IBS-M) and symptom severity. First-line interventions include dietary modification and fiber supplementation.

Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable …

Figure 8
Figure 8

Summary recommendations across all therapeutic categories for IBS are presented with corresponding evidence quality ratings and strength of recommendation. The guideline emphasizes shared decision-making with patients.

Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable …

Figure 5
Figure 5 Forest Plot

Subgroup analyses by peppermint oil formulation (enteric-coated versus non-enteric-coated) reveal that enteric coating may enhance efficacy by delivering the active compound directly to the lower gastrointestinal tract.

The impact of peppermint oil on the irritable bowel syndrome: a meta-analysis …

Figure 9
Figure 9 Chart

Sensitivity analyses excluding high-risk-of-bias studies confirm the robustness of the treatment effect. The benefit of peppermint oil persists regardless of IBS subtype or study quality.

The impact of peppermint oil on the irritable bowel syndrome: a meta-analysis …

Figure 1. Principal co-ordinate analysis (PCoA) of the baseline microbial differences between the two study populations.
Figure 5 Chart

Principal coordinate analysis of baseline microbial communities reveals separation between constipated patients and healthy controls, indicating distinct microbiome configurations associated with chronic constipation.

The Effect of Psyllium Husk on Intestinal Microbiota in Constipated Patients and …

Figure 2. Microbial changes introduced by the psyllium supplementation to the intestinal microbiota of healthy adults.
Figure 6 Chart

Psyllium supplementation alters the intestinal microbiota of healthy adults, with specific increases in Faecalibacterium and other fiber-fermenting taxa. These changes are consistent with enhanced saccharolytic fermentation.

The Effect of Psyllium Husk on Intestinal Microbiota in Constipated Patients and …

Figure 7
Figure 7 Chart

Microbial taxa changes in constipated patients following psyllium supplementation show distinct patterns compared to healthy volunteers. Certain Lachnospiraceae and Ruminococcaceae members increase selectively.

The Effect of Psyllium Husk on Intestinal Microbiota in Constipated Patients and …

Figure 5. Significant associations between acetate and the abundance of microbial taxa in constipated patients.
Figure 8 Chart

Significant associations between fecal acetate concentrations and specific microbial taxa are identified in constipated patients. Higher Lachnospira and Roseburia abundance correlates with increased acetate production.

The Effect of Psyllium Husk on Intestinal Microbiota in Constipated Patients and …

Figure 6
Figure 6 Diagram

Butyrate modulates immune cell function in the gut mucosa, suppressing pro-inflammatory macrophage and dendritic cell activation while promoting regulatory T-cell differentiation. These immunomodulatory effects contribute to intestinal homeostasis.

Gut Microbial Metabolite Butyrate and Its Therapeutic Role in Inflammatory Bowel Disease: …

Figure 7
Figure 7 Diagram

Dietary fiber fermentation pathways in the colon illustrate how complex carbohydrates are sequentially broken down by microbial consortia, ultimately yielding butyrate, propionate, and acetate as primary end products.

Gut Microbial Metabolite Butyrate and Its Therapeutic Role in Inflammatory Bowel Disease: …

Figure 8
Figure 8 Chart

Clinical evidence from intervention studies suggests that butyrate supplementation, either orally or via enema, may reduce disease activity scores in ulcerative colitis patients. Response rates vary across delivery methods and formulations.

Gut Microbial Metabolite Butyrate and Its Therapeutic Role in Inflammatory Bowel Disease: …

Figure 1. Likely mechanisms through which dietary fiber affects the functions of the gastrointestinal tract. Dietary fiber acts as a prebiotic to intestinal microbiota that causes changes in their composition and induces the growth of beneficial bacteria.
Figure 3 Diagram

Dietary fiber acts as a prebiotic for intestinal microbiota, promoting growth of beneficial bacteria and production of short-chain fatty acids. This diagram illustrates multiple mechanisms through which fiber affects gastrointestinal function, including modulation of gut microbiome composition and intestinal barrier integrity.

Dietary fiber in irritable bowel syndrome (Review).

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