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lüll Systematic review and meta-analysis of Saccharomyces boulardii in adult patients McFarland LVWorld J Gastroenterol 2010[May]; 16 (18): 2202-22This article reviews the evidence for efficacy and safety of Saccharomyces boulardii (S. boulardii) for various disease indications in adults based on the peer-reviewed, randomized clinical trials and pre-clinical studies from the published medical literature (Medline, Clinical Trial websites and meeting abstracts) between 1976 and 2009. For meta-analysis, only randomized, blinded controlled trials unrestricted by language were included. Pre-clinical studies, volunteer studies and uncontrolled studies were excluded from the review of efficacy and meta-analysis, but included in the systematic review. Of 31 randomized, placebo-controlled treatment arms in 27 trials (encompassing 5029 study patients), S. boulardii was found to be significantly efficacious and safe in 84% of those treatment arms. A meta-analysis found a significant therapeutic efficacy for S. boulardii in the prevention of antibiotic-associated diarrhea (AAD) (RR = 0.47, 95% CI: 0.35-0.63, P < 0.001). In adults, S. boulardii can be strongly recommended for the prevention of AAD and the traveler's diarrhea. Randomized trials also support the use of this yeast probiotic for prevention of enteral nutrition-related diarrhea and reduction of Helicobacter pylori treatment-related symptoms. S. boulardii shows promise for the prevention of C. difficile disease recurrences; treatment of irritable bowel syndrome, acute adult diarrhea, Crohn's disease, giardiasis, human immunodeficiency virus-related diarrhea; but more supporting evidence is recommended for these indications. The use of S. boulardii as a therapeutic probiotic is evidence-based for both efficacy and safety for several types of diarrhea.|*Saccharomyces/classification[MESH]|Adult[MESH]|Anti-Bacterial Agents/adverse effects[MESH]|Contraindications[MESH]|Diarrhea/etiology/prevention & control[MESH]|Enteral Nutrition/adverse effects[MESH]|Evidence-Based Medicine[MESH]|Humans[MESH]|Intestinal Diseases/etiology/prevention & control[MESH]|Intestines/microbiology[MESH]|Practice Guidelines as Topic[MESH]|Probiotics/adverse effects/*therapeutic use[MESH]|Travel[MESH]|Treatment Outcome[MESH] |