Probiotics: American Gastroenterological Association (AGA) Issues New Guidelines Not Supporting The Use of Probiotics For Many Digestive Conditions
: After a careful review and analysis of all available research publications and reports, the American Gastroenterological Association (AGA) has released new clinical guidelines that state for most digestive conditions there is not enough evidence to support the use of probiotics.
The AGA publication is the first clinical guideline to focus on probiotics across multiple GI diseases while also considering the effect of each single-strain or multi-strain formulation of probiotics independently instead of grouping them all under the single umbrella of "probiotics."
These new guidelines are published in Gastroenterology
, AGA's official journal. https://www.gastrojournal.org/article/S0016-5085(20)34729-6/fulltext
The AGA guideline supports use of certain probiotic formulations in only three settings:
1. For the prevention of Clostridioides difficile (C. difficile) infection in adults and children taking antibiotics,
2. For the prevention of necrotizing enterocolitis in preterm, low birthweight infants,
3. For the management of pouchitis, a complication of inflammatory bowel disease.
However there was insufficient evidence to recommend probiotics for treatment of Crohn's disease, ulcerative colitis, irritable bowel syndrome (IBS) and C. difficile infection.
Importantly for acute infectious gastroenteritis in children, AGA recommends against the use of probiotics.
Dr Grace L. Su, a Professor of Gastroenterology from the University of Michigan, Ann Arbor and the Chairwoman of the panel drafting the guidelines told Thailand Medical News, “Patients taking probiotics for Crohn’s Disease, Ulcerative Colitis or Irritable Bowel Syndrome (IBS) should consider stopping it immediately. The supplements can be costly and there is not enough evidence to prove a benefit or confirm lack of harm. Talk with gastroenterologist.”
Considering the widespread use and often biased sources of information, it is essential that the public have objective guidance about the appropriate use of and indications for probiotics.
In the United States itself, it is estimated that more than 3.9 million adults have taken some form of probiotics, with many patients looking to probiotics to improve their gastrointestinal health. Globally the numbers are much more especially in countries like Japan, China, South Korea, Taiwan and Vietnam where interestingly the incidences of digestive cancers and diseases are extremely high.
The American Gastroenterological Association employed the gold-standard for guideline development, GRADE methodology, to evaluate the available evidence on clinical efficacy of probiotics.
Dr Su added, "While our guideline does highlight a few use cases for probiotics, it more importantly underscores that the public's assumptions about the benefits of probiotics are not well-founded, and that there is also a major variation in results based on the formulation of the probiotic product.”
Among some of the key guideline recommendations are:
-In the case of preterm infants (born before 37 weeks), low birthweight (< 2500 g) infants, specific probiotics can prevent mortality and necrotizing enterocolitis, reduce the number of days required to reach full feeds, and decrease the duration of hospitalization.
-Only certain probiotics of specific formulations should be considered for the prevention of C. difficile infection in adults and children who take antibiotics and for the management of pouchitis, a complication of ulcerative colitis that has been treated surgically.
-It was warned that probiotics do not appear to be beneficial for children in North America who have acute gastroenteritis they should not be given routinely to children who present to the emergency room due to diarrhea.
-To date there was insufficient evidence for AGA to make recommendations regarding the use of probiotics to treat C. difficile infection, Crohn's disease, ulcerative colitis or IBS. For these conditions, AGA suggests that patients consider stopping probiotics, as there are associated costs and not enough evidence to suggest lack of harm.
-Future well-designed clinical trials will be needed to refine these AGA recommendations on probiotics and to investigate other clinical conditions relevant to gastroenterology.
Doctors and gastroenterologists should suggest the use of probiotics to their patients only if there is clear benefit and should recognize that the effects of probiotics are not species-specific, but strain- and combination-specific.
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