New AGA guideline critical of probiotic use in clinical settings

The American Gastroenterological Association (AGA) released new clinical guidelines, stating for most digestive conditions there is not enough evidence to support the use of probiotics, according to the report published in the journal  Gastroenterology.

In developing the guidelines, the AGA said it used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate the available evidence on clinical efficacy of probiotics. The guidelines supports use of certain probiotic formulations in three settings: for the prevention of Clostridioides difficile (C. difficile) infection in adults and children taking antibiotics; for the prevention of necrotizing enterocolitis in preterm, low birthweight infants; and for the management of pouchitis, a complication of inflammatory bowel disease.

According to the organization, there was insufficient evidence to recommend probiotics for treatment of Crohn's disease, ulcerative colitis, irritable bowel syndrome, and C. difficile infection. For acute infectious gastroenteritis in children, the AGA recommends against the use of probiotics, the report said.

Other guideline recommendations include:

• For preterm (born before 37 weeks), low birthweight (less than 2,500 grams) 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.
• Certain probiotics 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.
• 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.
• There was insufficient evidence for the AGA to make recommendations regarding the use of probiotics to treat C. difficile infection, Crohn's disease, ulcerative colitis, or irritable bowel syndrome. For these conditions, the AGA suggests that patients consider stopping probiotics, as there are associated costs and not enough evidence to suggest lack of harm.
• Well-designed clinical trials will be needed to refine these AGA recommendations on probiotics and to investigate other clinical conditions relevant to gastroenterology.

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, the authors said.