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Guideline

Role of probiotics in the management of gastrointestinal disorders

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Find out if probiotics are recommended, and if so what strains, for specific GI conditions. This guideline covers C. difficile infection, adults and children on antibiotic treatment, Crohn’s disease, ulcerative colitis, pouchitis, irritable bowel syndrome (IBS), acute infectious gastroenteritis, and preterm/low-birth-weight infants.

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Recommendations

1. In patients with C. difficile infection, we recommend the use of probiotics only in the context of a clinical trial.

2. In adults and children on antibiotic treatment, we suggest the use of S boulardii; or the two-strain combination of L acidophilus CL1285 and L casei LBC80R; or the three-strain combination of L acidophilus, L delbrueckii subsp bulgaricus, and B bifidum; or the four-strain combination of L acidophilus, L delbrueckii subsp bulgaricus, B bifidum, and S salivarius subsp thermophilus over no or other probiotics for prevention of C. difficile infection.

3. In adults and children with Crohn’s disease, we recommend the use of probiotics only in the context of a clinical trial.

4. In adults and children with ulcerative colitis, we recommend the use of probiotics only in the context of a clinical trial.

5. In adults and children with pouchitis, we suggest the eight-strain combination of L paracasei subsp paracasei, L plantarum, L acidophilus, L delbrueckii subsp bulgaricus, B longum subsp longum, B breve, B longum subsp infantis, and S salivarius subsp thermophilus over no or other probiotics.

6. In symptomatic children and adults with irritable bowel syndrome, we recommend the use of probiotics only in the context of a clinical trial.

7. In children with acute infectious gastroenteritis, we suggest against the use of probiotics.

8. In preterm (less than 37 weeks gestational age), low-birth-weight infants, we suggest using a combination of Lactobacillus spp and Bifidobacterium spp (L rhamnosus ATCC 53103 and B longum subsp infantis; or L casei and B breve; or L rhamnosus, L acidophilus, L casei, B longum subsp infantis, B bifidum, and B longum subsp longum; or L acidophilus and B longum subsp infantis; or L acidophilus and B bifidum; or L rhamnosus ATCC 53103 and B longum Reuter ATCC BAA-999; or L acidophilus, B bifidum, B animalis subsp lactis, and B longum subsp longum), or B animalis subsp lactis (including DSM 15954), or L reuteri (DSM 17938 or ATCC 55730), or L rhamnosus (ATCC 53103 or ATC A07FA or LCR 35) for prevention of necrotizing enterocolitis over no and other probiotics.

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