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June 9, 2020

AGA does not recommend the use of probiotics for most digestive conditions

New AGA guideline finds that evidence to support use of probiotics to treat digestive diseases is greatly lacking, identifying only three clinical scenarios where current data suggests that probiotics may benefit patients.
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After conducting a detailed review of available literature, AGA has released new clinical guidelines finding that for most digestive conditions there is not enough evidence to support the use of probiotics. This 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.”

Key guideline recommendations:

  • For preterm (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.
  • 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 AGA to make recommendations regarding the use of probiotics to treat C. difficile infection, Crohn’s disease, ulcerative colitis or IBS. For these conditions, AGAsuggests that patients consider stopping probiotics, as there are associated costs and not enough evidence to suggest lack of harm.

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.

Read the AGA Institute guidelines and technical review on the role of probiotics in the management of gastrointestinal diseases to review the complete recommendations.

Resources

On-demand webinar in AGA University

Commentary written by members of the AGA Center for Gut Microbiome Research & Education scientific advisory board: Probiotics: promise, evidence, hope

AGA Clinical Guidelines
Evidence-based recommendations.
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