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Questions remain, more research needed on clinical use of probiotics

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WASHINGTON — Clinical use of probiotics is not ready for primetime, as limited and inconsistent data warrant further research, Eamonn Quigley, MD, said during a presentation at Digestive Disease Week 2015.

“For the consumer, quality control [of probiotics] remains a real issue,” Quigley, medical director of the Lynda K. and David M. Underwood Center for Digestive Disorders at Houston Methodist Hospital, said.

Eamonn Quigley

Previously, a Cochrane meta-analysis suggested that probiotics reduced diarrhea in certain populations. Results indicated that probiotics reduced the mean duration of diarrhea in children by about 1 day. In other studies, the incidence of antibiotic-associated diarrhea was reduced in nursing home patients.

“Unfortunately, this hasn’t panned out in other studies,” Quigley said.

Other research has demonstrated marginal effects or no effects of probiotics for other diseases and conditions, including inflammatory bowel disease, irritable bowel syndrome and liver disease, according to Quigley; though certain specific strains show promise for very specific indications. 

In addition, clinical data are lacking in human populations in many areas. Most research on probiotics has been conducted in animal models. One issue with relying on data derived from animal models is that animals are usually tested with much higher doses compared with humans, Quigley said.

“If you go to the supermarket and look at the probiotics, very few of them have been tested,” he said.

Quigley’s discussion focused on a number of other questions and issues surrounding the clinical use of probiotics, including:

• The duration of viability in relation to a product’s shelf-life.
• The optimal dose of probiotics, as there are very few dose-ranging studies.
• Combinations of cocktails vs. single organisms. “We hear that combinations of cocktails should be better — one is good, two is better, 10 is fantastic — but [are] there any data to support this?” Quigley asked.
• The future of probiotics as dead organisms, genetically modified organisms and other potential avenues.

Quigley concluded that the definition of probiotics as well as prebiotics requires revision and should be characterized in detail through in vitro and in vivo approaches. – by Stephanie Viguers 

For more information: Quigley E. Sp790: You Are What You Eat: Pre and Pro-Biotics. Presented at: Digestive Disease Week; May 15-19, 2015; Washington, D.C.

Disclosures: Quigley reports various financial relationships with Alimentary Health, Forest, Procter and Gamble, Rhythm, Salix, Shire, and Vibrant.

Editor's note: This article was updated on May 28, 2015, with clarifications from the presenter.