AGA does not recommend probiotics for most GI conditions
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In newly issued guidelines, the American Gastroenterological Association did not recommend using probiotics for most digestive conditions.
The society said there was insufficient evidence to make recommendations on the use of probiotics to treat Clostridioides difficile infection, Crohn’s disease, ulcerative colitis or irritable bowel syndrome. If patients with any of these conditions are taking probiotics, the AGA suggested that they stop due to associated costs and lack of evidence concerning potential harm.
Geoffrey A. Preidis, MD, PhD, of Texas Children’s Hospital told Healio Gastroenterology that specific probiotics should be considered for three groups of patients who typically do not receive them; low birthweight infants, adults and children taking antibiotics to prevent C. difficile infection and patients with pouchitis.
“On the other hand, probiotics are prescribed to many children with acute gastroenteritis, but recent data indicate probiotics are not beneficial and should not be used in this context,” he said. “Finally, some clinicians recommend probiotics for other GI conditions, including C. difficile infection, Crohn’s disease, ulcerative colitis or irritable bowel syndrome, but until additional trials are conducted, there is not enough evidence to recommend probiotics in these settings.”
The AGA recommended specific antibiotic strains for each suggested treatment. Preidis said it is important for patients to remember that not all probiotic strains are the same, and even different strains of the same species can have very different effects.
“Patients should be skeptical when reading product labels,” he said. “Many health claims are not supported by solid data. Probiotic strains, doses, viability and additional ingredients might not match what is advertised, and formulations might differ from batch to batch.”
The AGA found that there is still a significant knowledge gap in the area of probiotics but believes is remains an important topic for research. A lack of consistent harms reporting and product manufacturing details limit understanding of probiotics, and future research will have to address these hurdles, according to the guidelines.
Preidis encouraged patients to consult with their doctors before starting a probiotic regimen and said GIs should be prepared to help patients make decisions on whether or not to start probiotics.
“Potential benefits should be weighed against undesirable consequences, including the risk for side effects and the burden of adherence to therapy,” he said. “For some patients, the feasibility of obtaining – and the cost of purchasing – a specific probiotic will outweigh the potential benefits.”
Perspective
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Miguel Regueiro, MD
The AGA guidelines on probiotic use is important and a necessary piece regarding advancing the evidence-based understanding of probiotics for GI diseases. I support the guidelines, and they are reasonable. Probiotics are used frequently in this country whether over the counter or recommended for an ailment. A lot of my patients take them; maybe 50% at some point are actively taking probiotics. And, many of my patients have Crohn’s disease or ulcerative colitis. The guidelines and their specific uses from an evidence-based standpoint include pre-term and underweight newborns to prevent a condition known as necrotizing enterocolitis, the prevention of C. diff., and pouchitis after a proctocolectomy for ulcerative colitis. Those three clinical scenarios make sense.
There are a lot of unmet needs patients have so they may turn to probiotics. There are patients looking for treatments they think are safe to care for their ailments. The AGA guidelines are important because probiotics are overused and, while generally safe, it is good the AGA is taking an evidence-based approach. From a patient standpoint the guidelines may come as a surprise because so many people take probiotics and are so interested in taking them.
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