AGA Releases New Guidelines for Probiotic Use in Gastroenterology

Grace L. Su, MD

The American Gastroenterology Association (AGA) has released new guidelines calling for the use of certain probiotics in some circumstances, while recommending against their use for other situations.

A team, led by Grace L. Su, MD, Division of Gastroenterology and Hepatology, University of Michigan, have released new clinical guidelines for the relationship between the use of probiotics and gastrointestinal conditions.

The investigators found after reviewing the literature currently available using the GRADE method that there is not enough evidence that support the use of probiotics for the majority of digestive conditions, including Crohn’s disease, ulcerative colitis, irritable bowel syndrome (IBS), and Clostridioides difficile (C. difficile) infections.

"Patients taking probiotics for Crohn's, ulcerative colitis or IBS should consider stopping," guideline panel chair Su said in a statement. "The supplements can be costly and there isn't enough evidence to prove a benefit or confirm lack of harm. Talk with your doctor."

However, the investigators support the use of certain probiotic formulations for the prevention of 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.

The investigators also recommend against the use of probiotics for acute infectious gastroenteritis in pediatric patients.

The recommendations also including using specific probiotics for preterm and low birthweight infants to prevent mortality and necrotizing enterocolitis, reducing the number of days required to research full feeds, and decrease the duration of hospitalization.

To prevent C. difficile infections for both adults and children who take antibiotics, certain probiotics should be considered. These probiotics should also be used for the management of pouchitis, a complication of ulcerative colitis that has been treated surgically in the past.

The investigators also discovered that probiotics do not show any benefit for children in North America who have acute gastroenteritis and should not be given to children who present to the emergency room because of diarrhea.

"While our guideline does highlight a few use cases for probiotics, it more importantly underscores that the public's assumptions about the benefits of probiotics are not well-founded, and that there is also a major variation in results based on the formulation of the probiotic product," Su said.

Currently, experts estimate 3.9 million individuals in the US have taken some form of probiotics, with many looking to take probiotics in an effort to improve gastrointestinal health.

The new AGA guidelines represent the first set of clinical guidelines that focus on probiotics across multiple gastrointestinal disease, while also focusing on the effect of each single-strain or multi-strain formulation of probiotics independently, rather than grouping them all as “probiotics.”

The guideline panel chair recommends well-designed clinical trials to refine the new AGA recommendations on probiotics while investigating other clinical conditions relevant to gastroenterology.

In recent months, the AGA has updated several different clinical guidelines in the wake of the coronavirus disease 2019 (COVID-19) pandemic, including new guidelines for ulcerative colitis, IBD, gastrointestinal and liver manifestations, and for gastroenterologists in general for dealing with new safety protocols during the pandemic.

The study, “AGA Clinical Practice Guidelines on the Role of Probiotics in the Management of Gastrointestinal Disorders,” was published online in Gastroenterology.