It is estimated that more than 3.9 million American adults have taken some form of probiotics, with many patients looking to probiotics to improve their gastrointestinal health. However, after a detailed review of available literature, the 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.”

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Learning objectives

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 irritable bowel syndrome (IBS). For these conditions, AGA suggests that patients consider stopping probiotics, as there are associated costs and not enough evidence to suggest lack of harm.
• Well-designed clinical trials will be needed to refine these AGA recommendations on probiotics and to investigate other clinical conditions relevant to gastroenterology.  

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 on the Role of Probiotics in the Management of Gastrointestinal Diseases to review the complete recommendations. 

Faculty

Geoffrey Preidis, MD, PhD
Section of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics
Baylor College of Medicine and Texas Children’s Hospital
Houston, Texas, USA

Grace L. Su, MD, AGAF
Division of Gastroenterology and Hepatology
University of Michigan Ann Arbor, Michigan, USA

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