World Gastroenterology OrganisationGastroenterology2023advanced

Probiotics and Prebiotics

Published by World Gastroenterology Organisation · The Oxford 2011 Levels of Evidence

181References

10Tables

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Summary

AI-generated

This guideline reviews the history, definitions, mechanisms of action, product safety, and commercial marketplace of probiotics and prebiotics, and outlines the clinical evidence for their applications in specific gastrointestinal diseases.

probioticsprebioticsWGOgastroenterologyguidelinesrecommendationsacute diarrheaantibiotic-associated diarrhea

Key Takeaways

1
The effects of probiotics are highly strain-specific and dose-specific.
2
Strain designations for probiotics are important to link clinical benefits to specific products.
3
Clinical efficacy for probiotics is strongest in gastrointestinal conditions such as acute diarrhea, antibiotic-associated diarrhea, and necrotizing enterocolitis.
4
Use of probiotics in persons with compromised immune function or serious underlying disease should be restricted to proven safe strains.
5
Prebiotics function by modulating resident microbiota to elicit a health benefit, primarily by enhancing beneficial bacteria.

Key Recommendations

3.2.1 Treatment of acute diarrhea

rec_1
Some probiotic strains are useful in reducing the severity and duration of acute infectious diarrhea in children. Oral administration shortens the duration of acute diarrheal illness in children by approximately 1 day.
Evidence: Step 1Treatment

3.2.3 Prevention of antibiotic-associated diarrhea

rec_2
Probiotics may provide a moderate effect for preventing antibiotic-associated diarrhea in children, adults, and elderly adults.
Evidence: Step 1Prevention

3.2.4 Prevention of C. difficile diarrhea

rec_3
Probiotics are effective for preventing C. difficile-associated diarrhea in patients receiving antibiotics. Probiotic use in patients who are not immunocompromised or severely debilitated appears to be safe.
Evidence: Step 2Prevention

3.4 Hepatic encephalopathy prevention and treatment

rec_4
Prebiotics such as lactulose are commonly used for the prevention and treatment of hepatic encephalopathy.
Evidence: Step 1Treatment/Prevention

3.10 Necrotizing enterocolitis

rec_5
Probiotic supplementation reduces the risk of necrotizing enterocolitis in preterm neonates.
Evidence: Step 1Prevention

Scope & Objectives

Clinical Topic

Gastroenterology

Objectives

To provide a general overview of clinical efficacy and summarize evidence for probiotics and prebiotics in adult and pediatric gastrointestinal conditions.

Target Patient Population

Adult and pediatric patients with gastrointestinal conditions

Patient Criteria & Setting

Therapeutic Area

Gastrointestinal Conditions

Guideline Scope

TreatmentPrevention

Special Populations

ElderlyInfantsPreterm neonates

Evidence Grading

System: The Oxford 2011 Levels of Evidence

Evidence Levels

Step 1Systematic review of randomized trials

Step 2Randomized trials with consistent effect, without systematic review

Step 3Supported by a single randomized controlled trial

Step 4Case-series, case-control studies, or historically controlled studies

Step 5Mechanism-based reasoning

Safety & Contraindications

Contraindications

Persons with compromised immune function or serious underlying disease (restricted to specific proven strains)

Authors & Contributors

Francisco GuarnerMary Ellen SandersHania SzajewskaHenry CohenRami EliakimClaudia HerreraTarkan KarakanDan MerensteinAlejandro PiscoyaBalakrishnan RamakrishnaSeppo Salminen

Guideline Features

Dosing information

Learning Context

Difficulty

advanced

Learning Paths

ProbioticsPrebioticsGastroenterologyMicrobiomeGut HealthClinical Efficacy