Updated Probiotic Guidelines

With many probiotic products on the market and a rising trend in consumption,  an increasing number of people are taking probiotic supplements for their purported positive effects. These tangible health benefits have been contested by the medical community, as there is not enough human-based clinical data to support their efficacy in the treatment of a variety of conditions. Making strong recommendations to patients is difficult at this stage due to the lack of research, however, probiotics are viewed as generally well-tolerated and considered safe. Upcoming guidelines from the American Gastroenterological Association (AGA) hope to elucidate the issues related to probiotic supplementation and will be the first clinical recommendations to clarify specific indications for probiotics.

Upcoming Probiotic Guidelines for Treatment

Draft guidelines were presented at Digestive Disease Week 2019, naming the live organisms that could be used to prevent certain health conditions. The AGA recommends the use of specific probiotic strains for the prevention of antibiotic-related Clostridium difficile infections and necrotizing enterocolitis in preterm infants as well as the treatment of pouchitis. The guidelines advise against the use of probiotics in pediatric patients with acute infectious gastroenteritis and maintain the need for caution in prescribing these supplements, particularly for immunocompromised patients.

While research into the microbiome and potential health benefits of probiotics continues, these recommendations aim to educate patients and health practitioners on the safe treatment protocols. According to the AGA, these guidelines are conditional due to a lack of sufficient clinical evidence. The recommendation that patients taking antibiotics supplement with specific probiotics for C difficile prevention as well as the recommendation of the use of multispecies probiotics to treat pouchitis are both conditional because of the low quality of evidence. Although there is higher quality evidence for the suggested use of specific probiotics for the prevention of necrotizing enterocolitis in preterm infants, researchers maintain this recommendation is also conditional.

To ensure the forthcoming recommendations are accurate despite scant evidence, the AGA is conducting a thorough technical review and plans a public comment period in the fall before they are finalized.

Problems with Probiotics

Researchers continue to analyze different live organisms and their combinations for the prevention and treatment of various conditions, while probiotic products are widely accessible for population use. Although they are considered safe and carry few adverse effects, their purported health benefits remain in question. While many probiotic preparations have successfully treated models of human diseases in animals, few have shown significant results in humans.

The disconnect may be related to a misunderstanding of the microbiome and the lack of knowledge about the mechanism of action for organisms affecting specific diseases, according to researchers. Previous studies have largely focused on bacteria in fermented foods, meanwhile, intestinal organisms have yet to be analyzed. Additionally, research implicates live organisms may need to be paired with other organisms in order to achieve their supposed effect. Ideal combinations of bacteria strains may vary based on their effect on different diseases.

As further research into the benefits of probiotics and their efficacy at treating and preventing certain health conditions is conducted, clinicians can follow the updated probiotic guidelines to determine the course of treatment. Until ideal combinations for treatment are identified and probiotic efficacy is proven, the AGA recommends a cautious approach to probiotic therapy.