Role of Probiotics in the Management of Gastrointestinal Disorders

Publication Date: June 9, 2020

Recommendations 

Treatment

In patients with C difficile infection, we recommend the use of probiotics only in the context of a clinical trial. (Evidence Gap, No recommendation)
612
In adults and children on antibiotic treatment, we suggest the use of S boulardii; or the 2-strain combination of L acidophilus CL1285 and L casei LBC80R; or the 3-strain combination of L acidophilus, L delbrueckii subsp bulgaricus, and B bifidum; or the 4-strain combination of L acidophilus, L delbrueckii subsp bulgaricus, B bifidum, and S salivarius subsp thermophilus over no or other probiotics for prevention of C difficile infection. (Low, Conditional (weak))
Comment: Patients who place a high value on the potential harms (particularly those with severe illnesses) or a high value on avoiding the associated cost and a low value on the small risk of C difficile development (particularly in the outpatient setting), would reasonably select no probiotics.
612
In adults and children with Crohn’s disease, we recommend the use of probiotics only in the context of a clinical trial. (Evidence Gap, No recommendation)
612
In adults and children with ulcerative colitis, we recommend the use of probiotics only in the context of a clinical trial.
612
In adults and children with pouchitis, we suggest the 8-strain combination of L paracasei subsp paracasei, L plantarum, L acidophilus, L delbrueckii subsp bulgaricus, B longum subsp longum, B breve, B longum subsp infantis, and S salivarius subsp thermophilus over no or other probiotics. (Very Low, Conditional (weak))
Comment: Patients for whom the feasibility and cost of using this combination of bacterial strain is problematic may reasonably select no probiotics.
612
In symptomatic children and adults with irritable bowel syndrome, we recommend the use of probiotics only in the context of a clinical trial. (Evidence Gap, No recommendation)
612
In children with acute infectious gastroenteritis, we suggest against the use of probiotics. (Moderate, Conditional (weak))
612
In preterm (less than 37 weeks gestational age), low-birth-weight infants, we suggest using a combination of Lactobacillus spp and Bifidobacterium spp (L rhamnosus ATCC 53103 and B longum subsp infantis; or L casei and B breve; or L rhamnosus, L acidophilus, L casei, B longum subsp infantis, B bifidum, and B longum subsp longum; or L acidophilus and B longum subsp infantis; or L acidophilus and B bifidum; or L rhamnosus ATCC 53103 and B longum Reuter ATCC BAA-999; or L acidophilus, B bifidum, B animalis subsp lactis, and B longum subsp longum), or B animalis subsp lactis (including DSM 15954), or L reuteri (DSM 17938 or ATCC 55730), or L rhamnosus (ATCC 53103 or ATC A07FA or LCR 35) for prevention of NEC over no and other probiotics. (-, Conditional (weak))
(Moderate/high)
612

Recommendation Grading

Disclaimer

Overview

Title

Role of Probiotics in the Management of Gastrointestinal Disorders

Authoring Organization

Publication Month/Year

June 9, 2020

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory

Intended Users

Physician, dietician nutritionist, nurse, nurse practitioner, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D019936 - Probiotics

Keywords

irritable bowel syndrome (IBS), Clostridioides difficile, Necrotizing Enterocolitis, Probiotics, Gastrointestinal Disorder, Infectious gastroenteritis, Lactobacillus plantarum, Lactobacillus acidophilus

Supplemental Methodology Resources

Technical Review