Probiotics and prebiotics

February 2023

Review Team

Francisco Guarner (Chair, Spain)
Mary Ellen Sanders (Co-Chair, USA)
Hania Szajewska (Co-Chair, Poland)

Henry Cohen (Uruguay)
Rami Eliakim (Israel)
Claudia Herrera (Guatemala)
Tarkan Karakan (Turkey)
Dan Merenstein (USA)
Alejandro Piscoya (Peru)
Balakrishnan Ramakrishna (India)
Seppo Salminen (Finland)

1. Probiotics and prebiotics—the concept

2. Products, health claims, and commerce

3. Clinical applications

4. Summaries of evidence for probiotics and prebiotics in adult and pediatric conditions—the global picture

5. References

We have comprehensively evaluated the evidence for gastrointestinal conditions. Table 7 lists the criteria used to establish the level of evidence.

Tables 8 and 9 summarize a number of gastrointestinal conditions for which there is evidence from at least one well-designed clinical trial that oral administration of a specific probiotic strain or a prebiotic is effective. The purpose of these tables is to inform the reader about the existence of studies that support the efficacy and safety of the products listed, as some other products on sale in the market may not have been tested. The column headed “Comments” includes the most recent (2020–2022) recommendations from major pediatric gastroenterology societies such as the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the American Gastroenterological Association.

For Tables 8 and 9, probiotics had to be described by genus, species, and strain designations in studies reporting the benefit. If the strain was not given, the strain designation was not included. Only positive studies (i.e., studies showing statistically significant results for its main outcome) were included. Negative (null) studies were not included (i.e., studies in which the results for the main outcome were not statistically significant). For each condition, a list of the probiotic strains or prebiotics found to have a beneficial effect is presented.

For clinical decisions, however, only evidence related to a specific probiotic strain and/or prebiotic is relevant. Each study should be considered within the context of the totality of the relevant evidence. The risk of bias in the included trials was not assessed.

The list may not be complete, as the publication of new studies is ongoing. Locally, other probiotics and/or prebiotics evaluated in randomized controlled trials (RCTs) may be available. The level of evidence may vary among the different indications. Doses shown are those used in the RCTs. The order of the products listed is random.

There is no evidence from comparative studies to rank the products in terms of efficacy. The tables do not provide grades of recommendation, but only levels of evidence according to evidence-based medicine criteria.

 

LEGGI TUTTO https://www.worldgastroenterology.org/guidelines/probiotics-and-prebiotics/probiotics-and-prebiotics-english