Role of Probiotics in the Management of Gastrointestinal Disorders

Publication Date: June 9, 2020
Last Updated: January 19, 2024

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

Overview

Title

Role of Probiotics in the Management of Gastrointestinal Disorders

Authoring Organization

American Gastroenterological Association

Publication Month/Year

June 9, 2020

Last Updated Month/Year

November 5, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

This document presents the official recommendations of the American Gastroenterological Association (AGA) on the role of probiotics in the management of gastrointestinal disorders. The guideline was developed by the AGA Institute's Clinical Guidelines Committee and approved by the AGA Governing Board. It is accompanied by a technical review that provides a detailed synthesis of the evidence from which these recommendations were formulated.

Target Patient Population

Patients with gastrointestinal disorders

Inclusion Criteria

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

Health Care Settings

Ambulatory

Intended Users

Dietician nutritionist, nurse, nurse practitioner, physician, 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

Source Citation

Grace L. Su, Cynthia W. Ko, Premysl Bercik, Yngve Falck-Ytter, Shahnaz Sultan, Adam V. Weizman, Rebecca L. Morgan. AGA Clinical Practice Guidelines on the Role of Probiotics in the Management of Gastrointestinal Disorders. Gastroenterology. 2020 Aug;159(2):697-705. doi: 10.1053/j.gastro.2020.05.059. Epub 2020 Jun 9.

Supplemental Methodology Resources

Technical Review