The following information is available for clinicians (including gastroenterologists, general practitioners, and dietitians) to learn about the science of probiotics, prebiotics, and gut microbiota as they apply to clinical practice.
Many of these materials were created by third parties. Please note that ISAPP bears no responsibility for the accuracy of these materials and/or the consequences of their use.
Evidence on probiotics and prebiotics by indication
To create these clinical practice guidelines, the AGA reviewed evidence for probiotics and several gastrointestinal disorders. See here for their conclusions. The AGA recommended certain probiotics to prevent necrotizing enterocolitis (NEC) and C. difficile infection, suggesting that all hospital formularies should stock at least one appropriately tested probiotic for these purposes. Further, all physicians should consider recommending appropriately tested probiotics to patients for whom they prescribe antibiotics. The AGA did not consider evidence for probiotics and antibiotic-associated diarrhea. For further explanation, see this blog post: ISAPP take-home points from American Gastroenterological Association guidelines on probiotic use for gastrointestinal disorders.
This Journal of Family Practice article gives a summary of the probiotics literature and a quick guide to evidence-based recommendations in primary care. Written by Daniel J. Merenstein, MD and Mary Ellen Sanders, PhD, along with Daniel J. Tancredi, PhD, the article includes points about safety, up-to-date practice recommendations by indication, and answers to nine questions about probiotics that are frequently asked by patients. The article can be accessed by logging into Medscape.
These guides, which list the level of evidence for various probiotic products by indication, are useful tools for healthcare professionals. They are created by the independent organization AEProbio through industry-funded non-restricted educational grants. They are also available as free mobile downloads: US version: Google Play and the App Store; Canadian version: App Store and Google Play
This review in Nutrition Bulletin, co-authored by ISAPP scientists, covers the definition and concept of probiotics and compiles evidence for different health benefits of probiotics.
This article from Journal of Family Practice online helps translate the evidence, providing evidence-based recommendations for use of probiotics or prebiotics for IBS, IBD, antibiotic-associated diarrhea, acute infectious diarrhea, traveler’s diarrhea, eczema, and diabetes.
These guidelines from World Gastroenterology Organisation (WGO) compile evidence for the use of probiotics for various indications. Note especially Tables 8 and 9, which list strains associated with graded evidence for gastrointestinal benefits.
This handbook from World Gastroenterology Organisation (WGO) includes 15 chapters by global experts, covering gut microbiota and its role in health and disease, as well as evidence for the use of probiotics and prebiotics.
This continuing education activity from Pharmacy Times, published in February 2018, features Dan Merenstein, MD, explaining prebiotic and probiotic evidence for different indications.
In this webinar from April 2018, Dan Merenstein, MD, and Mary Ellen Sanders, PhD, served as faculty for a CME-eligible webinar sponsored by Medscape on how healthcare professionals can help patients choose the most suitable probiotic for their needs. Accessing this webinar requires a login.
This ISAPP resource was developed in response to concerns about the consequences of frequent antibiotic prescriptions in UK hospitals, and covers evidence for co-prescribing probiotics with antibiotics in order to prevent antibiotic-associated diarrhoea and Clostridium difficile-associated diarrhoea.
Using an illustrative case, this resource from Journal of Family Practice lays out the rationale for administration of probiotics for the prevention of antibiotic-associated diarrhea.
This is a regulatory scientific opinion document from the European Food Safety Authority (EFSA) on the use of yogurt cultures to manage symptoms of lactose intolerance.
This is an UpToDate clinical decision support resource for healthcare providers and patients, authored by R. Balfour Sartor, MD. It covers evidence for the use of probiotics. Accessing this article requires a subscription.
This systematic review in Alimentary Pharmacology & Therapeutics, endorsed by the European Society for Primary Care Gastroenterology, aims to give clinicians “a practical reference guide on the role of specified probiotics in managing particular lower gastrointestinal symptoms/problems.”
This review in Alimentary Pharmacology & Therapeutics covers the management of acute gastroenteritis in children: it incorporates evidence published since the previous 2008 European guidelines on the management of acute gastroenteritis in children, which were developed by te European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society of Paediatric Infectious Disease (ESPID).
The result of a joint effort of the European Crohn’s and Colitis Organization (ECCO) and the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN), this document summarizes clinical guidelines for the management of pediatric ulcerative colitis, including appropriate use of probiotics. It represents the consensus of 27 experts in pediatric IBD.
In this three-webinar series for parents and clinicians, The NEC Society covers various issues related to probiotics in the neonatal intensive care unit (NICU). Webinar slides and videos are freely available. Presenters include Mark Underwood, MD, MAS; Ravi Patel, MD, MSc; and NEC Society director Jennifer Canvasser, MSW.
This Viewpoint published in JAMA Pediatrics covers the strength of evidence for probiotics used for the prevention of NEC in preterm infants and how it should translate into US NICU practices. Access to this article may require a subscription.
This ISAPP blog article by Dr. Ravi Patel explains evidence for gut ‘dysbiosis’ in NEC and describes the trials (around 63 to date) on probiotics for NEC prevention.
Evidence on diet and gut microbiota
These recordings cover the sessions of a recent scientific conference focused on gut microbiota, diet, and health. The recordings are freely accessible but require a login. Available through March 2021. Learning objectives for the conference are as follows:
- Understand the role of diet-microbiota interactions underlying human health and disease.
- Describe current evidence regarding dietary components (such as dietary fiber and fermented foods) and exercise and their influence on the human gut microbiome.
- Describe current understanding of metabolites produced by the gut microbiome and their link to human health and disease.
- Apply current understanding of probiotics for the management of adult and pediatric gastrointestinal disorders to clinical practice.
General information for patients or consumers
This ISAPP-created resource covers the definition and use of probiotics and lists some key points for consumers who wish to choose a probiotic that meets their needs.
This ISAPP-created resource covers the definition and uses of prebiotics and answers gives an overview of the benefits of prebiotics.
This educational program for the general public, developed by the World Gastroenterology Organisation, is a webcast that gives an overview of IBS and evidence for probiotic benefits.