Probiotics for the Management of Pediatric Gastrointestinal Disorders: Position Paper of the ESPGHAN Special Interest Group on Gut Microbiota and Modifications

Abstract

Background: Probiotics, defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host, are widely used despite uncertainty regarding their efficacy and discordant recommendations about their use. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Special Interest Group on Gut Microbiota and Modifications provides updated recommendations for the use of probiotics for the management of selected pediatric gastrointestinal disorders. Methods: All systematic reviews and/or meta-analyses, as well as subsequently published randomized controlled trials (RCTs) (until December 2021), that compared the use of probiotics in all delivery vehicles and formulations, at any dose, with no probiotic (ie, placebo or no treatment), were eligible for inclusion. The recommendations were formulated only if at least 2 RCTs on a similar well-defined probiotic strain were available. The modified Delphi process was used to establish consensus on the recommendations. Results: Recommendations for the use of specific probiotic strains were made for the management of acute gastroenteritis, prevention of antibiotic-associated diarrhea, nosocomial diarrhea and necrotizing enterocolitis, management of Helicobacter pylori infection, and management of functional abdominal pain disorders and infant colic. Conclusions: Despite evidence to support the use of specific probiotics in some clinical situations, further studies confirming the effect(s) and defining the type, dose, and timing of probiotics are still often required. The use of probiotics with no documented health benefits should be discouraged.

Strain-Specificity of Probiotics in Pediatrics: A Rapid Review of the Clinical Evidence

“…More than 200 randomized controlled trials (RCTs) have been performed to assess the effects of probiotics for the treatment and/or prevention of various pediatric conditions. In line with 2022 recommendations developed by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition, specific strains may be considered in the management of selected pediatric gastrointestinal disorders (4). For example, Lacticaseibacillus (formerly known as Lactobacillus ) rhamnosus GG, Saccharomyces boulardii (mostly CNCM I-745), or Limosilactobacillus (formerly known as Lactobacillus ) reuteri DSM 17938 may be recommended for the management of acute gastroenteritis in children.…”

Pathogen-Specific Benefits of Probiotic and Synbiotic Use in Childhood Acute Gastroenteritis: An Updated Review of the Literature

“…The latest position paper of the Working Group on Probiotics and Prebiotics of the ESPGHAN, published in 2022, provides weak recommendations for the use of L. rhamnosus and S. boulardii in the management of acute pediatric gastroenteritis, based on low evidence [ 68 ]. An even lower level of evidence sustained the administration of L. reuteri for the same purpose, whereas a recommendation was issued against the use of Bacillus clausii and against the combination of L. reuteri and L. helveticus in childhood diarrhea, similarly to their previous publication [ 18 , 81 ]. The authors have provided no specific advice for diarrhea with an established etiology and have also mentioned the potential impact of rotavirus vaccine coverage in influencing their analysis of previously published data [ 81 ].…”

“…An even lower level of evidence sustained the administration of L. reuteri for the same purpose, whereas a recommendation was issued against the use of Bacillus clausii and against the combination of L. reuteri and L. helveticus in childhood diarrhea, similarly to their previous publication [ 18 , 81 ]. The authors have provided no specific advice for diarrhea with an established etiology and have also mentioned the potential impact of rotavirus vaccine coverage in influencing their analysis of previously published data [ 81 ].…”

Comparative, randomized-controlled trial on efficacy and safety of Lactobacillus rhamnosus GG and Saccharomyces boulardii in treatment of acute diarrhea in Indian children (COMPARE-GG trial)

“…4 The latest guidelines by the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the Indian Academy of Pediatrics (IAP), published separately in 2022, positively recommend Lactobacillus rhamnosus GG and Saccharomyces boulardii, which are also two of the most commonly prescribed probiotics in pediatric population. 5,6 Despite the recommendations, there is insufficient head-on comparative data on the efficacy of these two probiotics. In order to further reduce the ambiguity around choosing the probiotic strain in the Indian population, this study aimed to compare the efficacy of Lactobacillus rhamnosus GG and Saccharomyces boulardii as an adjunct treatment for acute diarrhea in children aged 6-36 months.…”