Synbiotics in the Management of Pediatric Gastrointestinal Disorders

Abstract

Background: Synbiotics are a mixture comprising of live microorganisms and substrate(s) selectively utilized by host microorganisms that confers a health benefit on the host. There is an increasing number of studies investigating their role in different diseases and disorders. Aim: The purpose of this article is to provide recommendations for the use of synbiotics in the management of pediatric gastrointestinal disorders. The recommendations are developed by the ESPGHAN Special Interest Group on Gut Microbiota and Modifications. Methods: From existing literature databases, we searched and appraised all systematic reviews and/or meta-analyses, and subsequently published randomized controlled trials (RCTs) that compared the use of synbiotics, in all delivery vehicles and formulations, at any dose, compared to no synbiotics. Synbiotics which are part of infant formula were not assessed. The recommendations were formulated only if at least 2 RCTs that used a well-defined synbiotic were available. Results: Based on the currently available evidence, no recommendation can be formulated in favor or against the use of evaluated synbiotic combination in the treatment of acute gastroenteritis, prevention of necrotizing enterocolitis, Helicobacter pylori infection, inflammatory bowel disease, functional gastrointestinal disorders, and allergy in infants and children. Conclusions: There is a need for more, well-designed RCTs on the role of synbiotics in gastrointestinal disorders with the same outcome measures to enable the inter-studies comparisons.

Prebiotics in the management of pediatric gastrointestinal disorders: Position paper of the ESPGHAN special interest group on gut microbiota and modifications

“…The discussion continued until agreement was reached to retain, modify, or eliminate the statement from the final document. Once full consensus was reached, the statements were included in the final document 5,6 . The level of agreement is presented next to each statement/recommendation.…”

“…A modified Delphi process was used to establish consensus on the statements. 5,6 The draft document containing the list of statements formulated by the core group was circulated by email to all group members. Each member was asked to vote by marking "agree" or "disagree" beside each statement.…”

“…Initially, it was planned to use the system developed by the Grading of Recommendations, Assessment Development, and Evaluations Working Group, and to categorize the certainty of evidence (quality of the evidence) and the strength of recommendations, which were previously used for synbiotics and probiotics. 5,6 However, due to lack of evidence this could not be performed. A modified Delphi process was used to establish consensus on the statements.…”

“…Once full consensus was reached, the statements were included in the final document. 5,6 The level of agreement is presented next to each statement/recommendation.…”

Does the Gut Microbial Metabolome Really Matter? The Connection between GUT Metabolome and Neurological Disorders

“…Experimental results revealed that the administration of probiotics alone or in combination with prebiotics (fructooligosaccharides or galactooligosaccharides) improved the gastrointestinal barrier [ 205 , 206 ], which is the first line of “defence” from harmful factors occurring in food, and the microbiome. Probiotics and prebiotics are well-documented “problem-solution” for gastrointestinal diseases [ 207 , 208 ]. Moreover, probiotics can reduce CNS inflammatory processes and activation of microglia, demonstrating promising potential for use in neurodegenerative diseases as ingestible “psychobiotics”.…”