(Berlin, October 16, 2013) Clinicians with gastrointestinal (GI) patients often wish – and are asked by their patients – to recommend specific probiotics. However, a clear and accessible evidence-based reference guide on the role and effectiveness of specific probiotics and their clinical use for managing particular lower gastrointestinal problems has been lacking so far. Now a new reference guide, which was supported and facilitated by the European Society for Primary Care Gastroenterology (ESPCG), with a focus on the requirements of primary care physicians, provides the first practical consensus on the role of specific probiotics in the management of lower GI symptoms in adults in clinical practice. The guide will also be presented today at the United European Gastroenterology (UEG) Week 2013 in Berlin, Germany.
Recent research findings provide evidence for the impact the microbial community of the intestine (i.e. the gut microbiota) has on gastrointestinal symptoms and problems. Their beneficial effect, e.g., in prevention of side effects of antibiotics has been shown in several studies. At the same time doctors are increasingly asked by patients with GI symptoms to recommend specific probiotics. However, for clinicians, it is difficult to meet this request as “probiotics” is an umbrella term, covering a huge spectrum of bacterial strains, which have to be assigned to the appropriate conditions in a formulation and dose specific way in order to be really helpful.
Transferring research to daily practice
So far, clinical guidelines usually focus on specific disease entities; however, primary care physicians often have to deal with overlapping symptoms. Their needs are now met by a reference guide, written by an international Consensus group of experts, supported by and with the participation of ESPCG. It provides clinicians with practical guidance on which probiotic to select for which problem in the field of lower GI symptoms. “Our guide comprises evidence-based information from 37 randomised, placebo-controlled, high-quality studies on the effects of specific probiotics on lower GI diseases in adults, mostly irritable bowel syndrome (IBS) and antibiotic-associated diarrhoea (AAD). The consensus was achieved within a 10-member-panel in the course of a refined multi-level-process of anonymous and iterative feedback and voting,” says Professor Pali Hungin (Durham University, UK) from the ESPCG. “Our findings have been translated into a reference tool, listing 32 different available specific probiotics –– together with the formulations and the doses in relation to the conditions they have been applied to and the treatment outcomes established by the included studies. Additionally, our team’s assessments of the different studies are made transparent so that our conclusions are open to the judgement of the individual doctor.”
Beneficial in IBS and AAD
Among others, the reference guide gathers evidence on the beneficial outcome of probiotic treatment in two main areas: the prevention of antibiotic-associated diarrhoea (AAD) including H. pylori eradication therapy, and the reduction of overall symptom burden as well as abdominal pain and bloating in IBS patients. This is supported by the trials with a high evidence level included in the reference guide. There is also moderate evidence that specific probiotics improve bowel movements in IBS patients, and improve the general quality of life in GI patients. There is another important outcome of the meta-study: probiotics are safe. None of the consulted trials revealed significant adverse effects caused by their intake. “Our investigation demonstrates that specific probiotics which showed high and moderate supportive evidence for a beneficial outcome could be tried in treating a number of lower GI symptoms in adults. But this only applies if the probiotic is carefully chosen based on the patient’s symptoms, the clinical indication and the available evidence. In addition, it is important that it is taken in adequate doses on a regular basis for at least one month, unless it cannot be tolerated for any reason. Regarding these needs, we are confident that our consensus paper will be a helpful practical reference guide in clinicians’ daily practice.”
View the whole study on the Internet:
http://onlinelibrary.wiley.com/doi/10.1111/apt.12460/full
About the European Society for Primary Care Gastroenterology (ESPCG)
The ESPCG has a strong interest in promoting comparative research in primary care gastroenterology across Europe. It is a daughter organisation of United European Gastroenterology (UEG), participating in its scientific and educational committees. It has recently completed a major survey of clinical management and has published systematic reviews on IBS and gastro-oesophageal reflux disease.
The building of the ESPCG research network has been a primary aim of the Society for the near future.The building of the ESPCG research network is a primary aim of the society for the near future.
The consensus was supported and facilitated by the ESPCG, which received an unrestricted grant from Danone (Paris, France)
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