Use of probiotics in clinical practice with special reference to diarrheal diseases: A position statement of the Malaysian Society of Gastroenterology and Hepatology

Abstract

Probiotics comprise a large group of microorganisms, which have different properties and thus confer different benefits. The use of probiotics has shown promising results in the management of diarrheal diseases. While the availability of probiotic products has flourished in the marketplace, there is limited guidance on the selection of probiotics for clinical use. This position paper is aimed at informing clinicians about the proper selection criteria of probiotics based on current evidence on strain-specific efficacy and safety for the management of diarrheal diseases. Members of the working group discussed issues on probiotic use in clinical practice, which were then drafted into statements. Literature to support or refute the statements were gathered through a search of medical literature from 2011 to 2020. Recommendations were formulated based on the drafted statements and evidence gathered, revised as necessary, and finalized upon agreement of all members. Twelve statements and recommendations were developed covering the areas of quality control in the manufacturing of probiotics, criteria for selection of probiotics, and established evidence for use of probiotics in diarrheal diseases in adults and children. Recommendations for the use of specific probiotic strains in clinical practice were categorized as proven and probable efficacy based on strength of evidence. Robust evidence is available to support the use of probiotics for diarrheal diseases in clinical practice. Based on the results obtained, we strongly advocate the careful evaluation of products, including manufacturing practices, strain-specific evidence, and contraindications for at-risk populations when choosing probiotics for use in clinical practice. imbalance may occur due to several factors, including diet, infection, disease (e.g. irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), type 1 and 2 diabetes, atopic eczema, and obesity), and drugs (e.g. antibiotics). 1,2 Probiotics and prebiotics are among the most well-established interventions in modulating the gut microbiota for health benefits. 1 Specifically, probiotics are

Bacillus clausii for Gastrointestinal Disorders: A Narrative Literature Review

“…Several articles were identified in our literature search that report recommendations and consensus statements on the use of probiotics in GI conditions in adults and children, including those published by/on behalf of the World Gastroenterology Organisation, the European Society for Primary Care Gastroenterology, the European Society for Paediatric Gastroenterology Hepatology and Nutrition, the Mexican Association of Gastroenterology and Malaysian Society of Gastroenterology and Hepatology. Briefly, the overriding position of these articles is that current evidence supports the use of probiotics for GI disorders, with guidance provided on the specific bacterial strains that might be considered in conditions such as antibiotic-associated diarrhea and acute gastroenteritis [ 30 , 86 – 91 ]. The article by De Castro et al [ 90 ] presents consensus recommendations from an Asian expert panel specifically on the use of B. clausii in acute, chronic and antibiotic-associated diarrhea in children.…”

Critical Overview of Probiotics Efficacy on Health and its Safety

“…that estimate the size of the benefit when possible 51,52 . Online resources such as The Clinical Guide to Probiotic Products and can also help to identify products with clinical trial data for specific conditions 53 .…”

Probiotic Weizmannia coagulans MTCC 5856 as adjunct therapy in children's acute diarrhea—a randomized, double-blind, placebo-controlled study

“…Some clinical studies have evaluated the safety of a few strains of W. coagulans in children and reported they are well tolerated ( 31 , 32 ). Strain specificity is considered an important factor that determines the efficacy of probiotics in diarrhea ( 33 ). Therefore, in the present study, W. coagulans MTCC 5856 was supplemented along with the standard treatment of Zn and ORS to assess its safety and efficacy in children with acute diarrhea.…”