Probiotics for gastrointestinal disorders for children of the Asia-Pacific region: What is the evidence?
Senior Gastroenterologist, Royal Childrens Hospital Past President, Gastroenterological Society of Australia
An international group of paediatric gastroenterologists, most from the Asia-Pacific region, has met regularly to consider the evidence, and propose recommendations for the use of probiotics in paediatric gastrointestinal disorders in the region. Epidemiology and clinical patterns of intestinal diseases in Asia-Pacific countries were discussed and evidence-based recommendations proposed. Cultural aspects, health management issues and economic factors were also considered. Saccharomyces boulardii CNCM I-745 (Sb) and Lactobacillus rhamnosus GG (LGG) were strongly recommended as adjunct treatment to oral rehydration therapy for gastroenteritis.
Lactobacillus reuteri (Lr) could also be considered. Specific probiotics may be considered for prevention of antibiotic-associated diarrhea (with LGG or Sb); Clostridium difficile-induced diarrhea (with Sb); nosocomial diarrhea (with LGG); and infantile colic (with L. reuteri). Saccharomyces boulardii and others may help as adjunct treatment of Helicobacter pylori infection by improving tolerance to eradication therapy. Specific probiotics with a history of safe use in preterm and term infants may be considered in infants for prevention of necrotizing enterocolitis. There is, as yet, insufficient evidence for recommendations in other conditions.
Despite a diversity of epidemiological, socioeconomical and health system conditions, these recommendations apply well to Asia pacific countries but do need to be validated with proposed local randomized-controlled trials. The latest recommendations were published at the end of 2017 and will be reviewed and revised appropriately by the group as new evidence becomes available.
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