Furthermore, the ISSAPP states that probiotics have proven benefits in the management of acute infectious gastroenteritis (AGE), antibiotic-associated diarrhoea (ADD), gut transit, irritable bowel syndrome (IBS), abdominal pain and bloating, ulcerative colitis, and necrotising enterocolitis (NEC).¹

Acute infectious gastroenteritis

A Cochrane review, which included 63 randomised controlled studies (RCT) involving 8014 paediatric patients, evaluated the effect of administering probiotics for the treatment of AGE. The reviewers found that probiotics reduced the duration of diarrhoea by about one day, as well as the risk of diarrhoea lasting more than four days. A meta-analysis comparing the efficacy of Lactobacillus reuteri (L. reuteri) with placebo or no treatment, supports this finding.  The researchers found that the addition of L. reuteri to standard rehydration therapy compared to placebo or not intervention,  reduced the duration of diarrhoea by about 21 hours. It also reduced hospitalisation duration by between five and 13 hours. The addition of L. reuteri to standard rehydration therapy also increased the chance for cure on the first two days of treatment.^2,3

Antibiotic-associated diarrhoea

Another Cochrane review of 33 RCTs (n=6352), evaluated the efficacy of probiotics (Limosilactobacillus,Bifidobacterium, Streptococcus, S. boulardii or combinations), compared to placebo or other treatments in paediatric patients with ADD. The reviewers concluded that probiotics may be effective for preventing AAD. The incidence of AAD was 8% in the probiotic group, compared to 19% in the control patients.^4,5

Irritable bowel syndrome

IBS is a common and chronic GI condition characterised by abdominal pain, bloating, and changes in bowel habits associated with altered stool form, which can affect the quality of life and work productivity of patients. The efficacy and safety of probiotic products for the treatment of IBS are supported by an increasing number of clinical studies. A meta-analysis with 53 RCTs involving 5 545 patients provided data regarding the potential efficacy of probiotic combinations and specific probiotic species or strains for improving global IBS symptoms and abdominal pain.⁶

Ulcerative colitis

Evidence supports a role for the use of probiotics as adjunct therapy in patients with mild to moderate UC. Zocco et al evaluated the efficacy of Lactobacilli alone or in combination with mesalazine (5-ASA) and mesalazine as maintenance treatment in UC. Disease activity was measured at zero, six and 12 months. The primary endpoint was to evaluate sustained remission. They found that there were no differences in relapse rates at six and 12 months between the three treatment groups. However, treatment with Lactobacilliwas more effective than standard treatment with mesalazine in prolonging relapse-free time and represent a good therapeutic option to prevent relapse.⁷

Necrotising enterocolitis in very low birth weight infants

Probiotic bacteria are present in mother's milk, and maternal milk has a protective effect against NEC. However, breast milk is not always available, especially in mothers of preterm infants; hence, maternal production is poor due to premature delivery. Therefore, the administration of probiotics seems to be a logical step in the prevention of NEC. The most commonly used preparation was Lactobacillus spp., Bacillusspp., or a combination of both. Most RCTs compared the supplementation of a probiotic with placebo or no supplementation. In addition, most trials started supplementation within the first week of birth, usually with the first enteral feed. A recent Cochrane review performed a meta-analysis comparing different probiotic preparations. The reviewed population included 10 812 preterm infants distributed over 56 trials with an average gestational age of 28-32 weeks and an average birth weight of 1000–1200 g. The overall conclusion was that supplementation with probiotics reduced the risk of NEC with the combination of Bacillus and Lactobacillus spp. being the most effective.^8,9

REFERENCES:

1. Hill C, et al. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nature Reviews, 2013.
2. Allen SJ, et al. Probiotics for Treating Acute Infectious Diarrhea. Cochrane Database Syst Rev, 2010.
3. Patro-Golab B and Szajewska H. Systematic Review with Meta-Analysis: Lactobacillus reuteri DSM 17938 for Treating Acute Gastroenteritis in Children. An Update. Nutrients, 2019.
4. Guo Q, et al. Probiotics for the Prevention of Pediatric Antibiotic-Associated Diarrhea. Cochrane Database Syst Rev, 2019.
5. Alam S and Mushtaq M. Antibiotic associated diarrhea in children. Indian Pediatr, 2009.
6. Zhang T, et al. Efficacy of Probiotics for Irritable Bowel Syndrome: A Systematic Review and Network Meta-Analysis. Front Cell Infect Microbiol, 2022.
7. Zocco MA, et al. Efficacy of Lactobacillus GG in maintaining remission of ulcerative colitis. Alimentary Pharmacology and Therapeutics, 2006.
8. Seghesio E, et al. Probiotics in the Prevention and Treatment of Necrotizing Enterocolitis. Pediatr Gastroenterol Hepatol Nutr, 2021.
9. Sharif S, et al. Probiotics to prevent necrotising enterocolitis in very preterm or very low birth weight infants. Cochrane Database Syst Rev, 2020.