2020 Top Stories in Gastroenterology: AGA Guidelines on Probiotics in Management of GI Disorders

My choice for Top Story of 2020 is “AGA Clinical Practice Guidelines on the Role of Probiotics in the Management of Gastrointestinal Disorders,” by Su et al.¹ Probiotics are defined by the Food and Agriculture Organization of the United Nations and the World Health Organization as “live microorganisms which when administered in adequate amounts confer a health benefit on the host.” This practice guideline examines the evidence for the use of probiotics in five gastroenterological conditions, including Clostridioides difficile–associated diseases, inflammatory bowel disease, irritable bowel syndrome, infectious gastroenteritis, and necrotizing enterocolitis. These disease states were selected because they are conditions for which probiotics are often considered.

I selected this guideline as my 2020 top story not only because of the confusion that exists among healthcare providers about the efficacy of probiotics in treating or preventing GI diseases, but also because of the large amount of money spent on probiotic products in the absence of sound evidence. Although there are a number of studies regarding the role probiotics in gastrointestinal diseases, the methodologies, strain, and dose of microbes used, and endpoints and outcomes measured, vary widely, thus confounding the reaching of firm conclusions. This endeavor was a massive undertaking by several top academics in the country who used the well-established and accepted Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and best practices as outlined by the National Academy of Science to guide their recommendations.

The clinical guideline is accompanied by a “Technical Review on the Role of Probiotics in the Management of Gastrointestinal Diseases,”² which outlines the process used to guide these recommendations. Both the AGA Clinical Practice Guideline and Technical Review were funded by the AGA without outside influence from industry or other sources. There is not sufficient space to review the findings herein. Rather, my goal is to bring attention to this resource so healthcare providers can use it as an unbiased reference to inform their decisions regarding the use of probiotics in managing the specific set of Gi diseases addressed. Together these publications highlight the need for carefully designed, randomized, double-blind probiotic clinical trials in the future that focus on specific strains or strain combinations.