SOCIETAL PAPER:NUTRITIONProbiotics for the Management of PediatricGastrointestinal Disorders:Position Paper of theESPGHAN Special Interest Group on GutMicrobiota and Modifications'Hania Szajewska,MD,tRoberto Berni Canani,MD,Magnus Domellof,MD,tAlfredo Guarino,MD,sIva Hojsak,MD,Flavia Indrio,MD,tAndrea Lo Vecchio,MD,Walter A.Mihatsch,MD."Alexis Mosca,MD,"Rok Orel,MD,tSilvia Salvatore,MD,#Raanan Shamir,MD.ssChris H.P van den Akker,MD,sJohannes B.van Goudoever,MD,MYvan Vandenplas,MD,andMZvi Weizman,MD,on behalf of the ESPGHAN Special Interest Group on GutMicrobiota and ModificationsABSTRACTBackground:Probiotics,defined as live microorganisms that,when adminis-What Is Knowntered in adequate amounts,confer a health benefit on the host,are widely useddespite uncertainty regarding their efficacy and discordant recommendationsProbiotics are increasingly being used in the pediat-about their use.The European Socicty for Paediatric Gastroenterology,Hepatol-ric population.ogy and Nutrition (ESPGHAN)Special Interest Group on Gut Microbiota andUncertainty remains about how to appropriately useModifications provides updated recommendations for the use of probiotics forprobiotics.the management of selected pediatric gastrointestinal disorders.The effects of probiotics are considered to be strainMethods:All systematic reviews and/or meta-analyses,as well as subse-specific.quently published randomized controlled trials (RCTs)(until December2021).that comparedthe use of probiotics in all delivery vehicles and formu-What Is Newlations,at amy dose,with no probiotic (ie,placebo or no treatment),were eli-gible for inclusion.The recommendations were formulated only if at least 2Indications for the use of probiotics for selected gas-RCTs on a similar well-defined probiotic strain were available.The modifiedDelphi process was used to establish consensus on the recommendations.trointestinal disorders in children covered in earlierResults:Recommendations for the use of specific probiotic strains weredocuments are updated.Indications not covered in earlier documents aremade for the management of acute gastroenteritis,prevention of antibiotic-associated diarrhea.nosocomial diarrhea and necrotizing enterocolitis.included.management of Helicobacter pylori infection,and management of func-The recommendations formulated are meant totional abdominal pain disorders and infant colic.be broadly applicable and should be viewed as theConclusions:Despite evidence to support the use of specific probiotics inpreferred management.However,they are not thesome clinical situations,further studies confirming the effect(s)and defin-only approach and depend on individual clinicaling the type,dose,and timing of probiotics are still often required.The usescenanos.of probiotics with no documented health benefits should be discouraged.Key Words:children,infants,microbiota,microbiome(JPGN2022:76:232-247)Received May 26,2022;accepted September 30,2022.sity Children's Hospital Ljubljana,Ljubljana,Slove
