Szajewska Hania, Berni Canani Roberto, Domellöf Magnus, Guarino Alfredo, Hojsak Iva, Indrio Flavia, Lo Vecchio Andrea, Mihatsch Walter A, Mosca Alexis, Orel Rok, Salvatore Silvia, Shamir Raanan, van den Akker Chris H P, van Goudoever Johannes B, Vandenplas Yvan, Weizman Zvi
From the Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland.
the Department of Translational Medical Science - Section of Paediatrics. University of Naples Federico II, Naples, Italy.
J Pediatr Gastroenterol Nutr. 2023 Feb 1;76(2):232-247. doi: 10.1097/MPG.0000000000003633. Epub 2022 Oct 11.
Probiotics, defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host, are widely used despite uncertainty regarding their efficacy and discordant recommendations about their use. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Special Interest Group on Gut Microbiota and Modifications provides updated recommendations for the use of probiotics for the management of selected pediatric gastrointestinal disorders.
All systematic reviews and/or meta-analyses, as well as subsequently published randomized controlled trials (RCTs) (until December 2021), that compared the use of probiotics in all delivery vehicles and formulations, at any dose, with no probiotic (ie, placebo or no treatment), were eligible for inclusion. The recommendations were formulated only if at least 2 RCTs on a similar well-defined probiotic strain were available. The modified Delphi process was used to establish consensus on the recommendations.
Recommendations for the use of specific probiotic strains were made for the management of acute gastroenteritis, prevention of antibiotic-associated diarrhea, nosocomial diarrhea and necrotizing enterocolitis, management of Helicobacter pylori infection, and management of functional abdominal pain disorders and infant colic.
Despite evidence to support the use of specific probiotics in some clinical situations, further studies confirming the effect(s) and defining the type, dose, and timing of probiotics are still often required. The use of probiotics with no documented health benefits should be discouraged.
益生菌被定义为当给予足够数量时能对宿主产生健康益处的活微生物，尽管其功效存在不确定性且关于其使用的建议不一致，但仍被广泛使用。欧洲儿科胃肠病学、肝病学和营养学会（ESPGHAN）肠道微生物群与改变特别兴趣小组提供了关于使用益生菌治疗特定儿科胃肠道疾病的最新建议。
所有比较了任何剂量的所有递送载体和制剂中的益生菌使用与不使用益生菌（即安慰剂或不治疗）的系统评价和/或荟萃分析，以及随后发表的随机对照试验（RCTs）（截至2021年12月）均符合纳入标准。仅当有至少2项关于相似明确益生菌菌株的RCTs时才制定建议。采用改良德尔菲法就这些建议达成共识。
针对急性胃肠炎的治疗、抗生素相关性腹泻的预防、医院获得性腹泻和坏死性小肠结肠炎的预防、幽门螺杆菌感染的治疗、功能性腹痛疾病和婴儿腹绞痛的治疗，提出了使用特定益生菌菌株的建议。
尽管有证据支持在某些临床情况下使用特定益生菌，但通常仍需要进一步研究来证实其效果并确定益生菌的类型、剂量和使用时机。应不鼓励使用无健康益处记录的益生菌。
