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World J Gastroenterol. Dec 7, 2017; 23(45): 7952-7964
Published online Dec 7, 2017. doi: 10.3748/wjg.v23.i45.7952
Probiotics for gastrointestinal disorders: Proposed recommendations for children of the Asia-Pacific region
Donald Cameron, Quak Seng Hock, Musal Kadim, Neelam Mohan, Eell Ryoo, Bhupinder Sandhu, Yuichiro Yamashiro, Chen Jie, Hans Hoekstra, Alfredo Guarino
Donald Cameron, Department of Gastroenterology and Clinical Nutrition, Royal Children’s Hospital, Melbourne 3052, Australia
Quak Seng Hock, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
Musal Kadim, Child Health Department, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta 12220, Indonesia
Neelam Mohan, Department of Pediatric Gastroenterology, Hepatology And Liver Transplantation, Medanta The Medicity 122001, Gurugram Haryana, India
Eell Ryoo, Department of Pediatrics, Gachon University, Gil Gachon Children’s Hosptial, Incheon 21565, South Korea
Bhupinder Sandhu, Department of Paediatric Gastroenterology, Royal Hospital for Children, Bristol BS2 8BJ, United Kingdom
Yuichiro Yamashiro, Probiotics Research Laboratory, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
Chen Jie, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 610041, Zhejiang Province, China
Hans Hoekstra, Department of Pediatrics, Hieronymus Bosch Hospital, ’s-Hertogenbosch 5223GZ, The Netherlands
Alfredo Guarino, Unit of Pediatrics Infectious Diseases and Clinical Nutrition of the Department of Translational Medical Science-Section of Pediatrics, University of Naples Federico II, Naples 80131, Italy
Author contributions: All of the authors attended the working group meeting of international experts, and read, edited, and approved the manuscript at each draft stage; Hoekstra H and Guarino A reviewed and evaluated the literature, and designed the scientific program of the initial meeting in Paris at the Sorbonne University and the second meeting in Osaka.
Supported by a medical educational grant from Biocodex, France.
Conflict-of-interest statement: The working group meeting was funded by a medical education grant from Biocodex, France. Professor Yamashiro has received research funding from Yakult Honsha Co. Ltd. Japan. All other authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Donald Cameron, MD, PhD, Professor, Department of Gastroenterology and Clinical Nutrition, Royal Children’s Hospital, 50 Flemington Road, Parkville Victoria, Melbourne 3052, Australia. don.cameron@rch.org.au
Telephone: +61-3-93456644 Fax: +61-3-88889944
Received: January 24, 2017
Peer-review started: January 31, 2017
First decision: April 21, 2017
Revised: September 29, 2017
Accepted: November 1, 2017
Article in press: November 1, 2017
Published online: December 7, 2017
Processing time: 65 Days and 23.5 Hours
Abstract

Recommendations for probiotics are available in several regions. This paper proposes recommendations for probiotics in pediatric gastrointestinal diseases in the Asia-Pacific region. Epidemiology and clinical patterns of intestinal diseases in Asia-Pacific countries were discussed. Evidence-based recommendations and randomized controlled trials in the region were revised. Cultural aspects, health management issues and economic factors were also considered. Final recommendations were approved by applying the Likert scale and rated using the GRADE system. 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 could also be considered. Probiotics may be considered for prevention of (with the indicated strains): antibiotic-associated diarrhea (LGG or Sb); Clostridium difficile-induced diarrhea (Sb); nosocomial diarrhea (LGG); infantile colic (L reuteri) and as adjunct treatment of Helicobacter pylori (Sb and others). 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 insufficient evidence for recommendations in other conditions. Despite a diversity of epidemiological, socioeconomical and health system conditions, similar recommendations apply well to Asia pacific countries. These need to be validated with local randomized-controlled trials.

Keywords: Lactobacillus rhamnosus; Gastroenteritis; Guidelines; Probiotics; Children; Recommendations; Asia-Pacific; Saccharomyces boulardii

Core tip: This paper includes recommendations based on guidelines and local data for use of probiotics strains in the prevention or treatment of intestinal diseases in children of Asia-Pacific region. Notwithstanding major differences in health management and local conditions between countries, recommendations for children living in various countries of Asia-Pacific region are similar. Saccharomyces boulardii and Lactobacillus rhamnosus GG may be used in gastroenteritis, nosocomial infections, antibiotic-associated diarrhea. Selected strains may have a place in infantile colic, Helicobacter pylori treatment, and necrotizing enterocolitis. This document provides a helpful guidance to use probiotics in children based on local data and considerations.