World Gastroenterology Organisation Global Guidelines – Probiotics and prebiotics 2023 update

Current insights into the clinical applications (in alphabetical order) for probiotics or prebiotics in gastroenterology are summarized below. It should be noted that the description provides a general overview of clinical efficacy. However, the effects of probiotics are strain-specific and dose-specific, and for prebiotics the effects are based on the particular formulation.


For specific recommendations for different indications on the basis of levels of graded evidence, Tables 8 and 9 should be consulted. Meta-analyses are regarded as providing the highest level of evidence for evaluating clinical efficacy. However, applying meta-analysis to clinical trials with probiotics is fraught with problems due to the heterogeneity of trial designs, the heterogeneity of the probiotic interventions used, the heterogeneity of the populations studied, and the relatively small numbers included in each clinical trial.


Such issues can plague meta-analyses conducted on any intervention, but the strain-specificity of effects needs to be carefully taken into account with meta-analyses on probiotics. Combining data on different probiotic strains without a rationale that similar underlying mechanisms of action are driving the effects observed should be avoided when using the results to make medical recommendations



Published: Feb 2023

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