Helping patients make informed choices about probiotics: a need for research
Open accessAbstract
Applications of probiotics in the treatment of gastrointestinal disorders are gaining acceptance among patients, despite evidence that probiotics can present substantial health risks, particularly for patients who are immunocompromised or seriously ill. Patients will likely formulate their attitudes and beliefs about probiotic therapies with reference to interpretive frameworks that compare probiotics with more familiar therapeutic modalities, including complementary and alternative medicines, pharmacological therapies, and gene-transfer technologies. Each of these frameworks highlights a different set of benefit-to-risk considerations regarding probiotic usage and reinforces extreme characterizations of both the therapeutic promise and peril of probiotics. Considerable effort may be required to help patients make informed choices about probiotic therapies.
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Primary care physicians' familiarity with probiotics is limited.
“primary care physicians are increasingly confronted with questions about the suitability (or otherwise) of probiotics, but their familiarity with probiotics is limited.18–19”
From Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice - an evidence-based international guide (2013) · cites this paper as [18]
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Cites
Frank, D. N., St. Amand, A. L., Feldman, R. A., Boedeker, E. C., Harpaz, N., & Pace, N. R. (2007) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0706625104 · Cited by 4,611 · see citing works
Gut flora in health and disease
Guarner, F., & Malagelada, J. (2003) · The Lancet · doi:10.1016/s0140-6736(03)12489-0 · Cited by 3,395 · see citing works
O’Mahony, L., McCarthy, J., Kelly, P., Hurley, G., Luo, F., Chen, K., O’Sullivan, G. C., Kiely, B., Collins, J. K., Shanahan, F., et al. (2005) · Gastroenterology · doi:10.1053/j.gastro.2004.11.050 · Cited by 1,448 · see citing works
Besselink, M. G., van Santvoort, H. C., Buskens, E., Boermeester, M. A., van Goor, H., Timmerman, H. M., Nieuwenhuijs, V. B., Bollen, T. L., van Ramshorst, B., Witteman, B. J., et al. (2008) · The Lancet · doi:10.1016/s0140-6736(08)60207-x · Cited by 1,367 · see citing works
Kruis, W., Frič, P., Pokrotnieks, J., Lukáš, M., Fixa, B., Kaščák, M., Kamm, M. A., Weismueller, J., Beglinger, C., Stolte, M., et al. (2004) · Gut · doi:10.1136/gut.2003.037747 · Cited by 1,285 · see citing works
(2006) · CRC Press eBooks · doi:10.1201/9781420006452.ch4 · Cited by 909 · see citing works
Complementary and alternative medicine: use and disclosure in radiation oncology community practice
Rausch, S. M., Winegardner, F., Kruk, K. M., Phatak, V. S., Wahner‐Roedler, D. L., Bauer, B. A., & Vincent, A. (2010) · Supportive Care in Cancer · doi:10.1007/s00520-010-0846-5 · Cited by 813 · see citing works
Probiotic use in clinical practice: what are the risks?
Boyle, R. J., Robins-Browne, R. M., & Tang, M. L. (2006) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/83.6.1256 · Cited by 776 · see citing works
Saccharomyces boulardii in Maintenance Treatment of Crohn’s Disease
Guslandi, M., Mezzi, G., Sorghi, M., & Testoni, P. A. (2000) · Digestive Diseases and Sciences · doi:10.1023/a:1005588911207 · Cited by 722 · see citing works
Hu, Z., Yang, X., Ho, P. C., Chan, S. Y., Heng, P. W. S., Chan, E., Duan, W., Koh, H., & Zhou, S. (2005) · Drugs · doi:10.2165/00003495-200565090-00005 · Cited by 664 · see citing works
Explaining risks: turning numerical data into meaningful pictures
Edwards, A., Elwyn, G. J., & Mulley, A. G. (2002) · BMJ · doi:10.1136/bmj.324.7341.827 · Cited by 645 · see citing works
Eisenberg, D. M., Kessler, R. C., Rompay, M. I. V., Kaptchuk, T. J., Wilkey, S. A., Appel, S. M., & Davis, R. B. (2001) · Annals of Internal Medicine · doi:10.7326/0003-4819-135-5-200109040-00011 · Cited by 636 · see citing works
Strategies to help patients understand risks
Paling, J. (2003) · BMJ · doi:10.1136/bmj.327.7417.745 · Cited by 556 · see citing works
Gut microbiota: a potential new territory for drug targeting
Jia, W. P., Li, H., Zhao, L., & Nicholson, J. K. (2008) · Nature Reviews Drug Discovery · doi:10.1038/nrd2505 · Cited by 471 · see citing works
Advising Patients Who Seek Alternative Medical Therapies
Eisenberg, D. M. (1997) · Annals of Internal Medicine · doi:10.7326/0003-4819-127-1-199707010-00010 · Cited by 437 · see citing works
Gastrointestinal microbiology enters the metagenomics era
Frank, D. N., & Pace, N. R. (2008) · Current Opinion in Gastroenterology · doi:10.1097/mog.0b013e3282f2b0e8 · Cited by 405 · see citing works
GUYONNET, D., CHASSANY, O., DUCROTTE, P., PICARD, C., MOURET, M., MERCIER, C. ‐., & MATUCHANSKY, C. (2007) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2007.03362.x · Cited by 365 · see citing works
Herb–drug interactions: Review and assessment of report reliability
Fugh‐Berman, A., & Ernst, E. (2001) · British Journal of Clinical Pharmacology · doi:10.1046/j.0306-5251.2001.01469.x · Cited by 362 · see citing works
Snydman, D. R. (2008) · Clinical Infectious Diseases · doi:10.1086/523331 · Cited by 336 · see citing works
Small Intestinal Bacterial Overgrowth: Roles of Antibiotics, Prebiotics, and Probiotics
Quigley, E. M. M., & Quera, R. (2006) · Gastroenterology · doi:10.1053/j.gastro.2005.11.046 · Cited by 328 · see citing works
Probiotics for maintenance of remission in Crohn's disease
Rolfe, V. E., Fortun, P., Hawkey, C. J., & Bath-Hextall, F. J. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004826.pub2 · Cited by 252 · see citing works
Probiotics for treatment of Clostridium difficile-associated colitis in adults
Pillai, A. A., & Nelson, R. L. (2008) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004611.pub2 · Cited by 251 · see citing works
Effects of probiotic on intestinal mucosa of patients with ulcerative colitis
Cui, H.-H. (2004) · World Journal of Gastroenterology · doi:10.3748/wjg.v10.i10.1521 · Cited by 209 · see citing works
Probiotic therapy of intestinal inflammation and infections.
Sartor, R. B. (2005) · PubMed · Cited by 204 · see citing works
Malaguarnera, M., Greco, F., Barone, G., Gargante, M. P., Malaguarnera, M., & Toscano, M. A. (2007) · Digestive Diseases and Sciences · doi:10.1007/s10620-006-9687-y · Cited by 190 · see citing works
Probiotics and Their Potential Health Claims
Santosa, S., Farnworth, E. R., & Jones, P. J. H. (2006) · Nutrition Reviews · doi:10.1111/j.1753-4887.2006.tb00209.x · Cited by 184 · see citing works
Verdú, E. F., Bercík, P., Bergonzelli, G. E., Huang, X.-X., Blennerhasset, P., Rochat, F., Fiaux, M., Mansourian, R., Corthésy-Theulaz, I., & Collins, S. M. (2004) · Gastroenterology · doi:10.1053/j.gastro.2004.06.007 · Cited by 180 · see citing works
Plein, K., & Hotz, J. (1993) · PubMed · Cited by 167 · see citing works
Szajewska, H., & Mrukowicz, J. Z. (2005) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2005.02624.x · Cited by 158 · see citing works
Probiotics and prebiotics in gastrointestinal disorders
Fedorak, R. N., & Madsen, K. L. (2004) · Current Opinion in Gastroenterology · doi:10.1097/00001574-200403000-00017 · Cited by 148 · see citing works
Messner, M. J., Shaw, S., Regli, S. E., Rotert, K., Blank, V., & Soller, J. A. (2006) · Journal of Water and Health · doi:10.2166/wh.2006.024 · Cited by 133 · see citing works
Honeycutt, T., Khashab, M. E., Wardrop, R. M., McNeal-Trice, K. A., Honeycutt, A. L. B., Christy, C. G., Mistry, K. P., Harris, B. D., Meliones, J. N., & Kocis, K. C. (2007) · Pediatric Critical Care Medicine · doi:10.1097/01.pcc.0000282176.41134.e6 · Cited by 130 · see citing works
Mechanisms of Action of Probiotics in Intestinal Diseases
O’Hara, A. M., & Shanahan, F. (2007) · The Scientific World JOURNAL · doi:10.1100/tsw.2007.26 · Cited by 129 · see citing works
Lata, J., Novotný, I., Příbramská, V., Juránková, J., Fric, P., Kroupa, R., & Stibůrek, O. (2007) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0b013e3282efa40e · Cited by 129 · see citing works
Genetically engineered probiotics
Steidler, L. (2003) · Best Practice & Research Clinical Gastroenterology · doi:10.1016/s1521-6918(03)00072-6 · Cited by 120 · see citing works
Designer probiotics for prevention of enteric infections
Paton, A. W., Morona, R., & Paton, J. C. (2006) · Nature Reviews Microbiology · doi:10.1038/nrmicro1349 · Cited by 112 · see citing works
Probiotics in Clinical Practice: An Overview
Zuccotti, G., Meneghin, F., Raimondi, C., Dilillo, D., Agostoni, C. V., Riva, E., & Giovannini, M. (2008) · Journal of International Medical Research · doi:10.1177/14732300080360s101 · Cited by 99 · see citing works
Risk communication in the clinical consultation
Thomson, R., Edwards, A., & Grey, J. (2005) · Clinical Medicine · doi:10.7861/clinmedicine.5-5-465 · Cited by 99 · see citing works
Review article: probiotics in gastrointestinal and liver diseases
Jonkers, D. M. A. E., & Stockbrügger, R. W. (2007) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2007.03480.x · Cited by 88 · see citing works
Complementary and alternative medicine: The importance of doctor-patient communication
Pappas, S. G., & Perlman, A. I. (2002) · Medical Clinics of North America · doi:10.1016/s0025-7125(03)00068-3 · Cited by 79 · see citing works
Complementary and alternative medicine in gastroenterology: The good, the bad, and the ugly
Koretz, R. L., & Rotblatt, M. (2004) · Clinical Gastroenterology and Hepatology · doi:10.1016/s1542-3565(04)00461-6 · Cited by 68 · see citing works
Complementary Alternative Medicine in Patients with Inflammatory Bowel Disease: Use and Attitudes
Quattropani, C., Ausfeld‐Hafter, B., Straumann, A., Heer, P., & Seibold, F. (2003) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365520310000591a · Cited by 66 · see citing works
Probiotics and Prebiotics in Human Health
Saier, M. H., & Mansour, N. M. (2005) · Microbial Physiology · doi:10.1159/000090345 · Cited by 57 · see citing works
Bittner, A. C., Croffut, R. M., & Stranahan, M. C. (2005) · Clinical Therapeutics · doi:10.1016/j.clinthera.2005.06.005 · Cited by 55 · see citing works
Besselink, M. G., van Santvoort, H. C., Buskens, E., & Boermeester, M. A. (2008) · Data Archiving and Networked Services (DANS) · Cited by 45 · see citing works
VSL#3: An Analysis of Basic and Clinical Contributions in Probiotic Therapeutics
Gionchetti, P., Lammers, K. M., Rizzello, F., & Campieri, M. (2005) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2005.05.003 · Cited by 40 · see citing works
Probiotic Microbes: The Scientific Basis
Walker, R., & Buckley, M. R. (2006) · Cited by 36 · see citing works
Meier, R. M., & Steuerwald, M. (2005) · Current Opinion in Critical Care · doi:10.1097/01.ccx.0000166396.42894.60 · Cited by 35 · see citing works
Probiotics in the critically ill: Handle with care!*
Singhi, S. C. (2007) · Pediatric Critical Care Medicine · doi:10.1097/01.pcc.0000282165.04260.59 · Cited by 6 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Modulation of intestinal barrier by intestinal microbiota: Pathological and therapeutic implications
Natividad, J. M. M., & Verdu, E. F. (2013) · Pharmacological Research · doi:10.1016/j.phrs.2012.10.007 · Cited by 525 · see citing works
A systematic review of the safety of probiotics
Didari, T., Solki, S., Mozaffari, S., Nikfar, S., & Abdollahi, M. (2014) · Expert Opinion on Drug Safety · doi:10.1517/14740338.2014.872627 · Cited by 367 · see citing works
Hungin, A. P. S., Mulligan, C., Pot, B., Whorwell, P., Agréus, L., Fracasso, P., Lionis, C., Mendive, J., Philippart de Foy, J.-M., Rubin, G., et al. (2013) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.12460 · Cited by 212 · see citing works
Gordon, J. I. (2012) · Science · doi:10.1126/science.1224686 · Cited by 172 · see citing works
CORDINA, C., SHAIKH, I., SHRESTHA, S., & CAMILLERI‐BRENNAN, J. (2011) · Journal of Digestive Diseases · doi:10.1111/j.1751-2980.2011.00534.x · Cited by 29 · see citing works
- Authors
- Sharp, R. R., Achkar, J.-P., Brinich, M. A., & Farrell, R. M.
- Affiliations
- Cleveland Clinic (US)
- Corresponding author
- Sharp, Richard R
- Venue
- The American Journal of Gastroenterology
- Published
- 2009-04
- Volume
- 104
- Issue
- 4
- Pages
- 809-813
- ISSN
- 0002-9270 (ISSN-L)
- 1572-0241
- PMC
- PMC2746707
- OpenAlex
- W2049721160
- Cited by
- 43
- References
- 49
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 2 · 2022: 1 · 2021: 2 · 2020: 1 · 2018: 4 · 2017: 2 · 2016: 2 · 2015: 5 · 2014: 3 · 2013: 2 · 2012: 4
- FWCI
- 0.46
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Funders
- National Human Genome Research Institute (R01HG004877)
- Topics
- Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- probiotics, informed consent, patient decision-making, gastrointestinal diseases, immunocompromised patients, risk-benefit assessment, complementary and alternative medicine, patient attitudes and beliefs
- MeSH terms
- Gastrointestinal Diseases, Humans, Informed Consent, Patient Compliance, Patient Education as Topic, Physician-Patient Relations, Probiotics, Biomedical Research
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