World Gastroenterology Organisation Global Guidelines: Probiotics and Prebiotics

Guarner, Francisco; Sanders, Mary Ellen; Szajewska, Hania; Cohen, Henry; Eliakim, Rami; Herrera-deGuise, Claudia; Karakan, Tarkan; Merenstein, Dan; Piscoya, Alejandro; Ramakrishna, Balakrishnan; Salminen, Seppo; Melberg, Jim

doi:10.1097/mcg.0000000000002002

Cited by 209Probiotics and Fermented FoodsInfant Nutrition and HealthGut microbiota and health

World Gastroenterology Organisation Global Guidelines: Probiotics and Prebiotics

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Guarner, Francisco, Sanders, Mary Ellen, Szajewska, Hania, Cohen, Henry, Eliakim, Rami, Herrera-deGuise, Claudia, Karakan, Tarkan, Merenstein, Dan +4 more·2024·Journal of Clinical Gastroenterology

DOI 10.1097/mcg.0000000000002002

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Abstract

The concept of beneficial microbes was first suggested by Elie Metchnikoff who postulated that lactic acid bacteria offered health benefits capable of promoting longevity. Disorders of the intestinal tract were frequently treated with viable nonpathogenic bacteria to change or replace the intestinal microbiota. The German professor Alfred Nissle isolated a nonpathogenic strain of Escherichia coli from the feces of a First World War soldier who did not develop enterocolitis during a severe outbreak of shigellosis. In Japan, Dr. Minoru Shirota isolated Lacticaseibacillus paracasei strain Shirota to battle diarrheal outbreaks. Today, a search of human clinical trials in PubMed shows that over 1500 trials have been published on probiotics. Although these studies are heterogeneous with regard to the strains and populations included, accumulated evidence supports the view that benefits are measurable across many different outcomes that have been assessed. This article is an update of a previous publication in the Journal of Clinical Gastroenterology,1 and is based on the guideline recently posted on the WGO website. Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.2 Our glossary of terms is based on the definitions proposed by the International Scientific Association of Probiotics and Prebiotics. Lactobacilli, along with species of Bifidobacterium, have historically been common probiotics. In 2020, the genus Lactobacillus underwent a major restructuring to better address the wide diversity of microbes assigned to the genus. Twenty-three new genera were defined, including some with well-studied probiotic species (Table 1). TABLE 1 - New Names for Some Prominent Former Lactobacillus Probiotic Species. Still Included in the Lactobacillus Genus are Lactobacillus acidophilus, L. gasseri, L. crispatus, L. johnsonii, L. helveticus, and L. delbrueckii subsp. bulgaricus (Sometimes Abbreviated as L. bulgaricus). Former name New name Lactobacillus casei Lacticaseibacillus casei Lactobacillus paracasei Lacticaseibacillus paracasei Lactobacillus rhamnosus Lacticaseibacillus rhamnosus Lactobacillus plantarum Lactiplantibacillus plantarum Lactobacillus brevis Levilactobacillus brevis Lactobacillus salivarius Ligilactobacillus salivarius Lactobacillus fermentum Limosilactobacillus fermentum Lactobacillus reuteri Limosilactobacillus reuteri From the International Scientific Association for Probiotics and Prebiotics (ISAPP), “The big breakup of Lactobacillus,” available at https://www.nestlenutrition-institute.org/infographics/big-breakup-lactobacillus. GLOSSARY OF TERMS - Probiotics Live microorganisms that, when administered in adequate amounts, confer a health benefit on the host Prebiotic A selectively fermented ingredient that results in specific changes in the composition and/or activity of the gastrointestinal microbiota, thus conferring benefit(s) upon host health Synbiotics A mixture comprising live microorganisms and substrate(s) selectively utilized by host microorganisms that confers a health benefit on the host. There are 2 types of synbiotic: complementary (mixtures of probiotics and prebiotics) and synergistic (mixtures of live microbes selected to utilize a coadministered substrate for a health effect) Postbiotic A preparation of inanimate microorganisms and/or their components that confers a health benefit on the host The yeast Saccharomyces boulardii and some E. coli and Bacillus species are also used. Newcomers to the probiotic ranks include Clostridium butyricum, recently approved as a novel food in the European Union. Lactic Acid Bacteria, which have been used for the preservation of food by fermentation for thousands of years, may also potentially impart health benefits. However, the term “probiotic” should be reserved for live microbes that have been shown in controlled human studies to impart a health benefit. Fermentation is globally applied in the preservation of a range of raw agricultural materials, such as cereals, roots, tubers, fruit and vegetables, milk, meat, and fish. The prebiotic concept, first proposed by Gibson and Roberfroid in 1995,3 is a more recent one than probiotics. The key aspects of a prebiotic are that it is nondigestible by the host and that it leads to health benefits for the consumer through a positive influence on the resident beneficial microbes. The administration or use of prebiotics or probiotics is intended to influence the gut environment, which is inhabited by trillions of microbes, for the benefit of human health. Both probiotics and prebiotics have been shown to have beneficial effects that extend beyond the gut, but this guideline will focus on gut effects. Prebiotics typically consist of nonstarch polysaccharides and oligosaccharides, although other substances are being studied as candidate prebiotics—such as resistant starch, conjugated linoleic acid, and polyphenols. Most prebiotics are used as food i

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Reported effective doses commonly range from 109-1010 CFU per dose, although requirements vary by strain; S. boulardii CNCM I-745 has demonstrated efficacy at approximately 5 × 109 CFU (~250 mg) administered twice daily.
“Reported effective doses commonly range from 10⁹–10¹⁰ CFU per dose, although requirements vary by strain; for example, S. boulardii CNCM I-745 has demonstrated efficacy at approximately 5 × 10⁹ CFU (~250 mg) administered twice daily.55”
From Safety and efficacy concerns in Indian probiotics: Insights from whole-genome sequencing and in vitro assessment (2026) · cites this paper as [55]
Adverse events related to probiotic use are typically rare and mild but can occur.
“Adverse events related to probiotic use are typically rare and mild but can occur [43].”
From Vaginal probiotics as therapeutic adjuncts for improving embryo transfer success rates: a systematic review and meta-analysis (2025) · cites this paper as [43]

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The efficacy and safety of probiotics in people with cancer: A systematic review
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A COMPARATIVE STUDY TO DETERMINE THE EFFECTIVENESS AND SAFETY OF PROBIOTICS AS AN ADJUNCT TO ANTIHISTAMINES COMPARED TO ANTIHISTAMINES ALONE IN PATIENTS WITH ALLERGIC RHINITIS
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Authors: Guarner, F., Sanders, M. E., Szajewska, H., Cohen, H., Eliakim, R., Herrera-deGuise, C., Karakan, T., Merenstein, D., Piscoya, A., Ramakrishna, B., Salminen, S., & Melberg, J.
Affiliations: Hospital Quirón Teknon (ES)
International Scientific Association for Probiotics and Prebiotics, Centennial, CO
Medical University of Warsaw (PL)
Medical School UDELAR, Montevideo, Uruguay
Sheba Medical Center (IL)
University Hospital Vall d’Hebron, Barcelona, Spain
Gazi University (TR)
Georgetown University (US)
Hospital Guillermo Kaelin de La Fuente, Lima, Peru
SIMS Hospital, Chennai, India
University of Turku (FI)
Corresponding author: Guarner, Francisco
Merenstein, Dan
ORCID: Guarner, Francisco
Sanders, Mary Ellen
Szajewska, Hania
Cohen, Henry
Eliakim, Rami
Karakan, Tarkan
Piscoya, Alejandro
Salminen, Seppo
Venue: Journal of Clinical Gastroenterology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2024-06-13
Volume: 58
Issue: 6
Pages: 533-553
ISSN: 0192-0790 (ISSN-L)
1539-2031
DOI: 10.1097/mcg.0000000000002002
OpenAlex: W4399729367
Cited by: 209
References: 195
Citations by year: 2026: 69 · 2025: 63 · 2024: 27 · 2023: 10 · 2022: 6 · 2021: 10 · 2020: 9 · 2019: 5 · 2018: 2 · 2016: 2 · 2014: 4 · 2013: 1
FWCI: 33.95
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by
Locations: Journal of Clinical Gastroenterology (publishedVersion, cc-by)
PubMed (publishedVersion)
Topics: Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
Health Sciences › Nursing › Nutrition and Dietetics › Infant Nutrition and Health
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
Keywords: probiotics, prebiotics, gut microbiota, Lacticaseibacillus, Bifidobacterium, Lactiplantibacillus
MeSH terms: Gastroenterology, Gastrointestinal Diseases, Humans, Probiotics, Prebiotics

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