Probiotics do not help children with abdominal flu

Many parents give probiotics to their children when they have stomach bugs. But do these supplements really help to stop vomiting and diarrhea?

The answer – at least for two popular probiotics – seems to be: No.

"We have shown in two very large and rigorous studies that these probiotics were not working and they had no effect," says David Schnadower, a professor of pediatrics at the Cincinnati Children's Hospital Medical Center.

Schnadower led one of the studies, a project funded by the federal government and conducted in the United States. He also participated in the second test, a Canadian test supported by the government. The results of both are published in the New England Journal of Medicine.

Schnadower concludes that "these probiotics in particular should not be used for gastroenteritis".

Gastroenteritis is the technical name for stomach bugs, which can be caused by viruses, bacteria or parasites. The disease sends approximately 1.7 million children to emergency rooms and hosts 70,000 in the United States each year. Many more children spend miserable days at home with their parents.

The theory behind the use of probiotics is that friendly bacteria could help the body fight stomach problems and restore the normal balance of microbes in the digestive system.

But on the basis of the results, Schnadower and others recommend that doctors not suggest that parents use probiotics to treat their children with stomach bug or that moms and dads try to treat them themselves. same reason.

"If they do not work, do not spend your money on them," says Schnadower. "Spend your money to buy good food Buy yogurt Buy vegetables Buy fruit Fruits will benefit more than buying bacteria in pills that have no solid evidence for of their use. " (No study has revealed a security problem.)

Others argue that studies are far from the last word and must be considered in the context of previous research, with some indicating that probiotics might be effective under certain conditions.

"The conclusion of these two trials is not that" probiotics do not work, "wrote Mary Ellen Sanders, scientific lead at the International Scientific Association for Probiotics and Prebiotics. The group includes scientists and manufacturers of probiotics. "Scientists must take into account the entire body of evidence when they evaluate the effectiveness of any intervention, including acute infantile diarrhea. It is not scientifically valid." ignore previous research when new studies are done. "

But i-Health, Inc., the company that makes Culturelle, one of the tested probiotics, asked questions about how the US study was conducted. The company also noted that previous research had confirmed the effectiveness of the probiotic.

"The results should be considered in other successful clinical trials," wrote Seema Mody, senior director of research and development at i-Health, Inc., in an e-mail. .

But the researchers who led the new studies argue that previous tests were lower. "We were hoping for positive trials – a treatment for diarrhea in children – but we have to accept the reality," wrote Dr. Stephen Freedman of the Alberta Children's Hospital, who headed the clinic. Canadian study, in an e-mail.

At least one independent scientist agrees that the new studies are definitive, at least for the specific probiotics conducted for this specific condition. "These are important and very well done studies," said J. Thomas LaMont, chief of gastroenterology at the Beth Israel Deaconess Medical Center in Boston, who wrote an editorial accompanying the studies. "These studies are likely to have a significant impact on the elimination of medications that do not seem to work."

Schnadower, Freedman, LaMont and others pointed out that the results only apply to the two probiotic formulations tested in the study and only to gastroenteritis.

It is still possible that the probiotics tested in these studies work for other health problems. It is also possible that other probiotics work in the treatment of gastroenteritis or other conditions. A recent study, for example, found that a probiotic might help protect babies against sepsis, which can be life threatening.

But probiotics, which consist of live bacteria, are marketed for a vertiginous range of diseases – from digestive problems to general health maintenance and the prevention of chronic diseases such as obesity and heart disease. Some probiotics are even marketed to relieve mental health problems such as anxiety and depression.

The boom in the probiotic market, valued at several billion dollars, has been fueled by the explosion of research on the microbiome. The microbiome groups millions of bacteria, viruses, fungi and other microbes that populate and help maintain a healthy human body.

But most research on probiotics has consisted of small studies, many of which have been funded by companies that sell products. Probiotics are not subject to review and approval by the Food and Drug Administration.

As a result, many scientists and clinicians have wondered whether there is sufficient evidence to support the myriad of claims and have called for high quality independent reviews, such as the two new studies.

In the first study, Schnadower and colleagues studied 971 children aged 3 months to 4 years treated for gastroenteritis in 10 US emergency rooms. Children have either a probiotic containing the bacteria Lactobacillus rhammosus GG for five days or placebo. This probiotic is sold over the counter under the name of Culturelle.

The researchers reported that there was no significant difference in the length of time parents said that the vomiting and diarrhea of ​​their children lasted.

In the second study, researchers studied 886 children aged 3 months to 2 years with gastroenteritis in six Canadian emergency rooms. The young people either took a five-day course of a probiotic containing Lactobacillus rhamnosus R001 and Lactobacillus helveticus R0052 or placebo. This combination is popular in Southeast Asia.

Again, there was no significant difference between the groups.

"The rigor and magnitude of these two studies (…) have allowed the indicator to progress a little towards the conclusion that these two different preparations do not bring any benefit for this disease," wrote Phillip. Tarr, professor of pediatrics at Washington University in St. Louis. who helped lead the American study, in an email. "It is time to move on."