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WGO Publishes Updated Probiotics and Prebiotics Guideline


22 May 2023


Health & Consumers

The World Gastroenterology Organisation is pleased to announce the publication of the updated Probiotics and Prebiotics Guideline. This project was led by Prof. Francisco Guarner, MD, PhD, a clinical gastroenterologist and clinical researcher in probiotics and prebiotics in Spain, who brought together experts in gastroenterology, pediatrics, family medicine, probiotics, and prebiotics. Prof. Hania Szajewska, MD, PhD, a clinical pediatrician and clinical researcher in probiotics from the Medical University of Warsaw, Poland, was integral to assessing evidence for pediatric populations for the guidelines. Prof. Mary Ellen Sanders, PhD of the International Scientific Association for Probiotics and Prebiotics (ISAPP), co-chaired the project.

The Review Team of international experts consisted of Profs. Henry Cohen (Uruguay), Rami Eliakim (Israel), Claudia Herrera-deGuise (Guatemala), Tarkan Karakan (Turkey), Dan Merenstein (USA), Alejandro Piscoya (Peru), Balakrishnan Ramakrishna (India) and Seppo Salminen (Finland).

The use of probiotics and prebiotics in the practice of gastroenterology must be guided by evidence – and with new evidence continually emerging, clinicians can benefit from efforts to summarize this evidence and determine how it applies in clinical practice. For the 2023 update, 800 bibliographical entries of papers published in the 2017-2021 period were scrutinized. The Review Team adopted the guidelines for evaluation of probiotics established by FAO/WHO experts in 2002, where at least one double blind, randomized, placebo-controlled human trial with appropriate sample size and primary outcome is required to determine if the tested product is efficacious, and qualifies as a probiotic.

The Guideline is intended to provide specific information on interventions that may have benefit for indicated conditions. Recommendations included probiotics or prebiotics found in at least one randomized, controlled trial showing benefit. Trials that did not show benefit were not included. The Guideline serves an important role in informing gastroenterologists around the world, especially in regions where product availability might be limited. Especially useful are Tables 8 and 9, which summarize evidence for adult and pediatric uses, respectively. 

Prof. Francisco Guarner, Chair of the updated guideline states, "We hope our WGO guideline will assist doctors, pharmacists, dietitians and other healthcare professionals all around the world to integrate probiotics and prebiotics in an evidence-based manner into their daily work of patient care.”

While this updated version is only available in English so far, translations into French, Portuguese, Mandarin, Russian and Spanish are underway.

The updated Guideline can be accessed at