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Recommendations for Probiotic Use—2011 Update

Floch, Martin H. MD*; Walker, W. Allan MD; Madsen, Karen PhD; Sanders, Mary Ellen PhD§; Macfarlane, George T. PhD; Flint, Harry J. PhD; Dieleman, Levinus A. MD, PhD; Ringel, Yehuda MD#; Guandalini, Stefano MD**; Kelly, Ciaran P. MD††; Brandt, Lawrence J. MD‡‡

doi: 10.1097/MCG.0b013e318230928b

This study describes the consensus opinion of the participants of the third Yale Workshop on probiotic use. There were 10 experts participating. The recommendations update those of the first 2 meetings that were published in 2005 and 2008. The workshop presentations and papers in this supplement relate to the involvement of normal microbiota involved in intestinal microecology, how the microbes interact with the intestine to affect our immunologic responses, the stability and natural history of probiotic organisms, and the role of the intestinal microbatome with regard to affecting cardiac risk factors and obesity. Recommendations for the use of probiotics in necrotizing enterocolitis, childhood diarrhea, inflammatory bowel disease, irritable bowel syndrome, and Clostridium difficile diarrhea are reviewed. As in previous publications, the recommendations are given as A, B, or C ratings. The recent positive experiences with bacteriotherapy (fecal microbiome transplant) are also discussed in detail and a positive recommendation is made for use in severe resistant C. difficile diarrhea.

*Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT

Pediatric Gastroenterology and Nutrition Unit, Harvard Medical School, Mass. General Hospital for Children, Charlestown, MA

Division of Gastroenterology, University of Alberta, Alberta, Canada

§Dairy and Food Culture Technologies, Centennial, CO

Department of Bacteriology, University of Dundee, Dundee, Tayside, UK

Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, Scotland, UK

#Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC

**Department of Pediatrics, University of Chicago Comer Children’s Hospital, Chicago, IL

††Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

‡‡Division of Gastroenterology, Montefiore Medical Center/AECOM, New York, NY

Dr Floch is a consultant to Dannon and Pfizer and a speaker for Sigmatau and Procter & Gamble. Dr Walker and Dr Madsen declares no conflict of interest. Dr Sanders has consulted with numerous food, food ingredient, and dietary supplement companies over the past 12 months and has received consulting fees or honoraria for these services. She does not have any royalty, intellectual property rights, ownership interest (eg, stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit interests in any of these companies. Dr Macfarlane declares no conflict of interest. Dr Flint declares no conflict of interest. Dr Dieleman is a consultant for Abbott Canada, Merck Canada Inc., Ferring and Abbott Nutrition. He has received research support from Beneo-Orafti. Dr Ringel received research grants and/or served as consultant and/or participated in advisory-board and/or speaker for: Danisco, General Mills, Inc., Procter & Gamble, Salix Pharmaceuticals, Ironwood Pharmaceuticals, Pfizer, GSK and Smart-Pill. Dr Guandalini declares no conflict of interest. Dr Kelly declares no conflict of interest. Dr Brandt is a consultant for Optimer Pharmaceuticals, Inc.

Reprints: Martin H. Floch, MD, Clinical Professor of Medicine, Yale University School of Medicine, Section of Digestive Diseases, 40 Temple Street, Suite 1A, New Haven, CT 06510 (e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.