A Gastroenterologist's Guide to Probiotics

Matthew a. Ciorba, MD


Clin Gastroenterol Hepatol. 2012;10(9):960-968. 

In This Article

Safety of Probiotics

For most populations, probiotic consumption is considered safe and complications rare. A review on the safety of probiotics by Snydman points out that although case reports of bacteremia and endocarditis (LGG) as well as cases of fungemia (S boulardii) exist, epidemiologic evidence suggests that there is no overall increase in population risk based on usage data.[77] This position is substantiated by a recent US government commissioned review panel report.[78] As a caveat, however, a high profile multicenter placebo controlled Dutch RCT examining probiotic supplementation in severe acute pancreatitis found a higher incidence of mesenteric ischemia and death in the treatment group.[79] This is the only trial to date to infer such a relationship, but supports the concept that probiotics should be avoided in critically ill patients. Indwelling central vein catheters and perhaps cardiac valvular disease may be relative contraindications.[80]