Is there evidence for the efficacy of Biogaia (Lactobacillus reuteri) oral probiotics?

Efficacy of BioGaia (Lactobacillus reuteri) Oral Probiotics

Lactobacillus reuteri (particularly strain DSM 17938 or ATCC 55730 found in BioGaia products) has strong evidence supporting its efficacy for specific conditions, especially infantile colic, while evidence for other indications varies in strength.

Evidence for Specific Conditions

Strong Evidence

• Infantile Colic: L. reuteri (DSM 17938 or ATCC 55730) markedly reduced crying time in breastfed infants with colic (median difference -65 minutes/day) in multiple trials 1, 2
• Preterm Infants: L. reuteri (DSM 17938 or ATCC 55730) significantly:
  • Reduced rates of severe necrotizing enterocolitis (NEC) (OR 0.55,95% CI 0.34-0.91) with high certainty of evidence 1
  • Reduced days to reach full enteral feeds (MD -2.62 days) 1
  • Shortened hospitalization duration (MD -7.89 days) with high certainty of evidence 1

Moderate Evidence

• Diarrhea: L. reuteri can be recommended as an adjuvant therapy for diarrhea, particularly in pediatric populations 2
• Constipation: Evidence supports L. reuteri as an adjuvant strategy for constipation management 2
• Helicobacter pylori Infection: L. reuteri shows promise as an adjuvant therapy to standard treatment regimens 2

Limited or Insufficient Evidence

• Functional Abdominal Pain: Preclinical studies show potential but clinical evidence is still limited 2
• Inflammatory Bowel Disease: More research needed despite promising preclinical data 2
• Liver Diseases: Evidence is currently insufficient 1, 3

Strain Specificity Considerations

• Strain Specificity is Critical: Efficacy is highly strain-specific; benefits demonstrated for L. reuteri DSM 17938 or ATCC 55730 cannot be generalized to all L. reuteri strains 3, 4
• Dose Dependence: Therapeutic effects depend on appropriate dosing, which varies by indication 4

Safety Profile

• Generally Safe: Even in vulnerable populations like preterm infants, L. reuteri does not increase rates of sepsis and may actually protect from mortality 1
• Caution in Immunocompromised Patients: Standard precautions apply for severely immunocompromised individuals 1

Clinical Application Algorithm

1. For Infantile Colic:

   • First-line consideration for breastfed infants with colic symptoms 1, 2
   • Consider after ruling out other medical causes of excessive crying 5

2. For Preterm Infants:

   • Consider as preventive therapy for NEC and to reduce hospitalization time 1
   • Ensure proper strain identification (DSM 17938 or ATCC 55730) 1

3. For Other Conditions:

   • For diarrhea, constipation, or H. pylori treatment: Consider as adjunctive therapy 2
   • For conditions with limited evidence: Weigh potential benefits against costs 3

Common Pitfalls to Avoid

• Assuming All Probiotics Are Equal: Different strains have different effects; verify the specific strain has evidence for the intended use 3, 4
• Inadequate Dosing: Ensure sufficient dosage as per evidence-based recommendations 4
• Unrealistic Expectations: For conditions with limited evidence, set appropriate expectations with patients 3, 6
• Quality Concerns: The probiotic market is relatively unregulated; select products from reputable manufacturers with quality control measures 3