Beliefs and Practices of Canadian and U.S. Physicians Regarding the Use of Probiotics for Gastrointestinal Illnesses

Abstract

Introduction: Despite the popularity of probiotics with patients, little is known about their utilization and knowledge among Gastroenterologists (GIs) and Family Physicians (FPs). The Canadian Association of Gastroenterology (CAG) developed a needs assessment (NA) to determine utilization and knowledge patterns. Methods: A NA was developed based on the expert opinions and emailed to the members of the CAG, the American College of Gastroenterology (ACG), and other networks of FPs in the US and CAN. Results: A total of 276 physicians, ˜50% from US and CAN, responded to the NA. Respondents were mainly adult GIs (68%), from all “stages of career”, mostly male and from community/private setting, residing in large cities. Most physicians recommend probiotics to their patients (92%-CAN, 85%-US). The top reason for not recommending probiotics was lack of clinical evidence. Among physicians recommending probiotics, a given probiotic was selected based on clinical evidence of efficacy (70%-CAN; 56%-US), or because of a specific strain (44%-CAN; 48%-US). Top information sources were scientific/clinical literatureand clinical guidelines. Choice of a probiotic was determined mostly by clinical data (89%-CAN; 90%-US), followed by cost of probiotics, their stability, manufacturer credibility and manufacturing quality. Probiotics were most commonly recommended for Irritable Bowel Syndrome (IBS; 77%-CAN; 58%-US), followed by diarrhea (53%-CAN; 46%-US), pouchitis (33%-CAN; 38%-US), and constipation/ulcerative colitis (UC)/dyspepsia (all 5-16%). The actual use of probiotics in patients with specific diseases differed slightly between CAN and US (Table 1). Pills/capsules were the most recommended form of probiotic, mostly containing mixture of bacterial species, followed by Bifidobacterium and Lactobacillus.Rationale for recommending probiotics was based equally on personal belief in benefit and scientific evidence; the key exceptions being pouchitis followed by UC, where scientific evidence prevailed. Doctors felt that marketing had little impact (0-6% of all physicians). While most physicians felt fairly or very well informed (53%-CAN; 67%-US), a significant proportion of respondents (30%-CAN, 22%-US) were only somewhat informed. Conclusion: Probiotics are used commonly among GIs and FPs in CAN and US, mainly to treat functional GI disorders. However, knowledge of clinical data and scientific evidence for use of probiotics is discrepant among physicians in both countries.432 Figure 1. n=number of physicians who recommend probiotics for that indication; All results expressed in %.