Internet websites selling probiotics marketed to pediatric Crohnʼs patients have unstudied efficacy

Abstract

Probiotics are increasingly used in inflammatory bowel disease management. While these products are often used by pediatric Crohn's patients, there is limited data demonstrating their effectiveness. Lactobacillus GG is the only probiotic that has been studied in children. However, there is conflicting data on the efficacy of Lactobacillus GG. Nevertheless, the potential for effectiveness of probiotics has encouraged its use by pediatric Crohn's patients. This study evaluated the therapeutic claims, bacterial composition and cost of probiotics marketed for pediatric patients with Crohn's disease. Using the online search engine Google, “Crohn's AND probiotic” was searched using Boolean logic. Data was retrieved from 07/22/09-07/24/09. The first 100 websites were categorized as either commercial, academic, informational or as blogs. Commercial websites were defined as those marketing or selling a product. Academic websites were defined as those containing scholarly journal articles or textbooks. Informational websites were defined as sites containing information regarding Crohn's disease and probiotics, but did not market or sell any products. A blog was defined as a personal chronological log. For each commercial website, products which were marketed to pediatric patients were identified and the microbial composition was obtained. The first 100 websites were reviewed. There were 9 commercial websites, 32 academic websites, 36 informational websites and 22 blogs. 1 website was not operational. 20 different probiotics were advertised for sale. 5 products were marketed specifically for children and 3 products were marketed to both children and adults. 1 product was marketed to adults only, 10 products did not mention a target population and 1 product's information could not be obtained. Of the 5 products marketed for pediatric use, 3 were advertised as curative and 2 were advertised as adjunctive therapy. One of the products advertised as curative claimed to have been clinically studied (without references provided). The remaining products did not provide supporting data. The products contained between 3 and 6 microbes. None of the 5 products contained the studied bacteria Lactobacillus GG. Two of the products advertised as curative contained Lactobacillus acidophilus and Bifidobacterium bifidum. None of the other organisms in the products advertised as curative were the same. The 2 products advertised as adjunctive therapy had 6 identical organisms. The cost of the products ranged from $174 to 299 annually. Two of the products' cost could not be determined based upon the provided information. This study found that probiotics marketed to pediatric patients with Crohn's disease have limited supportive data. While future studies and clinical experience may justify probiotic use in Crohn's patients, presently only Lactobacillus GG has been studied in pediatric patients. Nevertheless, multiple probiotics are available and marketed for the pediatric population. Cautiousness must be exercised when incorporating new products into pediatric medical regimens when there is limited data demonstrating clinical efficacy. Physicians must be knowledgeable of the therapeutic claims of products marketed for children and offer balanced information to pediatric Crohn's patients.