Opinions of gastroenterologists about intestinal microbiota modulating agents: results of the survey in focus groups

Abstract

Aim. To study the opinions of gastroenterologists about drugs affecting the intestinal microflora.
 Materials and methods. A qualitative survey was conducted in focus groups to study the patterns of prescribing drugs that regulate intestinal microflora in chronic gastrointestinal diseases. The survey included only outpatient gastroenterologists who managed patients with irritable bowel syndrome, an uncomplicated diverticular disease with clinical manifestations and excessive bacterial growth in the small intestine for at least 3 years.
 Results. Physicians perceive the non-absorbable antibiotic rifaximin alpha as the drug of choice for treating these diseases; they are aware of its low bioavailability and suitability for repeated use. However, with severe clinical symptoms, some doctors tend to use systemic antibiotics before infectious or inflammatory complications are confirmed. It is due to the erroneous perception of systemic antibiotics as obviously more effective drugs than non-absorbable antibiotics. When choosing a drug, it is essential to consider the risk of antibiotic-associated diarrhea, adverse changes in the microflora, and the patient's comorbidities.
 Conclusion. Surveyed gastroenterologists consider rifaximin alfa (Alfa Normix) the most suitable drug that helps in routine practice achieve the desired result with a minimum risk of adverse events. Many study participants are skeptical about the effect of probiotics due to the lack of evidence but emphasize their safety and the request for probiotics from patients. Not all doctors are aware of metabiotics. Prebiotics and dietary fibers are perceived as agents that affect both the intestinal microflora and the stool frequency. Some healthcare professionals are concerned about prebiotics and probiotics registered as dietary supplements, which can cause patient misunderstandings. Identified opinions about such agents can be used in training gastroenterologists and developing clinical guidelines.