Systematic review with meta-analysis: Lactobacillus rhamnosus GG for treating acute gastroenteritis in children - a...

Area of Science:

• Pediatric Gastroenterology
• Microbiome Research
• Clinical Trials Methodology

Background:

• Recent large randomized controlled trials (RCTs) have questioned the efficacy of Lactobacillus rhamnosus GG (LGG) in treating acute gastroenteritis in children.
• Conflicting evidence necessitates a comprehensive review of existing RCTs to clarify LGG's role.

Purpose of the Study:

• To systematically review randomized controlled trials (RCTs) evaluating the use of Lactobacillus rhamnosus GG (LGG) for treating acute gastroenteritis in pediatric populations.
• To assess the impact of LGG on primary outcomes including stool volume and duration of diarrhea.

Main Methods:

• A systematic literature search was conducted across major databases (Cochrane Library, MEDLINE, EMBASE) for RCTs published up to January 2019.
• Included studies focused on children with acute gastroenteritis treated with LGG, with primary outcomes being stool volume and diarrhea duration.

Main Results:

• Eighteen RCTs involving 4208 children were analyzed. LGG showed no significant effect on stool volume but reduced diarrhea duration by an average of 0.85 days.
• Efficacy was observed with daily doses of ≥10^10 CFU and <10^10 CFU, with higher significance at the higher dose.
• LGG demonstrated greater effectiveness in European countries and was associated with reduced hospitalization duration, though one RCT found no effect on clinical severity at 14 days.

Conclusions:

• Despite recent contradictory findings, current evidence suggests Lactobacillus rhamnosus GG (LGG) effectively reduces diarrhea duration and hospitalization in pediatric patients with acute gastroenteritis.
• The positive effects, particularly on diarrhea duration, were more pronounced in European trials.
• High heterogeneity and methodological limitations across the included trials necessitate cautious interpretation of the overall findings.