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J Pediatr Gastroenterol Nutr. 2017 Jul;65(1):117-124. doi: 10.1097/MPG.0000000000001603.

Commercial Probiotic Products: A Call for Improved Quality Control. A Position Paper by the ESPGHAN Working Group for Probiotics and Prebiotics.

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*Children's Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia †Department of Translational Medical Sciences, Paediatric Section, and CEINGE Advanced Biotechnology, and European Laboratory for the Investigation of Food Induced Diseases (ELFID), University of Naples Federico II ‡Department of Translational Medical Sciences, Paediatric Section, University Federico II, Naples §Department of Paediatric Gastroenterology Division, Ospedale Pediatrico Giovanni XXIII University of Bari, Bari, Italy ||Department of Gastroenterology, Hepatology and Nutrition, University Medical Centre Ljubljana, University Children's Hospital Ljubljana, Ljubljana, Slovenia ¶Department IMDO, Vrije Universiteit Brussel, Brussels, Belgium #Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel **The Medical University of Warsaw, Department of Paediatrics, Warsaw, Poland ††UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium ‡‡Emma Children's Hospital-AMC and VU University Medical Center, Amsterdam, The Netherlands §§Ben-Gurion University, Faculty of Health Sciences, Beer-Sheva, Israel.


Probiotics have been proposed for a number of indications ranging from the hypothetical long-term immunomodulatory effects to proven benefits in the management of different clinical conditions.An increasing number of commercial products containing probiotics are available. In those products, irrespective if it is food, food supplement, medical food, or drug, the probiotic microorganisms have to be present in a sufficient number by the end of the shelf-life, to pass through the gastrointestinal tract resisting acid and bile, to colonize the gut, and to retain functional properties required to obtain the suggested beneficial effect. Finally, it should be contamination-free.Studies organized worldwide and summarized in this article have shown that inconsistencies and deviations from the information provided on the product label are surprisingly common. Frequently strains are misidentified and misclassified, products are occasionally contaminated, sometimes with even facultative or obligatory pathogens, strains are not viable, the labeled number of colonies cannot be verified, or the functional properties are diminished to the extent that preclude the proposed health benefit. As the probiotic preparations are commonly used for a wide range of conditions, the aim of the Working Group was to summarize results of the studies looking into the quality of the probiotic products and to raise the awareness of the important issue of their quality control.Based on the results obtained, we strongly suggest a more stringent quality control process. This process should ensure that the probiotic content as mentioned on the label meets the actual content throughout the shelf life of the product, while no contamination is present.

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