An “IBD Passport” Methodology to Assess the Impact of AGA Guidelines on the Behaviors of Gastroenterologists and Patients in Probiotic Use in North-Western Italy
AUTHORS
Renzo Suriani,Scientific Director A.M.I.C.I. Piemonte e Valle d'Aosta ODV, Turin Italy
Mauro Ravizza,formerly Gastroenterology Unit ASL Città di Torino, Turin, Italy
Elena Ercole,Gastroenterology Unit Mauriziano Hospital, Turin, Italy
Caterina Rigazio,Gastroenterology Unit Regina Margherita Hospital, Turin, Italy
Luca Dughera,Internal Medicine Clinic, University of Turin, Italy
Marco Astegiano,Gastroenterology Department University of Turin, Italy
Angela Sambataro,Giorgio Maria Saracco
ABSTRACT
American Gastroenterological Association (AGA), European Crohn's and Colitis Organization (ECCO), and European Society for Clinical Nutrition and Metabolism (ESPEN) currently provide different guidelines for prescribing probiotics in intestinal disorders. These conflicting results cause therapeutic uncertainty in clinicians and an unjustified increase in pharmaceutical spending for the patients, more frequently for patients reporting Inflammatory Bowel Diseases (IBD) in the remission phase. The researchers tried to understand in a group of clinicians and a group of IBD patients whether: a) the indications to prescribe probiotics have to be restricted from clinicians or patients according to recent AGA guidelines, b) the improvement in IBD symptoms during probiotic therapy has to be evaluated based on the opinions of the patient and c) the probiotic to use has to be chosen based on its lower cost. The Authors applied in the general community the Grounded Theory evaluating with the Patients' Outcome Reports (PROs) methodology of investigation. Two reports were addressed twice, in one month, to clinicians and patients selected from those participating in the published educational program "IBD passport", to obtain a critical assessment of the hypotheses. Only 40% of the gastroenterologists adhered to the three assumptions and no patient desired to give up his or her symptomatic treatment with probiotics even when warned that a possible positive result could be due only to a placebo effect. Guidelines for probiotics do not impact the behaviors of clinicians and patients in our area. Clinical trials concerning Live Bio-Therapeutic products (LPBs) could obtain scientifically proven results and clarify when and why to prescribe probiotics in IBD.
KEYWORDS
Probiotic, IBD, Guidelines
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