Lactobacillus rhamnosus GG (LGG) for Crohn Disease
Verdict: Counter-Evidence
Across 6 PubMed studies, the evidence for Lactobacillus rhamnosus GG (LGG) in Crohn Disease grades Tier D — counter-evidence. High-quality evidence indicates it is not effective (or is harmful) for this use.
D 🔴 D Counter-Evidence Counter-Evidence
Why this grade7-layer evidence engine
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Scoring transparency
All scores computed by a 7-layer evidence engine — fully auditableRaw score 0.28
D
C
B
A
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← counter-evidence / ineffectiveeffective / strong evidence →
Final grade
D · Counter-Evidence
Confidence
72%
Broadly consistent
Evidence level
E1
Cochrane high-quality SR/MA
▸View the full decision path (audit trail)
- compute_raw_score — 加權公式: L2×0.30 + L3×0.25 + L5×0.25 + L11×0.10 + L1×0.10 = 0.278
- tier_from_score — 依分數區間映射至 tier letter
- apply_hec_rules — 高品質 SR/MA 顯示 negative 主導 (3 negative > 1 positive)，下層 RCT 不能推翻
- tier_strict_requirement_check — Tier 條件達標，未降階
- detect_disputes — 偵測到 0 個 hard + 0 個 soft dispute
- decide_status — 依 tier + dispute 結果決定 status
PubMed studies (6)L2 · primary research & systematic reviews
Probiotics for maintenance of remission in Crohn's disease
Finding: Across 7 small trials no probiotic (including LGG) beat placebo: LGG after medical remission RR 0.83 (95% CI 0.25-2.80), after surgical remission RR 1.58 (95% CI 0.30-8.40), and in children RR 1.85 (95% CI 0.77-4.40) — all non-significant, with the authors concluding there is no evidence probiotics are beneficial for maintaining CD remission.
View on PubMed Meta-analysis: the effect and adverse events of Lactobacilli versus placebo in maintenance therapy for Crohn disease
Finding: Pooled across 6 RCTs Lactobacilli did not reduce clinical relapse (RR 1.15, 95% CI 0.90-1.48), and the strain-exact L. rhamnosus GG subgroup showed significantly INCREASED relapse (RR 1.68, 95% CI 1.07-2.64), prompting the authors to warn that LGG maintenance 'may increase the relapse rates of Crohn disease.'
View on PubMed A randomized, double-blind trial of Lactobacillus GG versus placebo in addition to standard maintenance therapy for children with Crohn's disease
Finding: Adding LGG did not prolong remission: 31% (12/39) relapsed on LGG vs 17% (6/36) on placebo (P=0.18), with median time to relapse 9.8 months on LGG vs 11.0 months on placebo (P=0.24) — numerically worse on LGG but not statistically significant.
View on PubMed Ineffectiveness of probiotics in preventing recurrence after curative resection for Crohn's disease: a randomised controlled trial with Lactobacillus GG
Finding: Among the 37 patients in clinical remission, endoscopic recurrence occurred in 60% (9/15) on LGG vs 35.3% (6/17) on placebo (P=0.297), and the authors concluded LGG neither prevents endoscopic recurrence nor reduces lesion severity after surgery.
View on PubMed Efficacy and safety of probiotics in the induction and maintenance of inflammatory bowel disease remission: a systematic review and meta-analysis
Finding: In this newer pooled analysis (10 RCTs, 777 UC+CD patients; not LGG-specific) probiotics showed no benefit for maintaining Crohn's remission (RR 0.80, 95% CI 0.61-1.06, P=0.12), with the authors concluding probiotics have 'no obvious therapeutic advantage in maintaining CD' remission.
View on PubMed Systematic review of randomized controlled trials of probiotics, prebiotics, and synbiotics in inflammatory bowel disease
Finding: Across 14 Crohn's disease studies (not LGG-specific) multiple probiotic-vs-placebo comparisons showed no significant difference in clinical outcomes, and the review concluded there is 'insufficient data to recommend probiotics for use in CD' while supporting their use in UC and pouchitis.
View on PubMed Regulatory & authoritative positionsL4/L5 · FDA / EMA / NIH ODS / Cochrane / Mayo …
L4a US FDA
Supportive
GRN No. 231 — Notified Substance: Lactobacillus casei subsp. rhamnosus strain GG. Intended Use: Ingredient in term infant formula, at levels not to exceed 10^8 colony forming units per gram of powdered formula. Notifier: Mead Johnson & Company. Agency Response: FDA has no questions (closure date: May 29, 2008). source↗
L4b EU EFSA
Cautious
The bacterial species L. rhamnosus (now Lacticaseibacillus rhamnosus) is considered by EFSA to be suitable for the qualified presumption of safety (QPS) approach to safety assessment. However, the EFSA Panel on Dietetic Products, Nutrition and Allergies concluded that a cause and effect relationship has not been established between the consumption of Lactobacillus rhamnosus GG (ATCC 53103, LGG)… source↗
L4c UK NHS
Neutral
Probiotics are generally classed as food rather than medicine, which means they don't go through the rigorous testing medicines do. ... For most people, probiotics appear to be safe. If you want to try them, and you have a healthy immune system, they shouldn't cause any unpleasant side effects. ... If you have an existing health condition or a weakened immune system, you should talk to a doctor… source↗
L4d TW TFDA / 衛福部
Supportive
Lactobacillus rhamnosus is listed in the 'Food Ingredients Available for Use' (可供食品使用原料) comprehensive list as a lactic acid bacterium (乳酸菌), in the form of bacterial cells (菌體), and can be used as a food ingredient or for food processing purposes. source↗
L4e WHO
Supportive
Administration of Lacticaseibacillus rhamnosus GG (LGG) to children with gastroenteritis is recommended by universal guidelines. The World Gastroenterology Organisation's Global Guidelines for Probiotics and Prebiotics (2023 update) lists LGG as having documented, positive results in multiple gut-related health areas. The FAO/WHO Joint Working Group (London, Ontario, 2002) 'Guidelines for the E… source↗
L5a NIH Office of Dietary Supplements
Supportive
Lactobacillus rhamnosus GG is an example where Lactobacillus is the genus, rhamnosus is the species, and GG is the strain. Treatment with LGG compared with placebo or no additional treatment reduced the risk of antibiotic-associated diarrhea in patients treated with antibiotics from 22.4% to 12.3% (relative risk: 0.49). However, when children and adults were evaluated separately, the difference… source↗
L5b Mayo Clinic
Cautious
there is very little evidence to justify the use of probiotics for the treatment of Crohn's disease source↗
L5c Cleveland Clinic
Neutral
Inflammatory bowel diseases, like ulcerative colitis and Crohn's disease ... Taking oral probiotics might help prevent or treat these conditions, although results may vary. The Lactobacillus genus, including L. acidophilus, L. rhamnosus, L. casei and L. plantarum. source↗
L5d Harvard Health
Cautious
Probiotics have not been studied as rigorously in Crohn's disease as in ulcerative colitis. Most of the limited set of studies found that probiotics are no better than placebo in reducing symptoms or promoting remission. source↗
L5e Specialty Society (condition-mapped)
Against
Probiotics do not seem to help people with Crohn's. source↗