This paper describes the consensus opinion of the participants in the 4th Triennial Yale/Harvard Workshop on Probiotic Recommendations. The recommendations update those of the first 3 meetings that were published in 2006, 2008, and 2011. Recommendations for the use of probiotics in necrotizing enterocolitis, childhood diarrhea, inflammatory bowel disease, irritable bowel syndrome and Clostridium difficile diarrhea are reviewed. In addition , we have added recommendations for liver disease for

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... e first time. As in previous publications, the recommendations are given as A, B, or C ratings. Sigma-tau, and Dannon for their major contributions in supporting this meeting and supplement, as they have in the past. Dr Sanders gave the first talk, 1 and her paper covers the recent perspectives on the concept of probiotics, controls by regulatory agencies, as well as safety issues. Most importantly, she discusses the concept that, when mecha-nistic similarities are shared, probiotic benefits may be attributable to groups of strains rather than only be considered strain specific. This has implications for clinical recommendations and for reviewing the totality of evidence for a systematic review and meta-analysis.