A Meta-Analysis of Probiotic Efficacy for Gastrointestinal Diseases

Department of Biology, Dalhousie University, Halifax, Nova Scotia, Canada.
PLoS ONE (Impact Factor: 3.23). 04/2012; 7(4):e34938. DOI: 10.1371/journal.pone.0034938
Source: PubMed


Meta-analyses on the effects of probiotics on specific gastrointestinal diseases have generally shown positive effects on disease prevention and treatment; however, the relative efficacy of probiotic use for treatment and prevention across different gastrointestinal diseases, with differing etiology and mechanisms of action, has not been addressed.
We included randomized controlled trials in humans that used a specified probiotic in the treatment or prevention of Pouchitis, Infectious diarrhea, Irritable Bowel Syndrome, Helicobacter pylori, Clostridium difficile Disease, Antibiotic Associated Diarrhea, Traveler's Diarrhea, or Necrotizing Enterocolitis. Random effects models were used to evaluate efficacy as pooled relative risks across the eight diseases as well as across probiotic species, single vs. multiple species, patient ages, dosages, and length of treatment. Probiotics had a positive significant effect across all eight gastrointestinal diseases with a relative risk of 0.58 (95% (CI) 0.51-0.65). Six of the eight diseases: Pouchitis, Infectious diarrhea, Irritable Bowel Syndrome, Helicobacter pylori, Clostridium difficile Disease, and Antibiotic Associated Diarrhea, showed positive significant effects. Traveler's Diarrhea and Necrotizing Enterocolitis did not show significant effects of probiotcs. Of the 11 species and species mixtures, all showed positive significant effects except for Lactobacillus acidophilus, Lactobacillus plantarum, and Bifidobacterium infantis. Across all diseases and probiotic species, positive significant effects of probiotics were observed for all age groups, single vs. multiple species, and treatment lengths.
Probiotics are generally beneficial in treatment and prevention of gastrointestinal diseases. Efficacy was not observed for Traveler's Diarrhea or Necrotizing Enterocolitis or for the probiotic species L. acidophilus, L. plantarum, and B. infantis. When choosing to use probiotics in the treatment or prevention of gastrointestinal disease, the type of disease and probiotic species (strain) are the most important factors to take into consideration.

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Available from: Tamara Romanuk, Oct 13, 2014
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    • "Such functional cultures may offer organoleptic, technological and nutritional advantages, but more importantly confer a health benefit to the host. Indeed, administration of probiotics has been linked to the prevention, and in some cases reduction or treatment, of various diseases, including viral or bacterial diarrhea, gastroenteritis, irritable bowel syndrome, inflammatory bowel disease (Crohn's disease and ulcerative colitis), depressed immune function, lactose intolerance, infant allergies, Helicobacter pylori infections, antibiotic-associated diarrhea in children and others (Deshpande, Rao, & Patole, 2011; Hempel et al., 2012; Ritchie & Romanuk, 2012). "
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    • "The application of lactic acid bacteria such as Lactobacillus spp. is a novel potential lifestyle intervention for alleviating the symptoms of type 2 diabetes mellitus, and in the future could act as an adjunct to diabetes treatment (Panwar et al. 2013, 2014). Some lactic acid bacteria have recognized antiinflammatory effects on the intestine and are used in clinical practice (Ritchie and Romanuk 2012). VSL#3 (VSL Pharmaceuticals, Inc., Gaithersburg, MD, USA), for example, is a probiotic bacterial preparation classified by the FDA as a 'medicinal food' that may be useful in the dietary management of three major gastrointestinal conditions: ulcerative colitis , ileal pouchitis and irritable bowel syndrome (Chapman et al. 2007). "

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    • "However, their efficacy varied between different age groups or length of treatment or for single versus multiple species (Ritchie and Romanuk 2012). Similarly, L. crispatus CCTCC M206119 strain was found to be involved in the exacerbation of intestinal inflammation in DSS-colitis mice (Zhou et al. 2012), suggesting the safety and strain based specificity against specific diseases (Ritchie and Romanuk 2012; Van Neil 2005). In a previous study conducted in our laboratory, Sudhakaran et al. (2013) assessed the anti-inflammatory properties of one of the most potent indigenous L. plantarum strains Lp91 both in vitro in THP- 1 cell lines and in vivo using mouse model under inflammatory conditions, demonstrating significant downregulation of TNF-a and increase in IL-6 expression. "
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    ABSTRACT: The relative expression of mucin, pro- and anti-inflammatory genes besides other signaling molecules in HT-29 cells by two test probiotic strains of Lactobacillus plantarum Lp9 and Lp91 and the reference strain L. plantarum 5276 was evaluated by RT-qPCR using Relative Expression Software Tool qBase-Plus under in vitro simulated gut conditions. Ten house keeping genes were evaluated by using geNorm 3.4 excel based application. The most stable genes were RPL27, ACTB and B2M which were subsequently used for calculating the normalization factor. Under pretreatment conditions (4 h probiotic treatment, followed by lipopolysaccharide challenge for 3 h), all the three strains evoked downregulation of IL-8 expression by ~100 %, while in case of TNF-α, the downregulation of the relative gene expression was at the rate of 98.2, 93.8 and 98.0 % with Lp5276, Lp9 and Lp91, respectively, under the same set of conditions. Lp91 evoked maximum downregulation of IL12p35 and IFN-γ with corresponding fold reduction in relative expression of the two genes by 96.5 and 96.7 % during pre-treatment conditions. However, IL-10 and IFN-α were significantly upregulated to the extent of 8.13 ± 0.36 and 2.62 ± 0.14 fold by Lp91 under the same conditions. Lp9 and Lp91 were also quite effective in inducing the expression of Cox-1 and Cox-2 in HT-29 cells as can be reflected from their ratios, i.e., 5.90 and 6.50 (under pretreatment conditions); 3.79 and 4.36 (under co-culture conditions). Thus, the two putative indigenous L. plantarum strains Lp9 and Lp91 demonstrated immunomodulating functions in HT-29 cells at significant levels under different experimental conditions.
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