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Probiotics and gastrointestinal diseases
Abstract
There is increasing evidence indicating health benefits by consumption of foods containing microorganisms, i.e. probiotics. A number of clinical trials have been performed to evaluate the effects in the prevention and treatment of gastrointestinal diseases caused by pathogenic microorganisms or by disturbances in the normal microflora. Gastrointestinal infections caused by Helicobacter pylori, traveller's diarrhoea, rotavirus diarrhoea, antibiotic-associated diarrhoea (AAD) and Clostridium difficile-induced diarrhoea are conditions that have been studied. There are also studies performed on the preventive effect of probiotics on radiation-induced diarrhoea and diarrhoea in tube-fed patients. Inflammatory bowel disease and irritable bowel syndrome, two idiopathic conditions where alterations in the normal microflora have been implicated as responsible for initiation, are two further areas where the use of probiotics has been regarded as promising. The results from clinical studies have not been conclusive in that the effects of probiotics have been strain-dependent and different study designs have been used. Treatment of acute diarrhoea in children and prevention of AAD are the two most justified areas for the application of probiotics.
... Gastrointestinal disease (GID) is a major cause of disease burden in the world [1][2][3][4][5][6]. GID is defined as the disease of the gastrointestinal tract, e.g., the esophagus, liver, stomach, small and large intestines, gallbladder, and pancreas. ...
... Likewise, its disability-adjusted life years (1730 per 100,000, 5.9%) ranked 8th among 21 disease groups in Korea for the year 2015 [4], whereas its medical cost amounted to USD 4 billion or 13% of all medical costs in the country for the year 2007 [5]. GID has a variety of causes including: (1) bad health behavior, e.g., low-fiber diet, insufficient exercise, disrupted routine, high-dairy diet, excessive stress; (2) unhealthy bowel habits; (3) excessive anti-diarrheal/antacid medication; and (4) pregnancy [6]. ...
... For instance, a majority of colorectal cancers develop when colorectal polyps, non-cancerous growths of colorectal tissues, begin to invade their surrounding tissues. Most of these colorectal polyps can be removed with no pain based on colonoscopy, whereas more advanced colorectal cancers require more complex surgical operations [1,6]. ...
This study reviews the recent progress of explainable artificial intelligence for the early diagnosis of gastrointestinal disease (GID). The source of data was eight original studies in PubMed. The search terms were “gastrointestinal” (title) together with “random forest” or ”explainable artificial intelligence” (abstract). The eligibility criteria were the dependent variable of GID or a strongly associated disease, the intervention(s) of artificial intelligence, the outcome(s) of accuracy and/or the area under the receiver operating characteristic curve (AUC), the outcome(s) of variable importance and/or the Shapley additive explanations (SHAP), a publication year of 2020 or later, and the publication language of English. The ranges of performance measures were reported to be 0.70–0.98 for accuracy, 0.04–0.25 for sensitivity, and 0.54–0.94 for the AUC. The following factors were discovered to be top-10 predictors of gastrointestinal bleeding in the intensive care unit: mean arterial pressure (max), bicarbonate (min), creatinine (max), PMN, heart rate (mean), Glasgow Coma Scale, age, respiratory rate (mean), prothrombin time (max) and aminotransferase aspartate (max). In a similar vein, the following variables were found to be top-10 predictors for the intake of almond, avocado, broccoli, walnut, whole-grain barley, and/or whole-grain oat: Roseburia undefined, Lachnospira spp., Oscillibacter undefined, Subdoligranulum spp., Streptococcus salivarius subsp. thermophiles, Parabacteroides distasonis, Roseburia spp., Anaerostipes spp., Lachnospiraceae ND3007 group undefined, and Ruminiclostridium spp. Explainable artificial intelligence provides an effective, non-invasive decision support system for the early diagnosis of GID.
... 4 Approximately 80% of the cases of traveler's diarrhea are caused by pathogens in the Enterobacteriaceae family, which includes Escherichia, Shigella, and Salmonella species. 10 Results from studies using different species of Lactobacillus showed varied results in the reduction of diarrhea, dependent upon the specific strain as well as the geographic region in which the subjects resided. 4, 10 For example, one study recorded a 15.6% decrease in diarrhea incidence in a group of travelers going to one location (in comparison to a placebo group), while no significant effect was seen when these tourists traveled to another destination. ...
... 4, 10 For example, one study recorded a 15.6% decrease in diarrhea incidence in a group of travelers going to one location (in comparison to a placebo group), while no significant effect was seen when these tourists traveled to another destination. 10 These differences may be accounted for by such variables as strain, travel history, and method of administration. 4 The most convincing results of probiotic use have been reported in the treatment of children with antibioticinduced nosocomial infections and virus-mediated diarrhea. ...
... However, the results of this study were inconclusive with respect to the probiotic's therapeutic effect. 10 Many early IBD probiotic studies suffered from too small sample sizes and insufficient monitoring times. As with many other studies involving probiotics, there is currently not enough scientific evidence to support the claim that they are beneficial in the treatment and prevention of IBDs. ...
Probiotics are living microorganisms that cause health benefits for a treated host, provided that the host consumes a sufficient amount of the microorganisms. This a rapidly expanding area of research and development because they can be added to diets as a form of preventative health care. This 7-page fact sheet answers questions about the history and current research into probiotics and how to select probiotic products. Written by Fiona Desland, Lauren Christiansen, Mafuza Rahman, Karim Khan, Anastasia Potts, Claudio F. Gonzalez, and Graciela Lorca, and published by the UF Department of Microbiology and Cell Science, December 2011. (Image ©2006 PLoS)
... Los probióticos se definen como "microorganismos vivos (o sus componentes 7 ) que, administrados en adecuadas cantidades, confieren un beneficio sobre la salud en el huésped" [2][3][4][5][6][7][8][9][10] . Su uso está muy extendido y el impacto económico resultante es enorme 5, 9 . ...
... Los microorganismos más usados como probióticos pertenecen al grupo de bacterias de ácido láctico (Lactobacillus (IMAGEN 1)) y Bifidobacterium (IMAGEN 2)), constituyentes importantes de la microbiota GI humana normal (TABLA 1) [1][2][3][4]7 ; Otros menos usados, pero que también están siendo investigados por sus posibles funciones probióticas, son cepas de Streptococcus, Escherichia coli, Bacillus [2][3][4] . También se emplean algunas levaduras no patógenas (Saccharomyces boulardii (IMAGEN 3)) que, normalmente, no se encuentran en el TGI [1][2][3][4]10 . ...
... Los microorganismos más usados como probióticos pertenecen al grupo de bacterias de ácido láctico (Lactobacillus (IMAGEN 1)) y Bifidobacterium (IMAGEN 2)), constituyentes importantes de la microbiota GI humana normal (TABLA 1) [1][2][3][4]7 ; Otros menos usados, pero que también están siendo investigados por sus posibles funciones probióticas, son cepas de Streptococcus, Escherichia coli, Bacillus [2][3][4] . También se emplean algunas levaduras no patógenas (Saccharomyces boulardii (IMAGEN 3)) que, normalmente, no se encuentran en el TGI [1][2][3][4]10 . ...
... A healthy intestine is one that maintains an important balance of bacteria such as lactobacilli, Bacteroides, clostridia, streptococci and coliform. Conditions such as climate, stress, excessive alcohol use, high-fat diets, meat, sugar, genetic disorders, chlorine and fluoride in drinking water, antibiotics, inadequate food, exposure to environmental toxins and many others factors could change the balance of our intestinal flora [10][11][12][13][14]. ...
... Lactobacillus sp. quickly colonized in intestinal epithelial which they disorder growth and proliferation of enteropathogens with producing bacteriocin and lactic acid and also reducing pH [10,17,18]. And also, Lactobacillus plays a critical role in the immune system, such as local control immune responses, allergic and inflammation diseases by increasing the activity of macrophages and immunoglobulin IgA production [19][20][21]. ...
Probiotics have antibacterial effects against pathogenic bacteria in the gut while maintaining the balance of intestinal flora such as Lactobacillus. This study aimed to evaluate the antimicrobial activity of four Lactobacillus species against intestinal pathogenic. Four different species of Lactobacillus (Lactobacillus bulgaricus (PTCC 1332), Lactobacillus casei (PTCC 1608), Lactobacillus plantarum (PTCC 1058) and Lactobacillus Fermentum (PTCC 1638)) were experimented to investigate the inhibitory activity against 4 bacterial enteric pathogens (Escherichia coli, Staphylococcus aureus, Shigella dysenteriae and Salmonella paratyphi A) which were separately inoculated in MRS medium (de Man, Rogosa and Sharpe medium) for 48 hours at 37 °C and pH 7. Our results showed that enteropathogens growth was stopped in the presence of all Lactobacillus and inhibition zone was between 12 and 32 millimeter. It can be concluded that these four Lactobacillus strains had potential antimicrobial compounds against human enteric pathogens and should be further studied for their human health benefits.
... Probiotic-containing foods and fermented foods are gaining attention due to their positive effects on the gut microbiota [13,14], and a good gut microbiota has a positive effect on sleep [15,16]. Studies on probiotic-containing foods and/or the gut microbiota include a small study of 8 people in which consumption of yogurt-containing probiotics improved gut bacteria after antibiotic treatment [17]. ...
... Moreover, animal studies have shown that the gut microbiota also affects the sleep-wake cycle, a basic state transition of the brain, and that abnormalities in the gut microbiota can lead to disturbances in brain functions such as memory formation, cognitive function, mental health, and circadian rhythms. Analysis of sleep-wake states by electroencephalography and electromyography has revealed that non-REM sleep during the sleep phase is decreased in mice in which the gut microbiota was removed and, conversely, that non-REM and REM sleep during the active phase are increased compared with normal mice [14]. This study analyzed a large dataset from participants who were considered to be representative of the Japanese population [26]. ...
Background
We previously reported that 1-year-old infants born to mothers who regularly consumed fermented food during pregnancy had a lower risk of sleep deprivation. However, it is not known if these positive effects are enhanced when infants themselves eat fermented foods or the long-term effects of such consumption. In this study, we examined the association between the frequency of fermented food intake during the child’s weaning period and sleep deprivation at age 1 and 3 years.
Methods
This birth cohort study used data from a nationwide, government-funded study called the Japan Environment and Children’s Study (JECS), covering 65,210 mother-child pairs. We examined the association between infants’ consumption of fermented foods at 1 year of age and sleep deprivation at 1 and 3 years of age.
Results
There was no association between yogurt or cheese intake and sleep duration at age 1; at age 3, there was no group difference, although a trend test showed that yogurt intake at age 1 was significantly associated with sleep duration at age 3. There was also no association between the frequency of cheese intake and inadequate sleep duration at age 3.
Conclusion
Frequency of children’s yogurt and cheese intake at age 1 was not associated with sleep duration at age 1 or 3. However, a trend test showed a significant association between the frequency of yogurt intake at age 1 and sleep duration at age 3.
... Although the A. muciniphila levels did not change when switching diets, the change in diet from an isoflavone diet to a phytoestrogen-free diet significantly reduced the abundance of Bifidobacterium species, specifically Bifidobacterium adolescentis and Bifidobacterium longum [58]. As Bifidobacterium is designated as beneficial "probiotic" species [59][60][61][62], losing these species after the diet change to phytoestrogen-free indicates overall deterioration of gut microbiome homeostasis. Interestingly, the phytoestrogen metabolizing genes and equol levels were lost within a week after switching the diet from an isoflavone diet to a phytoestrogen-free diet [58]. ...
Multiple sclerosis (MS) is a chronic and progressive autoimmune disease of the central nervous system (CNS), with both genetic and environmental factors contributing to the pathobiology of the disease. While HLA genes have emerged as the strongest genetic factor linked to MS, consensus on the environmental risk factors is lacking. Recently, the gut microbiota has garnered increasing attention as a potential environmental factor in MS, as mounting evidence suggests that individuals with MS exhibit microbial dysbiosis (changes in the gut microbiome). Thus, there has been a strong emphasis on understanding the role of the gut microbiome in the pathobiology of MS, specifically, factors regulating the gut microbiota and the mechanism(s) through which gut microbes may contribute to MS. Among all factors, diet has emerged to have the strongest influence on the composition and function of gut microbiota. As MS patients lack gut bacteria capable of metabolizing dietary phytoestrogen, we will specifically discuss the role of a phytoestrogen diet and phytoestrogen metabolizing gut bacteria in the pathobiology of MS. A better understanding of these mechanisms will help to harness the enormous potential of the gut microbiota as potential therapeutics to treat MS and other autoimmune diseases.
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... (ii) Enhancing the intestinal immune response. Probiotics have been proved to enhance humoral immunity response by increasing the cells secreting IgG, IgM, and IgA [12,13]. (iii) Improving intestinal barrier function. ...
Probiotics are widely recognized for their ability to prevent and therapy antibiotic-associated diarrhea (AAD). This study was designed to evaluate Lactiplantibacillus plantarum ELF051 ability to prevent colon inflammation and its effect on gut microbial composition in a mouse model of AAD. The mice were intragastrically administered triple antibiotics for 7 days and then subjected to L. plantarum ELF051 for 14 days. The administration of L. plantarum ELF051 ameliorated the pathological changes in the colon tissue, downregulated interleukin (IL)-1β and tumor necrosis factor (TNF)-α, and upregulated IL-10, and increased the intestinal short-chain fatty acids (SCFAs) level. Lactiplantibacillus plantarum ELF051 also regulated the Toll-like receptor/myeloid differentiation primary response 88/nuclear factor kappa light chain enhancer of activated B cells (TLR4/MyD88/NF-κB) and the phosphatidylinositol 3-kinase/protein kinase B/ NF-κB (PI3K/AKT/ NF-κB) inflammatory signaling pathways. 16S rRNA analyses showed that L. plantarum ELF051 increased the abundance and diversity of gut bacteria, restoring gut microbiota imbalance. A Spearman's rank correlation analysis showed that lactobacilli are closely associated with inflammatory markers and SCFAs. This work demonstrated that L. plantarum ELF051 can attenuate antibiotic-induced intestinal inflammation in a mouse AAD model by suppressing the pro-inflammatory response and modulating the gut microbiota.
... In addition, humans, like animals, live in continuous association with the complex population of microorganisms inhabiting their gastrointestinal tract. One of the main beneficial effects emanating from their alliance is the protection and enhancement of the host's resistance to infectious diseases [7,8,9]. However, the composition of this flora can be altered by various dietary and environmental factors, which make the host organism susceptible to digestive diseases or disorders. ...
This study aims to examine the effects induced by lead acetate (Pb) using different experimental approaches, such as neurobehavioral, biochemical, and histological in young Wistar rats during gestation and lactation, and to test the probiotic effect of Lactobacillus rhamnosus (Prob) throughout correcting or not the harmful effects of the studied metal. Chronic exposure to 0.2% lea acetate in rats during the development period resulted in a decrease in body and brain weights compared to controls. Test results for depression (forced swimming test), anxiety (Elevated plus
maze), and locomotor and exploratory activity (Open field) all show that Pb intoxication causes neurobehavioral disorders, leading to decreased locomotor activity and a reduction of the exploration behavior of the environment which reflects the establishment of a state of stress, anxiety, and depression. In fact, the
histopathological analysis revealed significant lesions in the brain tissue. Furthermore, the administration of probiotics (Prob) allowed the rats to regain body and brain weight when compared to the intoxicated rats. In addition, the use of various behavioral test techniques reveals that the administration of Lactobacillus rhamnosus corrects the depressive state, locomotor hypoactivity, and anxiety observed in rats exposed to Pb. Blood antioxidant status analysis revealed that Prob
restored the activity of different antioxidant enzymes (SOD, CAT, GPx, and GSH) and non-enzymatic enzymes (glutathione) in rats intoxicated and treated with Prob. In effect, the histological study showed a significant improvement in the brain histology in rats intoxicated and treated with Prob. This illustrates the important implications of probiotic lactobacilli and their therapeutic properties.
... Rinsing with chlorhexidine followed by lozenges containing S. salivarius K12 strain decreased the respiratory levels of VSCs in most subjects and maintained their levels for at least 2 weeks. (Sullivan and Nord, 2005). This strain produces two lantibiotic bacteriocins that inhibit gram-positive strains involved in halitosis (Meurman and Stamatova, 2007). ...
Oral diseases are among the most common diseases around the world that people usually suffer from during their lifetime. Tooth decay is a multifactorial disease, and the composition of oral microbiota is a critical factor in its development. Also, Streptococcus mutans is considered the most important caries-causing species. It is expected that probiotics, as they adjust the intestinal microbiota and reduce the number of pathogenic bacteria in the human intestine, can exert their health-giving effects, especially the anti-pathogenic effect, in the oral cavity, which is part of the human gastrointestinal tract. Therefore, numerous in vitro and in vivo studies have been conducted on the role of probiotics in the prevention of tooth decay. In this review, while investigating the effect of different strains of probiotics Lactobacillus and Bifidobacteria on oral diseases, including dental caries, candida yeast infections, periodontal diseases, and halitosis, we have also discussed postbiotics as novel non-living biological compounds derived from probiotics.
... Preoperative oral administration of symbiotic can enhance immune responses, attenuate systemic postoperative inflammatory responses and improve the intestinal microbial environment (Sugawara et al., 2006). Most commonly used probiotics are lactic acid producing bacteria such as Lactobacillus, Bifidobacterium, Enterococcus, and Bacillus (Sullivan and Nord, 2005). ...
... We found that lactate enhanced expression of Reg3g in intestinal enteroids and cell line in a dose-dependent manner ( Figures S7A and S7B). Since probiotics are used to treat a number of gut disorders and improve gut health (Pace et al., 2015;Sullivan and Nord, 2005;Wilhelm et al., 2008), we sought to determine the role of Reg3g for the protective effects of probiotics on gut barrier function. Probiotic-fed mice were given i.p. injection of LPS to challenge gut permeability. ...
Changing composition of the gut microbiome is an important component of the gut adaptation to various environments, which have been implicated in various metabolic diseases including obesity and type 2 diabetes, but the mechanisms by which the microbiota influence host physiology remain contentious. Here we find that both diets high in the fermentable fiber inulin and vertical sleeve gastrectomy increase intestinal expression and circulating levels of the anti-microbial peptide Reg3g. Moreover, a number of beneficial effects of these manipulations on gut function, energy balance, and glucose regulation are absent in Reg3g knockout mice. Peripheral administration of various preparations of Reg3g improves glucose tolerance, and this effect is dependent on the putative receptor Extl3 in the pancreas. These data suggest Reg3g acts both within the lumen and as a gut hormone to link the intestinal microbiome to various aspects of host physiology that may be leveraged for novel treatment strategies.
... Bifidobacteria are designated as useful "probiotic" species for the human gut and harbor βglucosidase enzyme activity required for initial hydrolysis of isoflavone glucosides [26][27][28] suggesting that the ISO diet likely selected a metabolic niche of β-glucosidase activity. In addition Bifidobacterium species are better known for their diverse carbohydrate metabolism SCFAs production interaction with the host secondary metabolite production and probiotic effect that influence inflammation and homeostasis. ...
The etiopathogenesis of multiple sclerosis (MS) is strongly affected by environmental factors such as diet and the gut microbiota. An isoflavone-rich (ISO) diet was previously shown to reduce the severity of MS in the animal model experimental autoimmune encephalomyelitis (EAE). Translation of this concept to clinical trial where dietary isoflavones may be recommended for MS patients will require preliminary evidence that providing the isoflavone-rich diet to people with MS (PwMS) who lack phytoestrogen-metabolizing bacteria has beneficial effects. We have previously shown that the gut microbiota of PwMS resembles the gut microbiota of mice raised under a phytoestrogen-free (phyto-free) diet in that it lacks phytoestrogen-metabolizing bacteria. To investigate the effects of phytoestrogens on the microbiota inflammatory response and EAE disease severity we switched the diet of mice raised under a phyto-free (PF) diet to an isoflavone-rich diet. Microbiota analysis showed that the change in diet from one that is ISO to one that is PF reduces beneficial bacteria such as Bifidobacterium species. In addition we observed functional differences in lipopolysaccharide (LPS) biosynthesis pathways. Moreover LPS extracted from feces of mice fed an ISO diet induced increased production of anti-inflammatory cytokines from bone marrow-derived macrophages relative to fecal-LPS isolated from mice fed a PF diet. Eventually mice whose diet was switched from a PF diet to an ISO diet trended toward reduced EAE severity and mortality. Overall we show that an isoflavone-rich diet specifically modulates LPS biosynthesis of the gut microbiota imparts an anti-inflammatory response and decreases disease severity.
... Probiotics, for example, are microorganism-derived supplements. Lactobacillus and Bifidobacteria, two types of live bacteria included in probiotics, protect against gastrointestinal disorders (Sullivan & Nord, 2005). ...
Alzheimer's disease (AD) is a neurological illness that causes memory loss over time. Currently, available pharmaceutical medicines and products are limited, and they have side effects at a higher price. Researchers and scientists have observed significant effects of nutraceuticals. Various preclinical and clinical studies were investigated for the Anti‐Alzheimer's activity of nutraceuticals. The increasing ability of the pathogenesis of AD has led to the analysis of novel therapeutic targets, including the pathophysiological mechanisms and distinct cascades. So, current improvement will show the most adequate and prominent nutraceuticals and suggested concise mechanisms involving autophagy regulation, anti‐inflammatory, antioxidant, mitochondrial homeostasis, and others. The effects of nutraceuticals cannot be ignored; it is important to investigate high‐quality clinical trials. Given the potential of nutraceuticals to battle AD as multi‐targeted therapies, it's vital to evaluate them as viable lead compounds for drug discovery and development. To the best of the authors ‘knowledge, modification of blood–brain barrier permeability, bioavailability, and aspects of randomized clinical trials should be considered in prospective investigations.
Practical applications
Advancements in molecular diagnostic and fundamentals have implemented particular usefulness for drug evaluation. An excess of experimental knowledge occurs regarding the effect of nutraceuticals on AD. There are various preclinical and clinical studies that have been done on nutraceuticals. In addition, various substitute inhibit and enhance some pathophysiological levels associated with AD. Nutraceuticals are easily available and have fewer side effects with cost‐effective advantages. However, further investigations and clinical trials are required to encourage its effect on disease.
... The era of biological medications is not new since live microorganisms (probiotics) were successfully used in controlling gastrointestinal diseases, including infantile diarrhea, necrotizing enterocolitis, antibiotic-associated diarrhea, Rotavirus diarrhea, Helicobacter pylori infections as well as traveler's diarrhea [18,19]. They have been used to inhibit Clostridium perfringens poultry meat infection and control food contamination and aflatoxin production [20,21]. ...
Background
There is an increasing demand to find a potent antibacterial agent against endodontic pathogens with the least toxic effect. The study aimed to evaluate the antibacterial activity of Lactobacilli probiotics on Enterococcus faecalis ( E. faecalis) in comparison to calcium hydroxide paste.
Methods
The study involved two stages; (stage one): determination of the antibacterial properties of three strains of Lactobacilli probiotics supernatants (PS); Lactobacillus plantarum , Lactobacillus rhamnosus , Lactobacillus acidophilus, and a cocktail mix of the three supernatants against E. faecalis using agar well diffusion method in both solution and gel phase. The formed zones of inhibition (ZOI) were measured in millimeters (mm) and compared to each other. PS solution and gel of the largest ZOI were further compared with calcium hydroxide paste (35% Ultra Cal XS Ca(OH) 2 ) This was followed by (stage two): assessment of the minimum inhibitory concentration (MIC) of the PS that showed the largest ZOI against E. faecalis by agar well diffusion assay for both PS solution and gel.
Results
All supernatants showed growth inhibition against E. faecalis, and the cocktail mix showed the largest ZOI. However, no significant difference was found between the supernatants in both the solution and gel phases ( p > 0.05). Ca(OH) 2 showed a significantly lower effect than both the cocktail mix solution and gel ( p < 0.05). The MIC of the cocktail mix solution and gel against E. faecalis was 50 mg/ml. ( p > 0.05).
Conclusion
PS has an antibacterial effect on E. faecalis and was more effective than Ca(OH) 2. Lactobacilli probiotics could be a promising antibacterial agent used as an irrigant or an intracanal medication.
... Trials in which fermented milk products were combined with whole cultures of probiotic Lactobacilli showed better results in terms of recovery from GI tract infections. The results suggest that probiotics may have a place as an adjunctive treatment in H. pylori infections and possibly in prophylaxis (Sullivan and Nord, 2005;Hamilton-Miller, 2003;Schultz et al., 2004;Sen et al., 2002;Niedzielin et al., 2001). Another model is the treatment against infections brought about by Salmonella, a significant GI tract pathogen. ...
Probiotics have an important role in healthcare industry with a special focus on balancing and restoration of gut microbiota. Probiotics helps in nutritional balance as well as disease prevention of both gut and outside the gut. Probiotics belong to bacteria, fungi, and yeast with a predominant genus of Lactobacillus, Enterococcus, Bifidobacterium, Saccharomyces, etc. Probiotics with nutritive claims (nutribiotics) are associated with two subdivisions namely therapeutic and pharmacological probiotics; they are collectively termed as pharmabiotics. The probiotics are obtained from various conventional (diary product, breast milk, fecal) and nonconventional (soil, fruit, insect, fish) sources. Probiotics mode of action associated with epithelial cells in terms of increased adhesion to intestinal mucosa, competitive exclusion of pathogenic microorganisms, production of antimicrobial substances, immune modulation, interaction with tolllike receptors (TLRs), and interaction with NOD-like receptors and probiotics. Apart from all these sources and mode of action, this chapter discusses the probiotic selection guidelines as well as potential of probiotics in healthcare sectors including antibiotics, obesity, cancer, diabetic, heart diseases, and as immune-stimulant. Probiotics could be a powerful and effective medication for the treatment and recovery of COVID-19 patients. Thus, overall healthcare section is more closely associated with the probiotic microbes and as a result of human gut feelings.
... One of the factors that affect children is the diet of their mothers during pregnancy, which is recognized as a lifestyle factor. For example, probiotic-containing and fermented foods are thought to influence the gut microbiota [4] and have received considerable interest because they are associated with maternal health [5,6] or, conversely, the development of diseases [7,8], depending on the amount consumed. It has also been reported that children born by cesarean section are at higher risk of mental and developmental disorders, and one possible reason for this is that they are not exposed to their mother's Open Access *Correspondence: inadera@med.u-toyama.ac.jp gut bacteria at birth. ...
Background
Using cohort data from the Japan Environment and Children’s Study (JECS), we previously reported that the risk of sleep deprivation in 1-year-old children was reduced with a higher maternal intake of fermented foods, particularly miso. The present study, which evaluates children from the same cohort at 3 years of age, is a continuation of that work.
Methods
After applying exclusion criteria to 104,062 records in the JECS dataset, we evaluated 64,200 mother-child pairs in which the child was 3 years old. We examined the association of the dietary intake of fermented foods during pregnancy with child sleep duration < 10 h at the age of 3 years.
Results
Multivariable logistic regression analysis with the lowest quartile used as a reference revealed adjusted odds ratios (95% confidence intervals) for the second through fourth quartiles of 0.98 (0.90–1.06), 0.93 (0.85–1.01), and 0.85 (0.78–0.94) for cheese intake.
Conclusions
The consumption of fermented foods during pregnancy is associated with reduced risk of sleep deprivation in 3-year-old children, albeit in a limited way.
... Probiotics are live micro-organisms, which, when administered in adequate amounts, confer a health benefit to the host. Probiotics act through diverse mechanisms that affect the microbiota [56,61] . This effect may be revealed through changes in either the populations of bacteria or bacterial metabolic activity. ...
More than several hundreds of millions of people will be diabetic and obese over the next decades because their actual therapeutic approaches aim at treating the consequences rather than causes of the impaired metabolism. The wide analysis of the genome cannot predict more than 10–20% of the disease, whereas changes in feeding and social behaviour have certainly a major impact. Several health-related effects associated with the intake of probiotics and prebiotics, including alleviation of lactose intolerance and reducing the risk of diabetes and obesity. Probiotics are live non-pathogenic bacterial components that are helpful in the prevention and treatment of metabolic syndrome or diseases. The probiotic bacteria used in commercial products today are mainly members of the genera Lactobacillus and Bifidobacterium. Additionally, oligosaccharides are the best known ―prebiotics, ―a selectively fermented ingredient that allows specific changes, both in the composition and/or activity in the gastrointestinal microflora that confers health benefits to the host. The isolated carbohydrates and carbohydrate-containing foods, including galactooligosaccharides (GOS), transgalactooligosaccharides (TOS), polydextrose, wheat dextrin, acacia gum, psyllium, banana, whole grain wheat, and whole grain corn also have prebiotic effects. Overall, a number of factors influence the composition of the microflora. These include changes in physiological conditions of the host (e.g., age stress, health status), composition of the diet, and environmental circumstances (e.g., antibiotic therapy, hygiene with antiseptics, etc.). Recognition of the health-promoting properties of certain gut microorganisms has encouraged dietary-based modulation of the human intestinal micro flora towards a more beneficial composition and metabolism. The other potential functional effects of prebiotics are on the bioavailability of minerals, and on lipid metabolism. Potential health benefits may include reduction of the risk of intestinal infectious diseases, cardiovascular disease, non-insulin-dependent diabetes, obesity, osteoporosis and cancer.
Keywords: Probiotic, prebiotic, intestinal microbiota, diabetes, obesity, metabolic diseases
... Examples are probiotics which derive from microorganisms. Live bacteria that are found in probiotics, such as Lactobacillus and Bifidobacteria, protect against gastrointestinal diseases [73]. In recent studies, it is also documented that they protect against the development of allergies in children [74]. ...
Introduction:
Alzheimer’s disease (AD) is a progressive neurodegenerative disease accompanying memory deficits. The available pharmaceutical care has some limitations mostly entailing side effects, shelf-life, and patient’s compliance. The momentous implications of nutraceuticals in AD have attracted scientists. Several preclinical studies for the investigation of nutraceuticals have been conducted.
Areas covered:
This review focuses on the potential use of a nutraceuticals-based therapeutic approach to treat and prevent AD. Increasing knowledge of AD pathogenesis has led to the discovery of new therapeutic targets including pathophysiological mechanisms and various cascades. Hence the present contribution will attend to the most popular and effective nutraceuticals with proposed brief mechanisms entailing antioxidant, anti-inflammatory, autophagy regulation, mitochondrial homeostasis, and more. Therefore, even though the effectiveness of nutraceuticals cannot be dismissed, it is indispensable to do further high-quality randomized clinical trials.
Expert opinion:
According to the potential of nutraceuticals to combat AD as multi-target directed drugs, there is critical importance to assess them as feasible lead compounds for drug discovery and development. To the best of the authors’ knowledge, modification of blood-brain barrier permeability, bioavailability, and features of randomized clinical trials should be considered in prospective studies.
... In addition, bacterial intestinal growth is observed in less than 10% of the cases and associated with aging or other comorbidities such as diabetes mellitus, collagenosis, colon diverticulosis [50]. ...
The condition index of bivalve molluscs reflects the nutritional state and metabolic response to different environmental pressures. The development of bivalves in natural environments is mediated by the interaction between environmental factors. The aim of this study is to determine the condition index of the marine bivalve Mytilus galloprovincialis and to establish the relationship between environmental parameters and the index values. This study was carried out between November and December 2017, at four sampling sites. The mean values of condition index varied between 4.96 g (at 2 Mai) and 9.88 g (at Midia Năvodari Port), the highest index values being recorded in port areas. From all the analyzed parameters, the condition index showed a clear relationship only with seawater temperature, chlorophyll a concentration and total suspended solids.
... Dysbiosis of the gut microbiota may contribute to the pathogenesis of diverticular disease [15•]. Probiotics are presumed to work by maintaining a healthy balance of commensal bacteria in the gut and preventing bacterial overgrowth [77,78]. Furthermore, probiotics may modulate the gut microbiota thereby creating an anti-inflammatory milieu [79]. ...
Purpose of review
The paradigm in the management of diverticular disease is continuously changing. This review serves as an overview of the management of diverticular disease including modifiable risk factors and medical and surgical therapies.
Recent findings
The treatment of acute uncomplicated diverticulitis has changed over time to a more conservative approach with the most recent trials showing that antibiotics neither accelerated recovery nor prevented complications of diverticulitis. Another paradigm shift has been in the surgical management of patients with acute diverticulitis with a more individualized approach favoring delay in surgery.
Summary
Diverticulosis is the most common finding on colonoscopy with a prevalence that increases with age. The management of diverticular disease and its complications are ever evolving with a focus on more conservative approach to the management of uncomplicated disease.
... Ingestion of live probiotic strains has more effective results which varies from strain to strain [88]. Whereas, it is not always essential to accomplish profits [89]. ...
Pollutants of environment increasing day by day and cause health hazard from past several decades. Environmental pollutants that are poorly ingested may be directly metabolized by the gut microbiota, which may lead to detrimental consequences for the host. Their exposure can alter gut microbiota that may associated with metabolic disorders and inflammatory progressions. Probiotics intervention may protect against pollutants toxicity by altering the metabolic activity and composition of gut microbiota. Probiotics have shown the lower threat of antibiotic-associated diarrhea by producing antagonistic effect against pathogenic strains. Besides, probiotics may also enhance host immune system by improving gut microbiota. This chapter summarizes the brief introduction of the classification of probiotics, gut microbiota and health along with different diseases associated with microbial community and functional mechanism of probiotics in metabolic disorders.
... There is increasing evidence indicating health benefits by consumption of foods containing microorganisms (probiotics). A number of clinical trials have been performed to evaluate the effects in the prevention and treatment of gastrointestinal diseases caused by pathogenic microorganisms or by disturbances in the normal microflora [3]. ...
This study was designed to evaluate the immunological effect of viable and heat killed Lactobacillus acidophilus in mice infected with Salmonella typhimurium. The immunological parameters were total and absolute counts of leucocytes and phagocytic index of peritoneal cells. Twelve mice were divided into four groups. Each group consists of 3 mice. Group 1 was used as a negative control. Group 2 was infected with Salmonella typhimurium and use as positive control. Group 3 was fed with viable Lactobacillus acidophilus culture, and infected with culture of Salmonella typhimurium. Group4 was fed with heat killed Lactobacillus acidophilus culture, and infected with Salmonella typhimurium. Results indicated that treatment mice with viable Lactobacillus acidophilus were effective in enhancing the immune responses against Salmonella typhimurium as compared to negative (distilled water) and positive (Salmonella typhimurium) controls. While, mice fed with heat killed Lactobacillus acidophilus showed no enhancing immune effect on mice infected with Salmonella typhimurium.
... In accordance with Yassir et al. (2002), the administration of probiotic microorganisms as Fig. 1 The normal microbiota and probiotic performance in collaboration with the host in metabolic activities and immune function and prevent colonization of opportunistic and pathogenic microorganisms. Source: (Sullivan and Nord 2005;World Gastroenterology Organisation, 2008) development agent on tilapia has utmost impact on the growth performance, wherein Micrococcus luteus was distinguished; in addition, the finest diet conversion proportion was observed by means of the same microorganism of probiotic. Accordingly, they reached the conclusion that M. luteus was counted among the best growth enhancer in fish farming. ...
The incidence of infections by pathogenic microorganisms, coupled with the experimental manifestation of infections, refers to a regular phenomenon in aquaculture species. A number of environmental changes generally give rise to traumatic scenarios, and activating the transient provocative reactions in the gut normally constitutes a factor to the anatomical and efficient intestinal diseases. These infections have frequently given birth to the momentous economic chaos in aquaculture sector. Putting efforts into resolving this issue, the inclusion of antibiotics in the diets of aquaculture species has been introduced either as growth promoters or the stimulation of the immune system against diseases. Nevertheless, both the fears and discussions of consumers and scientists over the antibiotic-resistant microbes and drug remains in meat have resulted into contentious views concerning the uses of antibiotics. This has resulted into forbidding the use of human antibiotics as growth promotants in the diet of animal since the year 2006 by the European Union; also, subsequent to that, in the year 2013, the United States also initiated a plan for the removal of human antibiotics in the diet as growth promotants. Making use of the prebiotics, synbiotics and probiotics as an alternative has proven as improving not just the growth but also the immunity and maintenance of intestine health of cultured species. They are administered in the feeds of culture species for the purpose of stimulating the good health, safeguarding the intestine against pathogenic microorganisms and reducing the inflammation. In the current investigation, we throw discussion on the present uses, together with the limitations and future directions, the immunomodulatory exploit of probiotics, synbiotics and prebiotics, which triggering directly or enhancing the non-specific immune structure of aquaculture species.
... Prebiotics such as inulin are nondigestible food ingredients which are fermented at the level of the colon, causing changes in the intestinal microbiota and resulting in beneficial effects [16]. Probiotics competing with pathogenic micro-organisms could lead to healthy benefits, reducing colonization and bacterial overgrowth of the gastrointestinal tract and favoring the balance of the gut microbiota [17]. ...
Background and aim:
Symptomatic uncomplicated diverticular disease (SUDD) is characterized by abdominal pain, bloating and altered bowel habits (constipation or diarrhea) attributed to diverticula in the absence of macroscopic mucosal alterations. There is no consensus about management of these patients. DIVER-100®, an association of natural active ingredients may be effective in the treatment of patients with SUDD. The aim was to evaluate the efficacy and safety of DIVER-100® in patients with SUDD.
Methods:
We conducted a prospective observational study to evaluate the efficacy of DIVER-100® in consecutive patients with SUDD, confirmed by radiology or endoscopy. All patients were treated with DIVER-100® 2 capsules/day 10 days per month, for 3 months. The primary endpoint was the clinical remission rate, defined as the reduction of abdominal pain and bloating, improvement of bowel habits and prevention of acute diverticulitis (AD). The secondary endpoint was the rate of adverse events.
Results:
One hundred and one patients were consecutively enrolled at the Internal Medicine and Gastroenterology Unit, Sant'Orsola Hospital, Bologna, Italy. DIVER-100® was effective in inducing remission of symptoms in 12 patients (11.9%) at 3 months and in 10 patients (9.9%) at 6 months. DIVER-100® significantly reduced abdominal pain and bloating in 45.5% and 57.4% of patients respectively (p <0.001) after 3 months. No episodes of AD and no adverse events related to DIVER--100® were recorded at month 6 in the study population.
Conclusions:
DIVER-100® is a safe and effective nutraceutical compound in obtaining remission and symptom relief in SUDD patients. Further randomized, placebo-controlled clinical trials are needed to confirm these preliminary data.
... The dietary habits of expectant mothers are lifestyle factors that are generally recognized to affect fetuses and infants. Recently, food products containing probiotics have been actively promoted as part of the maternal diet and have garnered considerable interest [4]. Specifically, certain types of fermented food are thought to affect the intestinal microbiota and have been linked to the maintenance of maternal health [5,6], or conversely the onset of illness, depending on the amount consumed [7,8]. ...
Background
Evidence indicates that human circadian rhythm is affected by the intestinal microbiota, and establishment of the circadian rhythm begins during fetal development. However, the relationship between maternal fermented food intake and infant sleep duration has not been previously investigated. In this study, we examined whether dietary consumption of fermented food during pregnancy is associated with infant sleep duration at 1 year of age.
Methods
This birth cohort study used data from a nationwide government-funded study called The Japan Environment and Children’s Study (JECS). After exclusions from a dataset comprising 104,065 JECS records, we evaluated 72,624 mother-child pairs where the child was 1 year old. We investigated the association between dietary intake of fermented foods during pregnancy and infant sleep duration of less than 11 h at 1 year of age.
Results
Multivariable logistic regression showed that maternal intake of fermented food, especially miso, during the pregnancy was independently associated with reduced risk of infant sleep duration of less than 11 h.
Conclusions
Further research, including interventional studies, is warranted to confirm the association between consumption of fermented foods during pregnancy and sufficient infant sleep duration.
Trial registration
UMIN000030786.
... In the food industry, L. plantarum has fermentative properties and has benefits in food and beverage production including for yogurt, cheese, pickles, beer, wine, and cider. In medicine, L. plantarum is used mostly as a probiotic and biotherapeutic agent to prevent and treat GI disease and diarrhea [8][9][10]. Some strains of L. plantarum inhibit pathogen growth [11], prevent adhesion and invasion of enteropathogens to intestinal epithelial cells [12], act as an anti-inflammatory and regulate immunomodulatory activities to reduce inflammatory responses [13,14], which enhances intestinal function to prevent diarrhea [15] and reduces allergenicity from soy flour [16]. ...
Background
Salmonella typhimurium is a cause of gastroenteritis including diarrhea. Lactobacillus plantarum is a probiotic widely used to prevent and treat diarrhea.
Objectives
To determine the protective effects of L. plantarum B7 on diarrhea in mice induced by S. typhimurium .
Methods
Inhibition of S. typhimurium growth by L. plantarum B7 was determined using an agar spot method. Mice were divided into 3 groups (n = 8 each): a control group, an S group administered 3 × 10 ⁹ CFU/mL S. typhimurium , and an S + LP group administered 1 × 10 ⁹ CFU/mL L. plantarum B7 and 3 × 10 ⁹ CFU/mL S. typhimurium daily for 3 days. Counts of S. typhimurium and percentage of fecal moisture content (%FMC) were determined from stool samples. Serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and CXCL1 were determined.
Results
L. plantarum B7 produced a clear zone on S. typhimurium . There were significantly less S. typhimurium in the feces from mice in the S+LP group than in the S group. Serum levels of TNF-α, IL-6, and CXCL1 in mice from the S group were significantly higher than levels in the S+LP and control groups. Feces from mice in the S group were soft and loose, whereas in the S+LP group they were hard and rod shaped. The %FMC in the S+LP group was significantly less than in the S group.
Conclusions
L. plantarum B7 can inhibit growth of S. typhimurium , decrease levels of proinflammatory cytokines, and attenuate symptoms of diarrhea induced in mice by S. typhimurium .
... The man like animals, live continuously in combination with its resident population of the gastrointestinal tract complex microorganisms. One of the main benefits from their alliance is the protection and improvement of resistance to infectious diseases of the host organism [1]. ...
... Pacientes com alimentação enteral são freqüentemente acometidos por diarréia de etiopatologia múltipla, sendo que hipoalbuminemia e uso de medicamentos estão geralmente envolvidos (SULLIVAN; NORD, 2005). O estudo duplo cego e placebo controlado de Bleichner et al. (1997) demonstrou redução significativa dos episódios de diarréia nesses pacientes pelo emprego de S. bourlardii. ...
The use of probiotic cultures as multifunctional health and welfare promoting agents has greatly increased with the publication of an ever-increasing number of scientific studies attesting their therapeutic efficacy. At the same time, a new approach has been developed for the functioning of the human intestinal tract, which is no longer seen as merely a digestive tube, but has become increasingly recognized as one of the main targets of immune responses. This review explores the main health benefits associated with the regular consumption of food products containing recognized probiotic strains. There is a substantial body of scientific evidence supporting the following health benefits of probiotics: balance of intestinal microbiota, relief of constipation, immunomodulation, prevention of colon cancer, improvement of lactose digestion, prevention of atopic eczema, suppressive activity against gastrointestinal pathogens (Helicobacter pylori, Listeria monocytogenes, Salmonella typhimurium, Giardia intestinalis), prevention of diseases of the female urogenital tract, in addition to other intestinal disorders (diarrhea, Crohn’s disease, irritable bowel syndrome, ulcerative colitis, pouchitis) and diseases of other body systems.
... [8] Trials done by using chlorhexidine rinse followed by K12 lozenges showed reduction in halitosis for two weeks. [9] ...
Probiotics are dietary supplements, which have been advocated for the prevention and the treatment of a wide range of diseases. These products consist of beneficial microorganisms , which stimulate health promoting flora thus, suppressing the pathologic colonization and disease spread. Since, probiotics are now widely used in both medical and dental specialties, a thorough understanding of their risks and benefits are essential. This review focuses on the recent trends in use of probiotics in dentistry as well as the potential risks associated with it.
... Probiotic culture, known to be (+)-lactic acid producer exhibiting promising therapeutic potential, is Lactobacillus casei. The action of this probiotic on intestinal flora results in vital benefits, including prevention and treatment of gastrointestinal disorders, such as colon irritation, constipation, paediatric and travellers' diarrhoea (20)(21)(22), ulcerative colitis and Crohn's disease (23)(24). Other important properties include liver improvement function (25), prevention of cancer and cardiovascular diseases (anticholesterolaemic effect) (26), antimicrobial activity (27)(28) and reduction of food intolerance (29). ...
Viability of L. casei during fermentation in soymilk and freeze-dried soymilk; effect of cryoprotectant, rehydration and storage temperature The aim of the work was to investigate the behaviour of L. casei and the effect of sorbitol on its viability during fermentation in soymilk drink. Values for pH, ranging from 6.82 to 3.42 in the soymilk drink without sorbitol and from 6.74 to 3.41 in the drink with sorbitol were noted during 72 h of fermentation at 25oC. The corresponding values for titratable acidity ranged from 0.071% to 0.758% and from 0.073% to 0.761%, respectively. Soymilk was found to support the growth of L. casei with improvement in viability for 0.24 log at the end of fermentation when sorbitol was added. Survival of L. casei and the effectiveness of sorbitol in improving viability during freeze-drying, subsequent rehydration and during a 5-week period of storage under different temperatures were also investigated. After freeze-drying, L. casei exhibited a survival percent of approximately 46%. Sorbitol improved the viability of L. casei by 0.51 log immediately after freeze-drying and by 1.30 log and 0.47 log during five weeks of storage at 25oC and 4oC, respectively. Further study revealed that the freeze-dried fermented soymilk rehydrated at 45oC was optimum for the recovery of L. casei with improvement in recovery for 0.68 log when sorbitol was added. A higher percent of survival was noted when the dried soymilk was stored at 4oC than at 25oC with improved viability at the end of 5 weeks storage for approximately 6 log for drinks with and without sorbitol. Fermented dried soymilk with sorbitol afforded significant tolerance of L. casei to acid stress. Generally, a stable probiotic diary product was prepared in which the concentration of L. casei remained above therapeutic level of 107 cfu/ml.
... Niacin product by bifidobacteria can reduce cholesterol level. 3 This research aim is to prove the benefit of fermented milk supplementation consumption in elementary students in farms area at Bantul district of Yogyakarta Special Region. The result is expected to be consideration in plan and implementation policy especially in food and nutrition field of children. ...
Probiotics drinks, containing Lactobacillus, were rapidly developed because of its benefit to the health. The bacteria reduced the pathogenic microorganism growth such as virus, fungi, and protozoa. The nutritional status is influenced by food intake, immunity and infection. The children of fisherman’s village are included in the insecure nutrition group because of the low social economic status and healthy living behavior. The aim of this research was to know the influence of daily consumption of probiotics in fermented milk to the nutrition status in elementary school children. This research is quasi-experimental with pretest-posttest control group design. Subjects of 95 elementary school children were divided into 2 groups: 62 children as treatment group and 33 children as control group. Determination of nutritional status is based on anthropometry according to CDC 2000 (BMI-age) growth-chart; and the biochemistry parameter consist of the level of serum total protein, albumin, blood urea nitrogen (BUN), urine creatinine and hemoglobin. Determination of serum total protein and BUN were carried out by Microkjeldahl method, hemoglobine by cyanmet hemoglobin method, albumin by dye-binding method, and creatinine level by Jaffe reaction method. The infection status was determined by anamnesis and laboratory examination of feces which was conducted to find the parasite in the stool. Of sixty five ml fermented milk, that contains of 6.5 x 109 Lactobacillus shirota strain, was consumed every day in 37 days. The data was analyzed by Wilcoxon test for nonparametric data and paired T-test for parametric data. The result shows that after the treatment, it increased the nutritional status athropometrically from underweight to normal (12.9%) and overweight to normal (3.23%). In biochemically, it increased the total protein level from 6,111 to 6,705 mg/dL (p=0,001) and decreased the BUN from 42,709 to 41,127 mg/dL (p=0,004) significantly eventhough it was in normal range. The conclusion is that consuming fermented milk for 37 days in children is proven to enhance the nutritional status both by anthropometric and biochemistry parameter.
Keywords: probiotic, nutritional status, Lactobacillus, fermented milk supplement
... Yeasts as probiotic improve nutrient absorption/assimilation from food and digestion. LAB used as probiotic stimulates and balances the immune system [2], prevents vaginal and urinary tract infections [10,11], prevents and treats side effects of antibiotic therapy [12], aids in digestion of lactose and dairy products by reducing lactose intolerance [13,14] helps in the regulation of bowel movements [15], reduces the toxic load of liver [16,17] inhibits the growth of bacteria which produces nitrates in bowel as production of nitrates could in certain cases cause cancer [2], prevents excessive growth of pathogenic microbes such as candida, E. coli, Helicobacter pylori and Salmonella [18][19][20][21][22] reduces the incidence of yeast infections [11], virginities and candidacies [23], calms down the colon irritation following surgery, supports healthy skin in youth, and is the primary bacteria in infants, which helps them to grow and develop their immune system [24,25], therapeutic for upper respiratory complaints [26], act as remedy for bad breath (halitosis) [27], increase ability to synthesize vitamin B, manufactures vitamin B complex [28], increase the ability to absorb calcium [29,30] reduce the occurrence of bladder cancer [31], prevent and manage atopic dermatitis (eczema) in children [32]. Evidences revealed that all the health claims linked to probiotics are mainly strain specific and the health claim raised by one strain could not be assumed for another strain, even though both comes under the same species [33]. ...
The advent of various health care policies and digital revolution has fuelled interest in the direction of food supplements, and as preventive or curative drug containing live non-pathogenic bacteria, probiotics. The widespread usage of probiotics by consumers and in clinical practice has emphatically made to understand the benefits associated with these products. The probiotic products are now being marketed worldwide by several multinational companies. Present review attempts to overview the health benefits of probiotics in impeding various lifestyle or metabolic associated disorders, clinical significance, their efficacy and influence on immune system.
... The use of probiotics has been proved beneficial against a series of gastrointestinal tract (GIT) disorders including infectious, antibiotic-associated, and travelers'diarrhea (Sullivan and Nord 2005 (Turroni et al. 2010;Shen et al. 2014;Tomasz et al. 2014), and H. pylori infection (Mukai et al. 2002;Tong et al. 2007;Dore et al. 2015;Holz et al. 2015;Szajewska et al. 2015). Specific effects on each of the aforementioned along with the respective mode of action have been recently presented by Domingo (2017). ...
Application of the latest approaches and protocols in probiotic research has resulted in significant advances over the last decade. These refer almost exclusively to the design of probiotic dairy products, mainly through the design of the probiotic culture incorporated. Several protocols have been developed for the assessment of probiotic potential through omic approaches, and many more are currently under development. In addition, through the improvement of our knowledge regarding the mechanisms that lead to infections and disorders, the genetic engineering of probiotic strains aiming at the delivery of bioactive molecules to specific cites was made possible. All these indicate that we are entering an exciting new era with great expectations.
... Probiotics may modify the gut microbial balance leading to health benefits due to their anti-inflammatory effects and capability to enhance anti-infection defences by maintaining an adequate bacterial colonization in the gastrointestinal tract and by inhibiting colonic bacterial overgrowth and metabolism of pathogens [25][26][27]. A recent systematic review aimed to summarize data on the efficacy of probiotics in DD in terms of remission of abdominal symptoms and prevention of AD [28]. ...
Background
Diverticular disease (DD) is a common condition, especially in Western countries. In about 80% of patients, colonic diverticula remain asymptomatic (diverticulosis), while approximately 20% of patients may develop abdominal symptoms (symptomatic uncomplicated diverticular disease, SUDD) and, eventually complications as acute diverticulitis (AD). The management of this condition has been improved, and in the last five years European countries and the USA have published guidelines and recommendations.
Scope
To summarize the latest evidence and clinical implication in treatment of DD focusing the attention either on the treatment of diverticulosis, SUDD and AD together with the primary and secondary prevention of diverticulitis.
Findings
The present review was based on the latest evidence in the treatment of DD in the last 10 years. In the last 5 years, six countries issued guidelines on DD with differences regarding covered topics and recommendations regarding treatments. At present there is a lack of rationale for drug use in patients with asymptomatic diverticulosis, but there are limited indications to suggest an increase in dietary fibre to reduce risk of DD. To achieve symptomatic relief in SUDD patients, several therapeutic strategies with fibre, probiotics, rifaximin and mesalazine have been proposed even if a standard therapeutic approach remained to be defined. Agreement has been reached for the management of AD, since recent guidelines showed that antibiotics can be used selectively, rather than routinely in uncomplicated AD, although use of antibiotics remained crucial in the management of complicated cases. With regard to treatment for the primary and secondary prevention of AD, the efficacy of rifaximin and mesalazine has been proposed although with discordant recommendations among guidelines.
Conclusion
Treatment of DD represented an important challenge in clinical practice, especially concerning management of SUDD and the primary and secondary prevention of AD.
... Mechanisms that have been suggested for this defensive effect contain improvement of the host immune system, competitive blockage of receptor sites (resulting in inhibition of virus cohesion and invasion), and production of substances that inactivate virus particles ( Senok et al., 2005). Many investigations have confirmed the activity of probiotics for the obstruction and treatment of other common gastrointestinal diseases, such as Helicobacter pylori infection and inflammatory bowel diseases, such as irritable bowel syndrome and Crohn's disease ( Niedzielin et al., 2001;Hamilton-Millar, 2003and Sullivan & Nord 2005). Reid et al., (2003 suggested that the probiotic bacteria play a critical role in preventing of the pathogenesis of bowel inflammatory disease, and may be using a mixture rather than a single probiotic strain for effective in alleviating the symptoms ...
Egyptian people are cheese consumer more than market milk consumer. White pickled cheese is the main soft cheese highly accepted by most citizens. The unique manufacture step of pickled cheese (Domiati cheese) is the addition of 10-12% salt directly to cheese milk before renneting. The use of raw milk, and the high salt concentration did not give the opportunity for starter culture application. The Egyptian standardization No. 1008/2005 demanded the necessity of cheese milk heat treatment for various cheese types. It is well known that cheese from row milk is not safe, but it has high organoleptic evaluation. It is very important to find suitable starter for our salty cheese, to have better taste and flavor for having healthy cheese (Healthy is better than tasty).
Probiotic bacteria defined as "live microorganisms which, when administered in adequate amounts, confer a health benefit on the host". (WHO, 2001)
There is a growing agreement on the beneficial effects of bifidobacteria in human health. It is now clear that bifidobacteria that exist in the large intestine are helpful for maintenance of human health. The production of cheeses containing probiotic is an effort to expand the range of probiotic dairy products. The incorporation of such health enhancing cultures would only result in a functional product if the cultures were to maintain viability during cheese ripening and if it do not adversely affect the quality of the product (Khalifa, 2005).
The global probiotics market totaled 31.8 billion and 34.0 billion in 2014 and 2015 respectively. The market should total 50.0 billion by 2020, growing at a compound annual growth rate of 8.0% from 2015 to 2020. The global probiotics market for the food and beverage industry totaled 23.2 billion and 24.8 billion in 2014 and 2015 respectively. (Agheyisi, 2016).
Although Bifidobacteria have been considered to be the most important organisms in infants, and lactobacilli and Escherichia coli are more numerous bacteria for children and adults than Bifidobacteria, it has now become clear that Bifidobacteria also constitute one of the major bacteria in the colonic flora of healthy children and adults. In the feces of children and adults, the numbers of Eubacteria, and Peptococcaceae outnumber Bifidobacteria, which constitute 5 - 10% of the total flora. The number of Enterobacteriaceae and Streptococci decreases to less than 108 cfu gram-1 of feces. Lactobacilli, and Veillonellae are often found, but the numbers are usually less than 108 cfu gram-1 of feces. In elderly persons Bifidobacteria decrease or disappear, Clostridia including C. perfringens significantly increase, and lactobacilli, Streptococci, and Enterobacteriaceae also increase as shown in (Fig. 1) (Mitsuoka, 1990). .
Fig. 1. Changes in the fecal flora with increased age (Mitsuoka, 1990).
For dietary organisms to be beneficial in food systems, they should maintain viability in the food until the time of consumption and be present in significant numbers, at levels of at least 107 viable cells per gram or milliliter of product (Ishibashi and Shimamura, 1993). For this reason, changes in the numbers of bacteria during ripening period must be known. Cheeses have a number of advantages over fresh fermented products such as yoghurt as a delivery system for viable probiotic to gastrointestinal tract as they tend to have higher pH, relatively higher fat content and more solid consistency. These offer protection to probiotic bacteria during storage and passage through the gastrointestinal tract (Ong, 2007).
A number of studies have addressed development of probiotic cheeses using Karish cheese (Osman, 2000), Cheddar cheese (Brearty et al., 2001), Tallage cheese (El-Zayat and Osman, 2001) and white soft cheese (Yilmaztekin et al., 2004 ; El-Fak et al., 2005; Yerlikaya, & Ozer, 2014; and Haddad et al., 2015).
Traditionally, starters are not used in the manufacture of Egyptian cheeses. Several attempts have been made to isolate salt tolerant organisms from ripened Domiati Cheese for use as starters. These include Enterococcus faecalis, Pedicoccus spp., Lb. mesenteroides and Lb. casei (El- Gendy et al., 1983). They are considered to be suitable starters for Domiati cheese made from pasteurized milk (Abd El-Salam and Alichanidis, 2004). Several starters have been evaluated for the manufacture of White brined cheeses and it has been suggested that lactococci and Lactobacillus delbrueckii subsp. bulgaricus, or even a yoghurt culture can give satisfactory results with respect to acidification of the milk (Bintsis and Papademas, 2002).
In this study, four probiotic strains including Bifidobacterium bifidum, Bifidobacteria longum, Lactobacillus delbrueckii ssp. bulgaricus, and Streptococcus thermophilus were examined as a potential candidate for incorporation in soft cheeses.
These strains have been selected based on their acid and bile tolerance, adhesion to intestinal cell line, oxygen sensitivity, anticarcinogenic properties and ability to modify gut microflora of human subjects (Lankaputhra & Shah, 1998; McIntosh et al., 1999; Crittenden et al., 2001; Ong 2007).
The objective of this study is to:
1- To find out a suitable starter for Egyptian soft white cheese made from heat treated milk (pasteurized).
2- The possibility of introducing Probiotic bacteria as a portion of the starter with keeping the quality and characteristic of our distinguished Egyptian soft cheese.
3- To run a comparative study about the proper percentage of the different strains under the study.
4- Evaluation of different combination of starter on the character of resultant soft white cheese.
5- Evaluate the benefit of probiotic soft cheese as a source of anti-hypercholesterolemia using the in vivo studies.
Gastric injury is an event that often occurs due to many factors, such as the use of drugs, stress factors, infections, chemicals, etc. The use of histamin 2(H2) receptor antagonist drugs and pump inhibitors have become the choice for gastric injury treatment so far and requires a relatively long time. The widespread use of probiotics has been shown to affect the healing process of digestive tract disorders, for example in the small intestine. This study aimed to investigate the effect of Lactobacillus plantarumIS-10506 in acceleratingthe healing of gastric injury induced by ketorolac in the rat. The experimental study used 64 Wistar rats divided into 4 groups, group 1 (control), group 2(ketorolac administration), group 3 (ketorolac and probiotic administration), and group 4(preventive treatment with probiotic before, ketorolac administration, and treatment with probiotic). Each group was divided into 4 subgroups based on the day of sacrifice, days 1, 5, 7, 10. The healing of gastric injury evaluating by epithelial defects improvement and fibroblast cells by hematoxylin and eosin (HE) staining.The group induced by ketorolac (group 2) showed the highest epithelial defect score (p=0.048) on day 1. The repair of the epithelial defect in group 3 and group 4 were significantly increased on day 5, while group 2remains defectiveon day 5(p=0.019). Fibroblast cells of groups 3 and 4 decreased significantly more than others on day 10(p=0.024). Lactobacillus plantarum IS-10506 influences the healing acceleration of gastric injury by ketorolac by enhancing epithelial regenerationand fibroblast cells.
Over 70% of human immune system resides in the gut, yet, these gut microbiomes not only regulate intestinal immune system but also influence the systemic immune responses. The role of gut microbiota in health and disease could be better understood with a system-level framework of intricate microbe–microbe and host–microbe chemical crosstalks. Probiotics have been proved to provide species-, strain-, and population-specific health benefits to the host while administered in sufficient doses along with the prebiotics. The synergistic effect of probiotic-prebiotic mixtures maintains gut homeostasis by utilizing prebiotics as a substrate for fermentation. Gut microbiome–host interaction augments by activating cellular and humoral immunomodulation at gastrointestinal digestive system, inflammatory diseases, immune system, nervous system, cardiovascular system, and urinary system. This chapter aimed to review the interactions between probiotics and enteric microbes in the host as well as the various mechanisms used by probiotics to inhibit colonization of intestinal pathogens. Further, the chapter emphasizes on the interactions between gut microbiome and central nervous system to enrich immunity for combating malnutrition and COVID-19. Evidence-based investigations show proven applications on gut microbiome through faecal microbiome transplantation and next-generation probiotics that targets specific health diseases were highlighted.
Diverticulosis and colonic diverticular diseases are increasingly common clinical conditions that are more frequently encountered in elderly patients in industrialized countries and place significant economic and clinical burdens on health-care systems. Treatment of colonic diverticulitis and diverticular bleeding has been well studied; however, prevention of these diverticular diseases has not been established.In this chapter, we discuss the efficacy of traditional herbal medicines, butyrate, curcumin, etc. Traditional herbal medicines may be useful in the treatment of mild-to-moderate acute diverticulitis and reduce episodes of recurrence of diverticulitis. Moreover, butyrate may reduce the frequency of diverticulitis episodes. Curcumin may provide relief from pain associated with symptomatic uncomplicated diverticular disease (SUDD). Larger-scale and multicenter studies are needed to warrant the use of these alternative medicines.KeywordsDiverticular diseaseSymptomatic uncomplicated diverticular disease (SUDD)Acute diverticulitisTraditional herbal medicineButyrateCurcumin
Beneficial microbes play a major role in human health with spectacular symbiotic relationship. The understanding of microbe interaction with human is essential for the novel personalized health care strategies. In this relation, application of probiotics is proposed to account for human health for the prevention and treatment of various diseases. This has driven the researchers with the aspirations to uncover the health impacts of various probiotic bacteria. Furthermore, probiotics have shown promising results as anti-inflammatory, anticancer, antimicrobial, antioxidant, and immunomodulatory potential. Henceforth, probiotics application is a simple, low-cost, receptive, and intrinsic approach to achieve better health outcome in human. In this chapter we have described the current evidences of beneficial bacteria and their influence on human health in the medical sector.
Probiotics are live microbial feed supplements exerts benefit to human and animal health by the microbial balance in the intestine. These bacteria have become increasingly popular during the last two decades due to explorative researches pointing to their beneficial effects on human health. They exhibit various mechanism ranges from bacteriocin and short-chain fatty acid production, lowering of gut pH, and nutrient competition to stimulation of mucosal barrier function and immune modulation. Probiotic foods, based on its origin, are categorized as dairy products and nondairy products, which are reported to be anticarcinogenic, hypocholesterolemic, and antagonists against pathogens. Microorganisms used as probiotics mainly include bacterial strains of Gram-positive bacteria belonging to the types Lactobacillus, Enterococcus, Pediococcus, and Bacillus species in which lactic acid bacteria (LAB) have been used as potential source. They have been found to enhance food quality, microbiological safety, biopreservation, and shelf life. Other potential benefits includes protection against vaginal or urinary tract infection, reduction in ulcers and intestinal tract infections, increased nutritional value, maintenance of mucosal integrity, reduction in catabolic products eliminated by kidney and liver, stimulation of repair mechanism of cells, breaking down and rebuilding hormones, relieving anxiety and depression, formation, maintenance or reconstruction of a well-balanced indigenous intestinal and/or respiratory microbial communities, inhibitory decalcification of the bones in elderly people, and synthesis of vitamins and predigestion of proteins. Probiotic foods act as food supplement and its emergence is recorded globally because of its nutritive value and its therapeutic potential against various ailments of human beings. Various research findings bring out the footstep toward the potentially carcinogenic agents like food dyes, aflatoxins, pesticides, nitrates, and cancer-causing agents in nonfoods such as smokeless tobacco; medications are inactivated by enzyme systems in gut bacteria. Nevertheless, these probiotic effects are still a matter of debate as further research is needed in long-term human studies. Even though tremendous scientific evidences the incorporation of probiotics in nutrition as a means of support to the human health benefits. There is an emerging alarm toward the use of probiotics which increases its role on nutrition and medicine over the next decade because of their application in the prevention, and treatment of various disorders should be considered by medical professionals and promoted by the food industry.
Probiotics are live microbial feed supplements exerts benefit to human and animal health by the microbial balance in the intestine. These bacteria have become increasingly popular during the last two decades due to explorative researches pointing to their beneficial effects on human health. They exhibit various mechanism ranges from bacteriocin and short-chain fatty acid production, lowering of gut pH, and nutrient competition to stimulation of mucosal barrier function and immune modulation. Probiotic foods, based on its origin, are categorized as dairy products and nondairy products, which are reported to be anticarcinogenic, hypocholesterolemic, and antagonists against pathogens. Microorganisms used as probiotics mainly include bacterial strains of Gram-positive bacteria belonging to the types Lactobacillus, Enterococcus, Pediococcus, and Bacillus species in which lactic acid bacteria (LAB) have been used as potential source. They have been found to enhance food quality, microbiological safety, biopreservation, and shelf life. Other potential benefits includes protection against vaginal or urinary tract infection, reduction in ulcers and intestinal tract infections, increased nutritional value, maintenance of mucosal integrity, reduction in catabolic products eliminated by kidney and liver, stimulation of repair mechanism of cells, breaking down and rebuilding hormones, relieving anxiety and depression, formation, maintenance or reconstruction of a well-balanced indigenous intestinal and/or respiratory microbial communities, inhibitory decalcification of the bones in elderly people, and synthesis of vitamins and predigestion of proteins. Probiotic foods act as food supplement and its emergence is recorded globally because of its nutritive value and its therapeutic potential against various ailments of human beings. Various research findings bring out the footstep toward the potentially carcinogenic agents like food dyes, aflatoxins, pesticides, nitrates, and cancer-causing agents in nonfoods such as smokeless tobacco; medications are inactivated by enzyme systems in gut bacteria. Nevertheless, these probiotic effects are still a matter of debate as further research is needed in long-term human studies. Even though tremendous scientific evidences the incorporation of probiotics in nutrition as a means of support to the human health benefits. There is an emerging alarm toward the use of probiotics which increases its role on nutrition and medicine over the next decade because of their application in the prevention, and treatment of various disorders should be considered by medical professionals and promoted by the food industry.
Pasteurized buffalo’s and cow’s skim milk was divided into sixteen lots, and then 3% salt of sodium chloride was added into each. The first part of skim milk (control) coagulated by adding 4ml rennet/liter, while the other fifteen lots of skim milk were divided into 3 groups. Yogurt starter group (Y) contains T1, T2, and T3 tuned into cheese by using 4ml rennet/liter and yoghurt starter in three different proportions. Bifidobacteria starter group (B) which contain T4, T5, and T6 tuned into cheese by using 4ml rennet/liter and Bifidobacteria starter in three different proportions. The admixture group (Y+B) which contains T7, T8, T9, T10, T11, T12, T13, T14, and T15 tuned into cheese by using 4ml rennet/liter and mix of yoghurt and Bifidobacteria starters in nine different proportions. Cheeses from different treatments were sampled and analyzed when fresh (d=0), and after 7, 15, 21, and 30 days of storage period.
Chitosan is an amino-polysaccharide made of glucosamine and N-acetyl-D-glucosamine. Owing to its biocompatible, biodegradable, and nontoxic nature, chitosan is considered as biomaterial, and these unique properties attested that chitosan has greater potential for biological applications. As cationic molecule, chitosan interacts with negatively charged gastrointestinal (GI) mucosal surface and hence is considered as potent mucoadhesive. Therefore chitosan-based encapsulation techniques provide better viability of probiotic microorganisms and protecting the latter in food products and at GI tract. In recent eons, chitosan or chitosan-based nanocomposites are considered as an attractive supportive matrix for enzyme immobilization because of the presence of reactive groups like amino and hydroxyl which supports long-term reusability of the immobilized biocatalyst. The current assignment highlights the recent research and cutting-edge strategies regarding chitosan-based nanomaterials in the field of probiotics encapsulation and enzyme immobilization.
In order to contribute to the diversification of the range of probiotic products, limited until now to the dairy matrices, and to valorize the local raw materials of Cameroon, we set ourselves the objective of finding the conditions of fermentation of the fresh sap of Rafia farinifera by two probiotic ferments, namely, L. fermentum and B. bifidum. We first characterized raffia sap physico-chemically and studied the ability of ferments and their viability in the sap. The physico-chemical characteristics of the sap (3.801%±0.037 dry matter, 7.044±0.172 g of ash per 100 g of dry matter, 10.789±1.388 g of reducing sugars per liter, titratable acidity of 4.44 equivalent grams of lactic acid per liter, pH of 4.12, 2.91±0.94 g of total phenol compounds per liter, density of 1.158 g/l and a Brix of 4.2) and the viability of the ferments in the latter showed the feasibility of this work. Moreover, the optimization of physico-chemical parameters thanks to the Box-Behnken model after maximizing Brix, reducing sugars and proteins and setting the pH at 4, lactic acidity at 9 g/l, the amount of probiotics at 1.00 E+10CFU/ml led to the following operating conditions : B. bifidum and L. fermentum seeding rates of 10 and 2.82%, respectively, an incubation temperature of 37°C and an incubation time of 14 h 2 min. Thus, these conditions made it possible to obtain a drink having a titratable acidity of 8 g of lactic acid/l, a pH of 3.87, a protein content of 574.6 (mg/l), a Brix of 5.47 and a quantity of probiotics of 1.13 E+8 CFU/ml. Beyond this optimization, a sensory analysis performed on the optimized product showed that it was organoleptically acceptable.
Since the consumers demand foods produced without additives, new friendly preservation strategies become significant in processing of foods. Bacteriocins are ribosomally synthesized peptides produced from many bacterial strains which are approved as natural due to being degraded by digestive enzymes. In Lactic acid bacteria (LAB), many strains have been identified as bacteriocin producers. In fact, nisin was approved by Food and Drug Administration (FDA) to be used as food additive in some foods. Lacticin and pediocin producers, Lactococcus lactis and Pediococcus acidilactici, respectively, have been used as protective cultures in food system. Bacteriocins produced by some LAB have shown wide antimicrobial activity against food related pathogens species such as Bacillus, Listeria, Staphylococcus and Clostridium. However, in recent years bacteriocins having specifically narrow-spectrum antimicrobial activity have been introduced. Bacteriocins are used either directly in food systems or by the addition of producer strains. In this way, it has been possible to prevent pathogenic microorganisms in various fermented food products. However, the effectiveness of the LAB bacteriocins may reduce due to their adsorption on to the hydrophobic surfaces and degradation with proteases. Therefore, the combinational usage of bacteriocins with other preservation methods, such as high hydrostatic pressure, pulse electrical field or essential oils, were reported successful at inhibiting pathogens including the Gram negatives. In the first part of the chapter, the general introduction to bacteriocins and new generation bacteriocins are discussed. In the second part, the applications of bacteriocins in different food systems have been explained and the combinational usage of bacteriocins together with different preservation methods have been exemplified.
Helicobacter infection is one of the gastrointestinal diseases, which is usually treated with antibiotics and chemical medicine. These treatments suffer from antibiotic resistance. Thus, this study provides a solution using nettle (Urtica Dioica) extract along with Bifidobacterium (BF). The main challenge is transferring these two compounds to the environment containing Helicobacter pylori (H. pylori) such as stomach. The interaction between the nettle extract and BF and also with H. pylori were studied regarding the inhibition zone diameter, viability of probiotics, pH and acidity changes at three different time intervals (1, 11, and 21 days). Results revealed that the samples containing the nettle extract showed bigger inhibition zone and consequently were more effective in preventing the growth of H. pylori. Furthermore, the nettle extract was enhanced the BF activity resulting in production of more antimicrobial metabolites. The alcoholic extract of nettle provided better inhibition properties than the aqueous extract. The formulated yogurts in this study could pave a new way in bringing new treatments for who suffers from Helicobacter infection induced gastrointestinal diseases.
The present study was focused on evaluating the effect of polyphenols rich extract from Passiflora ligularis (Granadilla) on the risk factors of metabolic syndrome. Twenty-eight overweight induced
Wistar rats were exposed to a two week 30% rich in sucrose diet. The
animals were distributed in a completely randomized experimental
design, forming a 2x3 +1 factorial model (2 sources of extract rich
in polyphenols from Passiflora ligularis and Camellia sinensis, 3
supplementation dose in drinking water 2.0, 2.5, and 3.0 g/l and 1
control group. After 42 days, analyzed variables were food and water
consumption, weight gain, blood glucose, cholesterol and serum triglycerides, and percentage of ethereal feces extracts. A sample of
liver was taken to determine the degree of hepatic steatosis by means
of histological analysis. Results showed effect of polyphenol extract
addition with relation to variables weight gain and lipid percentage
in feces (p < 0.05). The extract of Camellia sinensis statistically reduced water consumption in comparison to the control group. For
serum variables, significant glucose reduction was observed in the
rats fed with doses of 2.5 and 3.0 g/l of the extract rich in polyphenols
from Passiflora ligularis. In both sources of polyphenol-rich extracts,
the highest dose reduced triglycerides levels (p = 0.05).
It is well established in double-blind controlled studies that travelers’ diarrhea to a great extent can be prevented by prophylactic intake of antimicrobial chemotherapeutics [1, 2, 4]. Doxycycline; the combination of sulfamethoxazole/trimethoprim and trimethoprim alone; mecillinam; and recently norfloxacin and ciprofloxacin have shown protection rates of 60%–95%. However, the use of these agents may cause adverse reactions and may lead to emergence of resistant strains of enteric pathogens.
The possible role of Saccharomyces boulardii, a nonpathogenic yeast with beneficial effects on the human intestine, in the maintenance treatment of Crohns disease has been evaluated. Thirty-two patients with Crohns disease in clinical remission (CDAI < 150)="" were="" randomly="" treated="" for="" six="" months="" with="" either="" mesalamine="" 1="" g="" three="" times="" a="" day="" or="" mesalamine="" 1="" g="" two="" times="" a="" day="" plus="" a="" preparation="" of="">Saccharomyces boulardii 1 g daily. Clinical relapses as assessed by CDAI values were observed in 37.5% of patients receiving mesalamine alone and in 6.25% of patients in the group treated with mesalamine plus the probiotic agent. Our results suggest that Saccharomyces boulardii may represent a useful tool in the maintenance treatment of Crohns disease. However, in view of the products cost, further controlled studies are needed to confirm these preliminary data.
Recurrence of Clostridium difficile-associated diarrhea and pseudomembranous colitis occurs in up to 20% of patients after standard therapy. In these patients, subsequent recurrences are even more frequent. Saccharomyces boulardii, a nonpathogenic yeast, was found to be effective in preventing clindamycin cecitis recurrence in an animal model. We performed an open trial of S. boulardii to evaluate its efficacy in treating recurrences of C. difficile-associated colitis in humans. Thirteen patients with recurring C. difficile cytotoxin-positive diarrhea (who had an average of 3.6 previous recurrences) were treated with 10 days of vancomycin and a 30-day course of S. boulardii. Eleven (85%) had no further recurrences. S. boulardii may have a role in treating recurrent C. difficile diarrhea and colitis.
To determine the safety and efficacy of a new preventive agent for antibiotic-associated diarrhea (AAD) in patients receiving at least one beta-lactam antibiotic.
A double-blinded, placebo-controlled, parallel group study was performed in a high-risk group of hospitalized patients receiving a new prescription for a beta-lactam antibiotic and having no acute diarrhea on enrollment. Lyophilized Saccharomyces boulardii or placebo (1 g/day) was given within 72 h of the start of the antibiotic(s) and continued until 3 days after the antibiotic was discontinued, after which the patients were followed for 7 wk.
Of the 193 eligible patients, significantly fewer, 7/97 (7.2%), patients receiving S. boulardii developed AAD compared with 14/96 (14.6%) on placebo (p = 0.02). The efficacy of S. boulardii for the prevention of AAD was 51%. Using a multivariate model to adjust for two independent risk factors for AAD (age and days of cephalosporin use), the adjusted relative risk was significantly protective for S. boulardii (RR = 0.29, 95% CI = 0.08, 0.98).
The prophylactic use of S. boulardii given with a beta-lactam antibiotic resulted in a significant reduction of AAD with no serious adverse reactions.
OBJECTIVE--To determine the safety and efficacy of a new combination treatment for patients with Clostridium difficile-associated disease (CDD). The treatment combines the yeast Saccharomyces boulardii with an antibiotic (vancomycin hydrochloride or metronidazole). DESIGN--A double-blind, randomized, placebo-controlled, parallel-group intervention study in patients with active CDD. Patients received standard antibiotics and S boulardii or placebo for 4 weeks, and were followed up for an additional 4 weeks after therapy. Effectiveness was determined by comparing the recurrence of CDD in the two groups using multivariate analysis to control for other risk factors for CDD. SETTING--National referral study of ambulatory or hospitalized patients from three main study coordinating centers. PATIENTS--A total of 124 eligible consenting adult patients, including 64 who were enrolled with an initial episode of CDD, and 60 who had a history of at least one prior CDD episode. Patients who were immunosuppressed due to acquired immunodeficiency syndrome or cancer chemotherapy within 3 months were not eligible. INTERVENTION--Treatment with oral S boulardii (1 g/d for 4 weeks) or placebo in combination with a standard antibiotic. MAIN OUTCOME MEASURE--Recurrence of active CDD. RESULTS--A history of CDD episodes dramatically increased the likelihood of further recurrences. Multivariate analysis revealed that patients treated with S boulardii and standard antibiotics had a significantly lower relative risk (RR) of CDD recurrence (RR, 0.43; 95% confidence interval, 0.20 to 0.97) compared with placebo and standard antibiotics. The efficacy of S boulardii was significant (recurrence rate 34.6%, compared with 64.7% on placebo; P = .04) in patients with recurrent CDD, but not in patients with initial CDD (recurrence rate 19.3% compared with 24.2% on placebo; P = .86). There were no serious adverse reactions associated with S boulardii. CONCLUSIONS--The combination of standard antibiotics and S boulardii was shown to be an effective and safe therapy for these patients with recurrent CDD; no benefit of S boulardii was demonstrated for those with an initial episode of CDD.
Background: Lactobacillus johnsonii (Lj1) had an in vitro and in vivo inhibitory effect on Helicobacter pylori. Fermented milk containing Lj1 (LC1), coadministered with antibiotics had a favourable effect on H. pylori gastritis. Aim: Evaluate the effect of LC1 intake without antibiotics on H. pylori gastritis. Methods: Fifty H. pylori positive healthy volunteers were randomised in a double-blind study to LC1 or placebo. Gastric biopsies from the antrum and corpus were obtained before, and after 3 and 16 weeks of treatment, for histology and quantitative cultures. Results: Severity and activity of antral gastritis was reduced after 16-week LC1 intake (pretreatment and 16-week inflammatory cell score: 6.0 +/- 0.8 vs. 5.3 +/- 0.1; P = 0.04). H. pylori density decreased in the antrum after LC1 intake (3-week: 4.4 +/- 0.6; 16-week: 4.3 +/- 0.5 log(10) colony forming units (cfu) vs. pretreatment 4.5 +/- 0.4 log(10) cfu; P = 0.04, respectively). Mucus thickness increased after 16 weeks of LC1 consumption (change of mucus thickness with LC1 and placebo in the antrum: 0.6 +/- 1.3 vs. -0.2 +/- 1.0, P = 0.01; in the corpus: 0.3 +/- 1.1 vs. -0.6 +/- 1.5, P = 0.03). Conclusion: LC1 intake had a favourable, albeit weak, effect on H. pylori associated gastritis, particularly in the antrum. Regular ingestion of fermented milk containing L. johnsonii may reduce the risk of developing disorders associated with high degrees of gastric inflammation and mucus depletion.
Antibiotic-associated diarrhoea can be attributed in part to imbalances in intestinal microflora. Therefore, probiotic preparations are used to prevent this diarrhoea. However, although several trials have been conducted, no conclusive evidence has been found of the efficacy of different preparations, e.g. Lactobacillus spp. and Saccharomyces spp.
To conduct a meta-analysis of the data in the literature on the efficacy of probiotics in the prevention of antibiotic-associated diarrhoea.
A literature search was performed of electronic databases, Abstract Books and single paper references. Data were also obtained from the authors. Only placebo-controlled studies were included in the search. The Mantel-Haenszel test was used to estimate the relative risk for single studies and an overall combined relative risk, each study being submitted to the Mantel-Haenszel test for homogeneity.
Twenty-two studies matched the inclusion criteria. Only seven studies (881 patients) were homogeneous. The combined relative risk was 0.3966 (95% confidence interval, 0.27-0.57).
The results suggest a strong benefit of probiotic administration on antibiotic-associated diarrhoea, but further data are needed. The evidence for beneficial effects is still not definitive. Published studies are flawed by the lack of a placebo design and by peculiar population features.
Basic remarks: Among travellers to distant countries with a low socioeconomic status and poor hygiene, traveller's diarrhea is a major problem. Once this epidemiological fact had been recognized, intensive efforts were made to reduce the incidence of this illness by prophylactic medication. Among non-antibiotic substances investigated, Saccharomyces boulardii (SB) appeared to show promising results in earlier studies. Method: In a placebo-controlled, double-blind study, various dosages (250 mg and 1,000 mg SB) were administered prophylactically to 3,000 Austrian travellers to distant regions. Results: A significant reduction in the incidence of diarrhea was observed, with succcess depending directly on the rigorous use of the preparation. A tendency was noted for SB to have a varying regional effect, which was particularly marked in North Africa and in the Near-east (Turkey!); in addition, the effect also proved to be dose-dependent. The medication can be classified as low on side effects.
A three-year, double-blind placebo-controlled study was carried out in infants and toddlers with acute diarrhea to evaluate the efficacy of killed Lactobacillus acidophilus (LB strain) versus a placebo or loperamide, an agent which is no longer approved for use before two years of age. In addition to the study drugs, all the patients were treated as recommended by the WHO. One hundred three subjects aged one month to four years met all the inclusions criteria. No statistically significant differences were found between the three groups for age, sex, cause of diarrhea, duration of diarrhea, number of stools per day at baseline, or mode of rehydration. Treatment efficacy was evaluated on the basis of time to passage of the last abnormal stool (indicating the end of the risk period for dehydration), time to passage of the first normal stool (indicating recovery), and duration of the stool-free period. Recovery rates were not significantly different in the three groups. When the analysis was restricted to those patients who received oral rehydration, mean time to passage of the last abnormal stool was not significantly different in the three groups. In contrast, as compared with the placebo group, mean time to passage of the first normal stool was decreased by 27 hours in the L. acidophilus group. This difference was due to a decrease in the stool-free period. L. acidophilus treatment has no contraindications or adverse effects and may be a useful adjunct to the WHO regimen in pediatric patients with acute diarrhea.
Objective:
To evaluate efficacy of probiotics in prevention and treatment of diarrhoea associated with the use of antibiotics.
Design:
Meta-analysis; outcome data (proportion of patients not getting diarrhoea) were analysed, pooled, and compared to determine odds ratios in treated and control groups.
Identification:
Studies identified by searching Medline between 1966 and 2000 and the Cochrane Library. Studies reviewed Nine randomised, double blind, placebo controlled trials of probiotics.
Results:
Two of the nine studies investigated the effects of probiotics in children. Four trials used a yeast (Saccharomyces boulardii), four used lactobacilli, and one used a strain of enterococcus that produced lactic acid. Three trials used a combination of probiotic strains of bacteria. In all nine trials, the probiotics were given in combination with antibiotics and the control groups received placebo and antibiotics. The odds ratio in favour of active treatment over placebo in preventing diarrhoea associated with antibiotics was 0.39 (95% confidence interval 0.25 to 0.62; P<0.001) for the yeast and 0.34 (0.19 to 0.61; P<0.01 for lactobacilli. The combined odds ratio was 0.37 (0.26 to 0.53; P<0.001) in favour of active treatment over placebo.
Conclusions:
The meta-analysis suggests that probiotics can be used to prevent antibiotic associated diarrhoea and that S boulardii and lactobacilli have the potential to be used in this situation. The efficacy of probiotics in treating antibiotic associated diarrhoea remains to be proved. A further large trial in which probiotics are used as preventive agents should look at the costs of and need for routine use of these agents.
Background & Aims: We have recently documented the efficacy of a highly concentrated probiotic preparation (VSL#3) in the prevention of flare-up in patients with chronic pouchitis. The aim of this study was to compare probiotic therapy with VSL#3 versus placebo in the ability to prevent the onset of acute pouchitis during the first year after ileal pouch-anal anastomosis. Methods: Forty consecutive patients who underwent ileal pouch-anal anastomosis for ulcerative colitis were randomized to receive either VSL#3 (1 packet containing 900 billion bacteria/day) (n = 20) or an identical placebo (n = 20) immediately after ileostomy closure for 1 year. The patients were assessed clinically, endoscopically, and histologically after 1, 3, 6, 9, and 12 months. Health-related quality of life was assessed using the Inflammatory Bowel Disease Questionnaire. Results: Two of the 20 patients (10%) treated with VSL#3 had an episode of acute pouchitis compared with 8 of the 20 patients (40%) treated with placebo (log-rank test, z = 2.273; P Conclusions: Treatment with VSL#3 is effective in the prevention of the onset of acute pouchitis and improves quality of life of patients with ileal pouch-anal anastomosis.
Background: Ten to 15% of patients with pouchitis experience refractory or recurrent disease. The aim of this study was to evaluate the effectiveness of a single daily high dose probiotic preparation (VSL#3) in maintaining antibiotic induced remission, and quality of life (QOL), for one year in such patients. Methods: Patients with pouchitis at least twice in the previous year or requiring continuous antibiotics, associated with a pouchitis disease activity index (PDAI) ⩾7 (0 = perfect; 18 = worst), in whom remission was induced by four weeks of combined metronidazole and ciprofloxacin, were randomised to receive VSL#3 6 g or placebo once daily for one year or until relapse. Symptomatic, endoscopic, and histological evaluations were made before, and two and 12 months after randomisation or at the time of relapse. Remission was defined as a clinical PDAI ⩽2 and endoscopic PDAI ⩽1. Relapse was defined as an increased clinical PDAI score ⩾2 and increased endoscopic PDAI score ⩾3. QOL was assessed using the inflammatory bowel disease questionnaire (IBDQ). Results: Thirty six patients were randomised: 20 to VSL#3 and 16 to placebo. Remission was maintained at one year in 17 patients (85%) on VSL#3 and in one patient (6%) on placebo (p<0.0001). The IBDQ score remained high in the VSL#3 group (p = 0.3) but deteriorated in the placebo group (p = 0.0005). Conclusion: The once daily high dose probiotic VSL#3 is effective in maintaining antibiotic introduced remission for at least a year in patients with recurrent or refractory pouchitis. This is associated with a high level of quality of life.
OBJECTIVE:The influence of the gastrointestinal (GI) microflora in patients with irritable bowel syndrome (IBS) has not been clearly elucidated. This study was undertaken to see if patients with IBS have an imbalance in their normal colonic flora, as some bacterial taxa are more prone to gas production than others. We also wanted to study whether the flora could be altered by exogenous supplementation. In a previous study we have characterized the mucosa-associated lactobacilli in healthy individuals and found some strains with good colonizing ability. Upon colonization, they seemed to reduce gas formation.METHODS:The study comprised 60 patients with IBS and a normal colonoscopy or barium enema. Patients fulfilling the Rome criteria, without a history of malabsorption, and with normal blood tests underwent a sigmoidoscopy with biopsy. They were randomized into two groups, one receiving 400 ml per day of a rose-hip drink containing 5 × 107 cfu/ml of Lactobacillus plantarum (DSM 9843) and 0.009 g/ml oat flour, and the other group receiving a plain rose-hip drink, comparable in color, texture, and taste. The administration lasted for 4 wk. The patients recorded their own GI function, starting 2 wk before the study and continuing throughout the study period. Twelve months after the end of the study all patients were asked to complete the same questionnaire regarding their symptomatology as at the start of the study.RESULTS:All patients tolerated the products well. The patients receiving Lb. plantarum had these bacteria on rectal biopsies. There were no major changes of Enterobacteriaceae in either group, before or after the study, but the Enterococci increased in the placebo group and remained unchanged in the test group. Flatulence was rapidly and significantly reduced in the test group compared with the placebo group (number of days with abundant gas production, test group 6.5 before, 3.1 after vs 7.4 before and 5.6 after for the placebo group). Abdominal pain was reduced in both groups. At the 12-month follow-up, patients in the test group maintained a better overall GI function than control patients. There was no difference between the groups regarding bloating. Fifty-nine percent of the test group patients had a continuous intake of fermented products, whereas the corresponding figure for the control patients was 73%.CONCLUSIONS:The results of the study indicate that the administration of Lb. plantarum with known probiotic properties decreased pain and flatulence in patients with IBS. The fiber content of the test solution was minimal and it is unlikely that the fiber content could have had any effect. This type of probiotic therapy warrants further studies in IBS patients.
Involvement of pathogenic or potentially pathogenic bacteria in the pathogenesis of inflammatory bowel disease has long been suggested because, among other reasons, the inflammatory response resembles that in infectious bowel diseases. Elevated antibody levels to pathogen antigens and a changed metabolic activity of the intestinal microflora have been detected in patients with Crohn's disease. Several studies have revealed a possible etiologic link between intestinal microorganisms and inflammatory bowel disease. Therefore, several therapeutic strategies, including reduction or dilution of bacterial components in the intestine by antibiotics or intestinal lavage, respectively, inactivation of inflammatory bacterial products, and reconstitution of intestinal microflora have been employed, substantiating the idea that dysfunction of the intestinal mucosal barrier and an alteration of bacterial composition contribute to the inflammatory disease. However, the beneficial effect of restoration of the physiologic intestinal microflora in colonic inflammation by exogenous administration of a viable nonpathogenic bacterium has not been investigated before in a placebo-controlled study. Promising results came from the present pilot study in which the nonpathogenic Escherichia coli strain Nissle 1917 was tested for efficacy and tolerance in maintaining remission in patients with colonic Crohn's disease. Application of the physiologic bacteria reduced the risk for relapse and minimized the need for glucocorticoids. Therefore we are convinced that in Crohn's disease parts of the intestinal microflora, including the host's immune response toward indigenous flora or an impairment of the gut flora's metabolic activity are involved in the development or at least in the onset of relapse from remissive of colonic Crohn's disease. However, more data are necessary to prove the benefit of E. coli strain Nissle 1917 as a new therapy to maintain remission of colonic Crohn's disease.
OBJECTIVES:Several studies show that probiotics may prevent side effects during therapy against Helicobacter pylori (H. pylori). Other reports indicate competitive interaction between some probiotics and H. pylori. We compared efficacy of two different probiotics and one probiotic combination with placebo for preventing anti-H. pylori therapy-related side effects and for improving the eradication rate.METHODS:A total of 85 H. pylori positive, asymptomatic patients were randomized in four groups to receive probiotic or placebo both during and for 7 days after a 1-wk triple therapy scheme (rabeprazole 20 mg b.i.d., clarithromycin 500 mg b.i.d., and tinidazole 500 mg b.i.d.). Group I (n = 21) received Lactobacillus GG; group II (n = 22), Saccharomyces boulardii; group III (n = 21), a combination of Lactobacillus spp. and biphidobacteria; and group IV (n = 21), placebo. Subjects filled in weekly symptom questionnaires for 4 wk. Blinded investigators collected and analyzed data. H. pylori status was rechecked after 5–7 wk.RESULTS:Side effects occurred mainly during the eradication week. None of them caused therapy discontinuation. In all probiotic-supplemented groups, there was a significantly lower incidence of diarrhea and taste disturbance during the eradication week with respect to the placebo group. Overall assessment of tolerability was significantly better in the actively treated patients than in the placebo group. No differences in the incidence of side effects between the probiotic groups were observed. The H. pylori eradication rate was almost identical between the probiotic and placebo groups.CONCLUSIONS:All the probiotics used were superior to placebo for side effect prevention, but were not associated with better compliance with antibiotic therapy. The effect of probiotic supplementation on side effects during anti-H. pylori regimens seemed to be independent of the probiotic species used.
Significant progress and new insights have been gained in the 4 years since the first Maastricht Consensus Report, necessitating an update of the original guidelines. To achieve this, the European Helicobacter Pylori Study Group organized a meeting of specialists and experts from around the world, representatives from National Gastroenterology Societies and general practitioners from Europe to establish updated guidelines on the current management of Helicobacter pylori infection. The meeting took place on 21–22 September 2000.
Saccharomyces boulardii is a nonpathogenic yeast used in the treatment of Clostridium difficile diarrhea and colitis. We have reported that S. boulardii inhibits C. difficile toxin A enteritis in rats by releasing a 54-kDa protease which digests the toxin A molecule and its brush border membrane (BBM) receptor (I. Castagliuolo, J. T. LaMont, S. T. Nikulasson, and C. Pothoulakis, Infect. Immun. 64:5225–5232, 1996). The aim of this study was to further evaluate the role of S. boulardii protease in preventing C. difficile toxin A enteritis in rat ileum and determine whether it protects human colonic mucosa from C. difficile toxins. A polyclonal rabbit antiserum raised against purified S. boulardii serine protease inhibited by 73% the proteolytic activity present in S. boulardii conditioned medium in vitro. The anti-protease immunoglobulin G (IgG) prevented the action of S. boulardii on toxin A-induced intestinal secretion and mucosal permeability to [3H]mannitol in rat ileal loops, while control rabbit IgG had no effect. The anti-protease IgG also prevented the effects of S. boulardii protease on digestion of toxins A and B and on binding of [3H]toxin A and [3H]toxin B to purified human colonic BBM. Purified S. boulardii protease reversed toxin A- and toxin B-induced inhibition of protein synthesis in human colonic (HT-29) cells. Furthermore, toxin A- and B-induced drops in transepithelial resistance in human colonic mucosa mounted in Ussing chambers were reversed by 60 and 68%, respectively, by preexposing the toxins to S. boulardii protease. We conclude that the protective effects of S. boulardii on C. difficile-induced inflammatory diarrhea in humans are due, at least in part, to proteolytic digestion of toxin A and B molecules by a secreted protease.
The effectiveness of prophylactic ingestion of a commercial preparation of lactobacilli (Lactinex) for the prevention or modification of traveler's diarrhea was tested in a randomized double blind clinical trial in 50 volunteer travelers to Mexico from the United States. Twenty-six subjects received the lactobacilli preparation and 24 received placebo. The incidence of diarrhea and its duration during the 4 weeks of observation were quite similar for the two preparations: 35% for lactobacilli-treated subjects and 29% for placebo subjects. Typically, the diarrhea was mild, lasting 2 days. From the observations during this study we conclude that prophylactic ingestion of lactobacilli for 1 week does not reduce the incidence or duration of traveler's diarrhea either during the period of ingestion or during the following 3 weeks.
Human Lactobacillus sp strain GG (Lactobacillus GG) administered during acute rotavirus diarrhea has been shown to promote clinical recovery. To elucidate the immune mechanisms behind such a favorable outcome, the ELISPOT (solid phase enzyme-linked immunospot) assay of Ig- and specific antibody-secreting cells among circulating lymphocytes was used, giving indirect evidence of the immunologic events in the gut. After rehydration, 39 children with acute rotavirus diarrhea, mean age 16 (SD 6) mo, randomly received either a Lactobacillus GG fermented milk product (study group) or a pasteurized yogurt (placebo group). The duration of diarrhea was significantly shorter in the study group than in the placebo group [mean 1.1 (SD 0.6) versus 2.5 (SD 1.4)d, p = 0.001]. Lactobacillus GG therapy was associated with a significantly enhanced nonspecific humoral response during the acute phase of the infection, reflected in the IgG, IgA, and IgM Ig-secreting cell numbers. At convalescence, 90% of the study group versus 46% of the placebo group had developed an IgA specific antibody-secreting cell response to rotavirus (p = 0.006). The results indicate that Lactobacillus GG promotes recovery from rotavirus diarrhea via augmentation of the local immune defense. Furthermore, specific IgA response to rotavirus is endorsed, which is possibly relevant in protection against reinfections.
To determine the effect of a human Lactobacillus strain (Lactobacillus casei sp strain GG, Gefilac) on recovery from acute diarrhea (82% rotavirus), 71 well-nourished children between 4 and 45 months of age were studied. After oral rehydration, the patients randomly received either Lactobacillus GG-fermented milk product, 125 g (10(10-11) colony-forming units) twice daily (group 1); Lactobacillus GG freeze-dried powder, one dose (10(10-11) colony-forming units) twice daily (group 2); or a placebo, a pasteurized yogurt (group 3) 125 g twice daily; each diet was given for 5 days, in addition to normal full diet otherwise free of fermented dairy products. The mean (SD) duration of diarrhea after commencing the therapy was significantly shorter in group 1 (1.4 [0.8] days) and in group 2 (1.4 [0.8] days) than in group 3 (2.4 [1.1] days); F = 8.70, P less than 0.001. After rehydration, each dietary group maintained a positive weight trend. The urinary lactulose-mannitol recovery ratios (means [95% confidence intervals]) on admission were 0.09 (0.03, 0.24) in group 1, 0.12 (0.07, 0.22) in group 2, and 0.08 (0.04, 0.18) in group 3; no significant alterations in intestinal permeability were observed at retesting after 2 days of realimentation. The result indicates that early nutritional repletion after rehydration causes no mucosal disruption and is beneficial for recovery from diarrhea. It is further suggested that Lactobacillus GG in the form of fermented milk or freeze-dried powder is effective in shortening the course of acute diarrhea.
A placebo-controlled double-blind study was conducted on the efficacy of Lactobacillus GG in preventing travellers' diarrhoea. Altogether 820 persons travelling on holiday to southern Turkey to two destinations were randomized into two groups receiving either Lactobacillus GG or placebo in identical sachets. On the return flight each participant completed a questionnaire indicating the incidence of diarrhoea and related symptoms during the trip. Of the original group 756 (92%) subjects completed the study acceptably. The overall incidence of diarrhoea was 43.8% (331 cases). The total incidence of diarrhoea in the placebo group was 46.5% and in the Lactobacillus GG 41.0% indicating an overall protection of 11.8%. Protection rates varied between two different destinations with the maximum protection rate reported as 39.5%. Among older age groups there was significantly less diarrhoea when compared to younger travellers. Lactobacillus GG appeared to be effective in reducing the occurrence of travellers' diarrhoea in one of the two destinations with no side effects.
Saccharomyces boulardii, a nonpathogenic yeast, has been widely used in Europe to prevent antibiotic-associated diarrhea (AAD). We performed a prospective double-blind controlled study to investigate AAD in hospitalized patients and to evaluate the effect of S. boulardii, a living yeast, given in capsule form concurrently with antibiotics. Over 23 mo, 180 patients completed the study. Of the patients receiving placebo, 22% experienced diarrhea compared with 9.5% of patients receiving S. boulardii (p = 0.038). Risk factors found to be associated with AAD were multiple antibiotic combinations (containing clindamycin, cephalosporins, or trimethoprim-sulfamethoxazole) and tube feeding. Clostridium difficile, an anaerobe found in the stools of most patients with pseudomembranous colitis, was variably associated with AAD. We evaluated the role of C. difficile in AAD in the study population and found no significant association between the presence of C. difficile or cytotoxin with AAD. Approximately 33% of the patients without diarrhea harbored at least one C. difficile-positive stool and nearly 50% of these patients had detectable cytotoxin. Similar values were obtained in patients with diarrhea. Of C. difficile-positive patients, 31% (5/16) on placebo developed diarrhea compared with 9.4% (3/32) on S. boulardii; this difference was not statistically significant (p = 0.07). There were no discernable adverse effects of yeast administration. We conclude that S. boulardii reduces the incidence of antibiotic-associated diarrhea in hospitalized patients.
To the Editor: Acute diarrhea is the most common illness in travelers to high-risk areas, with up to half of those engaged in short-term travel affected.1 Although most episodes are mild and self-limiting, there is considerable morbidity and disruption to travel. Effective prophylaxis against traveler's diarrhea is therefore desirable. Antibiotics are efficacious but are not recommended for widespread use.1,2 The efficacy of nonpathogenic bacteria such as lactobacilli has been reported, although confirmatory data are lacking.3 Such bacteria may interfere with the colonization and invasion of the gut by enteropathogenic bacteria, as has been demonstrated in vitro.4 We therefore conducted . . .
Our objective was to test, in tube-fed patients whether treatment with antibiotics, the presence of hypoalbuminemia, or the use of hypertonic tube feeding is associated with a higher incidence of diarrhea; how often tube feeding actually causes diarrhea; and whether administration of a Lactobacillus preparation reduces the incidence of diarrhea. Our study design included a randomized, double-blind, placebo-controlled trial of patients on tube feeding for at least 5 days. Stool weights and clinical assessment of bowel function were used as outcome measures. Diarrhea was defined as > 200 g of stool, or three or more liquid stools, in any 24-h period. The tube feeding was considered responsible for diarrhea only when the latter resolved on discontinuation of the feeding. When diarrhea did not resolve, other causes were sought. Of 62 patients enrolled, 41 reached a trial end point. Of these, 34 completed 5 days of feeding without diarrhea, and 7 experienced diarrhea. Although diarrhea was associated with hypoalbuminemia and with protracted treatment with antibiotics, in only 1 subject who had a history of gastric surgery was it caused by tube feeding. The other 6 cases of diarrhea were caused by factors other than tube feeding, mainly drugs administered through the tube. Lactobacillus treatment did not alter the risk of diarrhea. Diarrhea occurs more commonly in tube-fed patients who have low serum albumin levels and have been treated with antibiotics for long periods, but these associations are generally not causal. Hypertonic feeding formulas are not associated with increased risk of diarrhea. Most cases of diarrhea in tube-fed patients are caused by factors extraneous to the tube feeding.
Acute diarrhoea is a serious cause of infant morbidity and mortality, and the development of preventive measures remains an important goal. Bifidobacteria (which constitute the predominant intestinal flora of breastfed infants), as well as other lactic-acid-producing organisms such as Streptococcus thermophilus, are thought to have a protective effect against acute diarrhoeal disease. However, their efficacy has not been assessed in controlled trials. In a double-blind, placebo-controlled trial, infants aged 5-24 months who were admitted to a chronic medical care hospital were randomised to receive a standard infant formula or the same formula supplemented with Bifidobacterium bifidum and S thermophilus. Patients were evaluated daily for occurrence of diarrhoea, and faecal samples, obtained weekly, were analysed for rotavirus antigen by enzyme immunoassay. Faecal samples were also obtained during an episode of diarrhoea for virological and bacteriological analyses. 55 subjects were evaluated for a total of 4447 patient-days during 17 months. 8 (31%) of the 26 patients who received the control formula and 2 (7%) of 29 who received the supplemented formula developed diarrhoea during the course of the study (p = 0.035, Fisher's exact test, two-tailed). 10 (39%) of the subjects who received the control formula and 3 (10%) of those who received the supplemented formula shed rotavirus at some time during the study (p = 0.025). The supplementation of infant formula with B bifidum and S thermophilus can reduce the incidence of acute diarrhoea and rotavirus shedding in infants admitted to hospital.
In 1987 we reviewed the literature on the concept of colonization resistance (CR) (12). In this concept, the indigenous anaerobic flora limits the concentration of potentially pathogenic (mostly aerobic) flora in the digestive tract. This implies that the risk of superinfections by aerobic flora would be eliminated by selecting those antimicrobial agents which spare the anaerobic flora. The concept of CR was based on experiments in animals and uncontrolled observations in patients. It was not validated conclusively. Since publication of our previous review (12), we have improved the design for studying the influence of antimicrobial agents on CR, especially by using human volunteers and analyzing the data in each volunteer separately with single-patient statistics (57, 63). This methodology was applied in the study of several antimicrobial agents (57-61, 63, 64). The resulting data provide a better understanding of the impact of antimicrobial agents on the microbial flora of the bowel. At present, it seems to be the case that some former conclusions were made prematurely, especially those pertaining to the availability of antimicrobial agents that do not impair CR (12, 47). This review will be restricted to a discussion of CR of the bowel.
Basic remarks:
Among travellers to distant countries with a low socioeconomic status and poor hygiene, traveller's diarrhea is a major problem. Once this epidemiological fact had been recognized, intensive efforts were made to reduce the incidence of this illness by prophylactic medication. Among non-antibiotic substances investigated, Saccharomyces boulardii (SB) appeared to show promising results in earlier studies.
Method:
In a placebo-controlled, double-blind study, various dosages (250 mg and 1,000 mg SB) were administered prophylactically to 3,000 Austrian travellers to distant regions.
Results:
A significant reduction in the incidence of diarrhea was observed, with success depending directly on the rigorous use of the preparation. A tendency was noted for SB to have a varying regional effect, which was particularly marked in North Africa and in the Near-east (Turkey!); in addition, the effect also proved to be dose-dependent. The medication can be classified as low on side effects.