Probiotics in GI Compromised Patients

1. Probiotics in GI Compromised Patients By Claudia Morffi Dietetic Intern Andrews University

2. Introduction • Kefir and other fermented products have been consumed for ages • 1857 Pasteur discovers lactic acid bacteria • 1908 Elie Metchnikoff suggests health benefits of lactic acid bacteria • 1935 First commercial product with lactic acid bacteria launched in Asia • 1965 Term “probiotic” used for the first time • 1980s First probiotic yogurt launched in Europe • 2006 Increased awareness of probiotics in US after launch of Activia

3. Introduction • Probiotics: “live microorganisms which when administered in adequate amounts confer a health benefit on the host” • “…that have been shown in properly controlled studies to confer benefits to health” • Live cultures are outside the probioticframework • Faecalmicrobiotatransplants are outside the probioticframework • New commensals and consortia may be called probiotics with substantial evidence

5. True Probiotics • Bifidobacterium species • Enterococcusfaecium • Lactobacillus strains • Saccharomycesboulardii • Bacillus species • Pediococcus

6. Probiotic Potential • Strengthening of the intestinal barrier function, • Modulation of immune responses • Supply of vitamins • Antagonism of pathogens (or other commensals) either by producing antimicrobials or by binding to the mucosa (so called competitive exclusion).

7. Clinical Efficacy

8. IBS • probiotics may suppress low-grade inflammation. • highly sensitive CRP (hs-CRP)

9. IBD • Crohn’s Disease • act against the inflammatory response of the body and become anti-inflammatory agents.

10. IBD • Ulcerative Colitis • it was discussed that probiotics do not improve remission rates and may reduce disease activity when combined with standard therapy

11. Harbingers of Health • The idea is simple: take lactic acid bacteria and incorporate genes into their DNA that produce protein that is beneficial to health. The bacteria could then deliver the protein to the gastro-intestinal tract as it goes about its business. Initial testing is cause for hope: thanks to these enhanced bacteria, researchers were successful in curing model mice of Crohn’s disease.

12. Diverticulitis • probiotics + antibx may help with symptom control in uncomplicated, symptomatic dz • More likely to remain symptom-free after 1 year when they were treated with Lactobacillus casei and mesalazine. • significantly improved the frequency of four other symptoms associated with chronic, non-acute symptomatic diverticular disease

13. Peptic Ulcer Disease • Potential to inhibit development of acute gastric mucosal lesions & accelerate the process of healing • H pylori not eradicated by probiotics might lower level of pathogen may suppress or reduce side effects of standard therapy (diarrhea)

14. Pancreatitis • Reduced total incidence of SIRS & organ failure (late phase of severe AP)

15. Clostridium Difficile • Complement to antibiotic therapy. • CDAD prevention (moderate evidence)

16. Diarrhea • Evidence largely supports the use of probiotics for antibiotic-associated diarrhea • Prevention and/or reduction of duration and complaints of rotavirus-induced diarrhea  • Modulation of the autochthonous (usually intestinal) microflora

17. Constipation • Adults with constipation have significantly decreased numbers of bifidobacteriaand lactobacilli in stool samples • Microbial treatment improves clinical symptoms, promotes the recovery of intestinal flora, and has no complications • Improve gut transit time, stool frequency and consistency, and constipation-related symptoms

18. Kidney Disease • Oxaletes • Probiotics may reduce the amount of oxalate that is absorbed by the body and excreted in the urine

19. Conclusions • Only certain strains of bacteria can be regarded as probiotics • Probiotics can safely be recommended for: • Ulcerative colitis • IBS • Constipation • Diarrhea • Research to be done

20. References