Journal of clinical gastroenterology
-
Acute pancreatitis (AP) is an acute inflammatory process ranging from mild forms to severe disease with high rates of mortality. In this disease, enteral nutrition helps in maintaining the integrity of the gut barrier, with consequent decreased bacterial translocation, a key factor in limiting the complications in severe AP. Modulation of the intestinal flora through the administration of probiotics (PBs) has thus an intriguing rationale as possible treatment option. ⋯ An interesting scenario emerges from the the papers that have been evaluated. The adjunct of PBs in the treatment of AP may show some advantage in terms of the reduction of infectious complications. Nevertheless, more data on efficacy and safety from a larger and stringently designed study are eagerly waited.
-
J. Clin. Gastroenterol. · Sep 2008
ReviewUnderstanding why probiotic therapies can be effective in treating IBD.
Probiotics, for the treatment of inflammatory bowel disease, are a group of specific nonpathogenic bacteria that are functionally and genetically defined by their ability to reduce inflammation in the intestine. Although probiotics also seem to have broad beneficial effects in humans, both as a food and as a therapeutic agent, there are specific identified mechanisms in some, but not all, of these bacteria that are important relative to the pathogenesis of inflammatory bowel disease. ⋯ In this regard, the role of probiotics for the clinical treatment of inflammatory bowel disease is emerging as the mechanisms and pathogenesis are being unraveled. It remains clear that probiotics are able to reduce gastrointestinal inflammation by exerting positive effects on epithelial cell and mucosal immune dysfunction.
-
Severe sepsis with associated multisystem organ dysfunction is a leading cause of death in patients hospitalized in intensive care units. The gastrointestinal system plays a key role in the pathogenesis of multisystem organ dysfunction owing to a breakdown of intestinal barrier function and increased translocation of bacteria and bacterial components into the systemic circulation. During critical illness, alterations occur in gut microflora owing to several factors, including changes in circulating stress hormones, gut ischemia, immunosuppression, the use of antibiotics, and lack of nutrients. ⋯ Recent studies have shown treatment of patients with multiple trauma or acute pancreatitis with synbiotic preparations resulted in reduced rates of infection, sepsis, and mortality in patients. Enterally fed patients in the intensive care unit treated with a probiotic compound demonstrated enhanced immune function and decreased incidence of diarrhea. Results from these clinical trials are encouraging, and warrant further investigation to clarify which probiotic bacterial strains are of most benefit to this population.
-
This review focuses on the efficacy of probiotics for diarrhea in children in different settings: day-care centers, diarrhea acquired in the hospital, antibiotic-associated diarrhea, and treatment of acute infectious diarrhea. For prevention of diarrhea acquired in day-care centers, 5 randomized and placebo-controlled trials have been published. Probiotics tested were Lactobacillus GG, Bifidobacterium lactis (alone or in combination with Streptococcus thermophilus), and Lactobacillus reuteri. ⋯ They consistently show a statistically significant benefit and moderate clinical benefit of a few, well-identified probiotic strains-mostly Lactobacillus GG and S. boulardii, but also L. reuteri-in the treatment of acute watery diarrhea, primarily rotaviral, in infants and young children of developed countries. Such a beneficial effect seems to result in a reduction of diarrhea duration of little more than 1 day, and to be exerted mostly on diarrhea due to rotavirus. The effect is not only strain-dependent, but also dose-dependent, with doses of at least 10 billion/d being necessary.
-
J. Clin. Gastroenterol. · Jul 2008
ReviewRole of probiotics in antibiotic-associated diarrhea, Clostridium difficile-associated diarrhea, and recurrent Clostridium difficile-associated diarrhea.
The role of probiotics in the prevention and treatment of antibiotic-associated diarrhea, Clostridium difficile diarrhea, and recurrent C. difficile diarrhea is reviewed. Various probiotics have variable efficacy. More studies are needed to define further their efficacies, roles, and indications.