Protection from Gastro-intestinal Diseases
with the use of Probiotics.
Presented at the symposium
Probiotics and Prebiotics held in Kiel, Germany June 11―12, 1998.
Probiotics are nonpathogenic microorganisms that, when ingested, exert a positive influence on the health or physiology of the host. They can influence intestinal physiology either directly or indirectly through modulation of the endogenous ecosystem or immune system.
The results that have been shown with a sufficient level of proof to enable probiotics to be used as treatments for gastrointestinal disturbances are:
- the good tolerance of yogurt compared with milk in subjects with primary or secondary lactose maldigestion,
- the use of Saccharomyces boulardii and Enterococcus faecium SF 68 to prevent or shorten the duration of antibiotic-associated diarrhea,
- the use of S. boulardii to prevent further recurrence of Clostridium difficile―associated diarrhea, and
- the use of fermented milks containing Lactobacillus Rhamnosus GG to shorten the duration of diarrhea in infants with rotavirus enteritis (and probably also in gastroenteritis of other causes).
Effects that are otherwise suggested for diverse probiotics include alleviation of diarrhea of miscellaneous causes; prophylaxis of gastrointestinal infections, which includes traveler's diarrhea; and immunomodulation. Trials of gastrointestinal diseases that involve the ecosystem are currently being performed, eg, Helicobacter pylori infections, inflammatory bowel disease, and colon cancer.
- Probiotics can be defined as nonpathogenic microorganisms that, when ingested, exert a positive influence on the health or physiology of the host.
- They consist of either yeast or bacteria, especially lactic acid bacteria.
- Their fate in the gastrointestinal tract and their effects differ among strains
- The effects of probiotics can be direct or indirect through modulation of the endogenous flora or of the immune system
.
Probiotics improve lactose digestion and have other enzymatic effects.
Lactose maldigestion occurs frequently, especially in adults (primary lactose maldigestion) and in persons with bowel resection or enteritis (secondary lactose maldigestion). It is well established that persons with lactose maldigestion experience better digestion and tolerance of the lactose contained in yogurt than of that contained in milk3.
The mechanisms involved have been extensively investigated. The importance of the viability of lactic acid bacteria was speculated as pasteurization reduced the observed digestibility. At least 2 mechanisms, which do not exclude each other, have been shown: digestion of lactose in the gut lumen by the lactase contained in the yogurt bacteria (the yogurt bacteria deliver lactase when lyzed by bile acids) and slower intestinal delivery or transit time of yogurt compared with milk 3-6.
In clinical practice, the replacement of milk with yogurt or fermented dairy products allows for better digestion and decreases diarrhea and other symptoms of intolerance in subjects with lactose intolerance, in children with diarrhea, and in subjects with short-bowel syndrome 3,4,7,8.
An enhanced digestion of a sucrose load was shown in infants with sucrase deficiency when they consumed Saccharomyces cerevisiae, ie, a yeast that contains the enzyme sucrase9. This is yet another example of a direct effect of a probiotic; however, its relevance in the treatment of sucrase deficient subjects is not established.
Antibiotic-Associated Diarrhea.
Diarrhea occurs in 20% of patients who receive antibiotics. Antibiotic-associated diarrhea (AAD) results from a microbial imbalance that leads to a decrease in the endogenous flora that is usually responsible for colonization resistance and to a decrease in the fermentation capacity of the colon. Clostridium difficile and Klebsiella oxytoca contribute to the occurrence of AAD in some cases and play a role in the pathogenesis of colonic lesions.
Several attempts have been made to determine whether the administration of probiotics would prevent antibiotic-associated intestinal symptoms (mainly AAD). Randomized controlled trials have showed a significant therapeutic effect of probiotics;
Three randomized, double-blind, placebo-controlled studies showed that oral administration of Saccharomyces boulardii (Ultralevure, Biocodex, France) can decrease the risk of AAD. Another study showed that S. boulardii significantly shortened the duration of AAD 22. The mechanism involved is unclear because multiple biological effects of the yeast in the gastrointestinal tract have been shown, which may contribute to the clinical efficacy of S. boulardii (ie, effects against the population levels of C. difficile, toxins, and intestinal secretion) 23, 24.
Gastritis
Gastroenteritis is the main cause of acute diarrhea and is a frequent disorder that usually heals spontaneously within a few days. Gastroenteritis can be due to several viral or bacterial pathogens or to parasites, but the most frequent cause in children is rotavirus infection. The use of oral rehydration solutions is the main treatment, but it does not shorten the duration of diarrhea.
Several controlled randomized trials showed a beneficial effect of probiotics and fermented dairy products in infantile or, less often, adult gastroenteritis; however, this is not a general property of all probiotics. Lactobacillus rhamnosus GG (L. GG, Valio, Finland) has been shown to be effective in the treatment of infant rotavirus diarrhea.
L. rhamnosus GG repeatedly reduced the duration of diarrhea by about half in randomized controlled trials. It also proved effective in the treatment of acute diarrhea in children in Asia 34, 35.
Abstract presented by:
Philippe R Marteau, Michael de Vrese, Christophe J Cellier and Jurgen Schrezenmeir
From the Gastroenterology Department, Hôpital Europèen Georges Lompidou, Assistance Publique des Hôpitaux de Paris and Paris V University, Paris, and the Institute of Physiology and Biochemistry of Nutrition, Federal Dairy Research Center, Kiel, Germany.
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