Evidence For Probiotics Research Articles

The evidence for probiotics in the treatment of digestive disorders in the pediatric population.

Health claims for many probiotic-labeled products are poorly substantiated. This technical review addressed the clinical question: "Do probiotics have a role in the management of the following conditions in childhood?" Evidence supports efficacy for probiotic strains of Saccharomyces boulardii, Lactobacillus reuteri, and Lactobacillus rhamnosus GG for improving outcomes of acute gastroenteritis, of S. boulardii and L. rhamnosus GG for antibiotic-associated diarrhea, and of S. boulardii for Clostridium difficile diarrhea. For functional constipation and GERD, a role for probiotics is questionable as evidence of efficacy is either absent or marginal and as existing treatments are effective. For infantile colic and chronic abdominal pain, where existing treatments have limited efficacy and some important side effects, the use of probiotics, given their safety, is recommended, notwithstanding the evidence is low to moderate. While there is some evidence that probiotics could improve outcomes in the management of celiac disease, obesity, and, to a lesser extent, promotion of growth, their role is adjunctive as dietary management is fundamental. The evidence also supports an adjunctive role for probiotics in the treatment of Helicobacter pylori infection and ulcerative colitis. Decisions on probiotic prescription need to take into account disease tempo, severity, and burden, as well as probiotic strain and dose. Any potential advantage will have to be weighed against the complexity and costs of an additional treatment.

Probiotics combination effectively improves constipation in pregnancy by modifying the gut microbiota composition.

Constipation during pregnancy can induce serious complications, including miscarriage and preterm labour, while the evidence of probiotics in improving constipation during pregnancy was little. In this study, 29 healthy pregnant women and 65 constipated pregnant women were enrolled to assess the effectiveness of probiotics on constipation during pregnancy. Our results showed that the probiotics were effective in improving the Constipation Severity Scale (CSS) and Bristol Stool Scale (BSS) scores, including increasing defecation frequency, decreasing defecation time, and improving fecal characteristics. 16S rRNA sequencing revealed that the probiotics effectively restored the diversity of intestinal microbiota. At the phylum level, Firmicutes (13.27% vs 57.20%) and Actinobacteria (3.77% vs 12.80%) were increased, while Bacteroidetes (77.82% vs 20.24%) was decreased. At the level of the genus, Faecalibacterium (2.03% vs 10.33%), Bifidobacterium (1.21% vs 8.56%), and Phascolarctobacterium (0.05% vs 2.88%), the beneficial bacteria were increased, while the Bacteroides (29.23% vs 12.28%) and Prevotella (24.32% vs 4.92%) were decreased. In conclusion, these results indicated that probiotics can effectively relieve the constipation symptoms by improving the diversity of intestinal microbiota, regulating the disturbance of microflorae, and restoring the balance of microflorae to exert a stronger moderating effect than diet and lifestyle modification. Our results provided clinical data and a theoretical basis for the exploitation of probiotics in treating constipation during pregnancy. Chinese Clinical Trial Registry: ChiCTR2100052069.

Effectiveness of Probiotic Therapy in the Management of PeriodontalDisease in Diabetic Patients: A Scoping Review.

Probiotics can compete with periodontal pathogens in the formation of dental biofilm, and they are able to modulate local and systemic immune responses. Thus, its use in diabetic patients with periodontal disease (PD) can overcome the limitations of conventional periodontal treatment. This scoping review aimed to understand the extent and type of evidence in relation to the effects of probiotic therapy on periodontal and glycaemic parameters of diabetic patients with PD. An electronic search was performed in the following databases: Cochrane Library, EMBASE, Virtual Health Library (including LILACS and BBO), PubMed (including Medline), Scopus, Web of Science, and Google Scholar. The review included clinical trials on patients with type 2 diabetes, diagnosed with gingivitis or periodontitis, who received probiotic therapy as a single therapy or adjuvant to scaling and root planning, and on whom the analyses of clinical periodontal, immunological, microbiological, or glycaemic parameters were performed. The electronic search yielded a total of 1165 articles. After removing duplicate titles and performing systematic screening, 6 studies were included in the qualitative summary. Probiotic administration improved clinical periodontal parameters (bleeding on probing and probing depth), oxidative stress markers, and inflammatory cytokines (IL-8, IL-10, and TNF-α) in relation to control groups. Experimental groups were also more advantageous in reducing the frequency of periodontopathogenic bacteria. However, the evidence of probiotics in decreasing glycated hemoglobin is still uncertain. Probiotics may provide safe additional benefits to periodontal parameters of patients with type 2 diabetes and periodontal disease.

Probiotics for Parkinson's disease: Current evidence and future directions.

The gut–brain axis is a hot topic in Parkinson's disease (PD). It has been postulated that gut pathogens and dysbiosis can contribute to peripheral inflammatory states or trigger downstream metabolic effects that exacerbate the neurodegenerative process in PD. Several preclinical and clinical studies have demonstrated disrupted intestinal permeability, intestinal inflammation, altered gut microbiome, and reduced fecal short‐chain fatty acids in PD. In this regard, microbial‐directed therapies such as probiotics are emerging as potential therapeutic options. Probiotic supplementation is postulated to confer a variety of health benefits due to the diverse functions of these live microorganisms, including inhibition of pathogen colonization, modulation/“normalization” of the microbiome and/or its function, immunomodulatory effects (e.g. reducing inflammation), and improved host epithelial barrier function. Interestingly, several PD animal model studies have demonstrated the potential neuroprotective effects of probiotics in reducing dopaminergic neuronal degeneration. Notably, two randomized placebo‐controlled trials have provided class I evidence for probiotics as a treatment for constipation in PD. However, the effects of probiotics on other PD aspects, such as motor disability and cognitive function, and its long‐term efficacy (including effects on PD drug absorption in the gut) have not been investigated adequately. Further targeted animal and human studies are also warranted to understand the mechanisms of actions of probiotics in PD and to tailor probiotic therapy based on individual host profiles to improve patient outcomes in this disabling disorder.

Probiotics, prebiotics, and synbiotics supplementation in prediabetes: protocol for a systematic review and meta-analysis.

Background:The prevalence of prediabetes and diabetes is increasing rapidly, and 5% to 10% of prediabetic patients will develop diabetes every year. Diabetes causes major health problems as well as a large economic burden. Human studies have demonstrated the beneficial effects of probiotics, prebiotics, and synbiotics supplementation in prediabetes. However, there are no systematic reviews that explore the therapeutic efficacy of probiotics, prebiotics, and synbiotics supplementation in patients with prediabetes. Therefore, we aim to synthesize the existing evidence evaluating the effectiveness and safety of probiotics, prebiotics, and synbiotics supplementation in prediabetic patients.Methods:We will search PubMed, EMBASE, Cochrane Library, Web of Science, the Clinical Trials.gov website, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Data Knowledge Service Platform from inception to August 2020. Additionally, the search will be conducted in multiple languages. Search terms are keywords and medical subject headings related to prediabetes, probiotics, prebiotics, and synbiotics. The primary outcomes are differences in glycated hemoglobin and fasting blood glucose. The secondary outcomes are differences in fasting insulin, homeostasis model assessment of insulin resistance, quantitative insulin sensitivity check index, and adverse events. The meta-analysis will be performed using the Revman5.3.0 software provided by the Cochrane Collaboration.Results:Our study will systematically evaluate the effectiveness and safety of probiotics, prebiotics, and synbiotics supplementation in prediabetes.Conclusion:The findings of this study will provide the best available evidence for probiotics, prebiotics, and synbiotics in the treatment of prediabetes, and provide a strong basis for clinical treatment.

Probiotics: A Potential Immunotherapeutic Approach for the Treatment of Schizophrenia.

Probiotics are in use for physiological boosting, health supplement, and for treatment since historical time. Recently, the to-and-fro pathways linking the gut with the brain, explaining the indirect communication via modulation of immune function and levels of various neurotransmitters, have been discovered, but how precisely these modulations alter the levels of neurotransmitters contributing to the cognitive and other symptom improvements in patients with schizophrenia remains a new arena of research for psychiatry and psychology professionals. The germ-free mice experiments have been the game changer in the mechanistic exploration. The antimicrobial usage alters the local gut flora and hence is associated with psychiatric side effects that strengthen the association further. The changes in the genetics of these bacteria with different types of diet and its correlation with neurotransmitters production capacity and the psyche of the individual are indeed an emerging field for schizophrenia research. Redressal of issues such as manufacturing, the shelf life of probiotics, and stability of probiotics in the gut milieu, in the presence of food, secretions, and exact volume needed for particular age group will help in refining the dose duration of probiotic therapy. Clinical trials are underway for evaluating safety and efficacy in schizophrenia. The gut microorganism transplant and pharmacovigilance of probiotics are important areas yet to be addressed accurately. This paper elucidates the pathways, clinical studies, availability of probiotics in the Indian market with their composition, regulatory issues in India about the probiotic use, and future of probiotic research in schizophrenia.

Nutritional strategies to prevent gastrointestinal toxicity during pelvic radiotherapy.

Radiotherapy-induced damage to non-cancerous gastrointestinal mucosa has effects on secretory and absorptive functions and can interfere with normal gastrointestinal physiology. Nutrient absorption and digestion may be compromised. Dietary manipulation is an attractive option with sound rationale for intervention. The aim of this review was to synthesise published evidence for the use of elemental formulae, low or modified fat diets, fibre, lactose restriction and probiotics, prebiotics and synbiotics to protect the bowel from gastrointestinal side effects during long-course, radical pelvic radiotherapy. Thirty original studies (recruiting n 3197 patients) were identified comprising twenty-four randomised controlled trials, four cohort studies and two comparator trials. Endpoints varied and included symptom scales (Inflammatory Bowel Disease Questionnaire, Common Technology Criteria for Adverse Events, Radiation Therapy Oncology Group) and Bristol Stool Scale. Dietary and supplement interventions were employed with many studies using a combination of interventions. Evidence from RCT was weak for elemental, low or modified fat and low-lactose interventions and modestly positive for the manipulation of fibre during radiotherapy. Evidence for probiotics as prophylactic interventional agents was more promising with a number of trials reporting positive results but strength and strains of interventions vary, as do methodologies and endpoints making it difficult to arrive at firm conclusions with several studies lacking statistical power. This consolidated review concludes that there is insufficient high-grade evidence to recommend nutritional intervention during pelvic radiotherapy. Total replacement of diet with elemental formula could be effective in severe toxicity but this is unproven. Probiotics offer promise but cannot be introduced into clinical practice without rigorous safety analysis, not least in immunocompromised patients.

As C. difficile Increases, Vigilance Is Called For

NASHVILLE, TN – Clostridium difficile infection remains the primary cause of infectious diarrhea in long-term care facilities, and its incidence and severity are increasing, according to Laurie Archbald-Pannone, MD, MPH, of the University of Virginia, Charlottesville. Elderly patients on antibiotics, especially those in health care settings, are at greatest risk for C. difficile infection (CDI) and have the highest CDI mortality rate, Dr. Archbald-Pannone said at AMDA Long Term Care Medicine–2014. Historically, clindamycin and cephalosporins have been most associated with CDI in hospitals and PA/LTC facilities, but almost any antibiotic can be implicated, she said. Currently, the commonly used antibiotics – fluoroquinolones – are the drugs most frequently associated with CDI, Dr. Archbald-Pannone noted. Treating infection can be complicated, so prevention is the best strategy for combating the spread of CDI, Dr. Archbald-Pannone said. It requires a three-pronged approach including proper antibiotic prescribing, preservation of normal flora, and environmental containment. One of the most effective and important strategies for preventing CDI is minimizing the frequency, duration, and number of antibiotics prescribed. Giving antibiotics when they are not needed, continuing them beyond when they are necessary, prescribing them at the wrong dose, prescribing the wrong antibiotic for a given infection, and using broad spectrum agents to treat susceptible bacteria represent antibiotic misuse. The result can be the emergence of antimicrobial-resistant pathogens. “Antibiotics are one of those things we have to think through a little more globally than just how it impacts our one patient,” Dr. Archbald-Pannone said. She pointed out that the Centers for Disease Control and Prevention recommends a three-step “time out” approach to improving antibiotic stewardship: ensuring at the outset that dose, duration, and indication are included for all antibiotic orders; obtaining cultures anytime an antibiotic is ordered; and reassessing choice of treatment based on the culture results. Antibiotics are associated with CDI because they disrupt the normal flora – sometimes after just a single dose. Probiotics, such as Lactobacillus acidophilus and Lactobacillus casei, as well as probiotic-yogurt products, can preserve normal flora and so help prevent CDI, Dr. Archbald-Pannone said. Several studies suggest that the use of probiotics is associated with about a 20% reduction in antibiotic-associated diarrhea, she said. Evidence of probiotics’ use as treatment of CDI is lacking, Dr. Archbald-Pannone said. C. difficile spores can survive on environmental surfaces for months, and a 10% bleach solution is required to penetrate their protective armor and kill the spores, Dr. Archbald-Pannone said. Because the spores are very sticky, extra care must be taken when it comes to hand hygiene. The CDC recommends washing hands before any of the following: having direct contact with a patient, putting gloves on, inserting an invasive device, and moving from a contaminated to a clean site within the same patient encounter. Wash hands after the following: touching a patient's skin (including intact skin), touching body fluids or broken skin, touching an inanimate object in the patient's vicinity, and removing gloves. The proper hand washing technique involves wetting hands with warm water, applying soap and rubbing to make a lather that covers all surfaces, rubbing hands for 20 more seconds to physically remove the spores, and rinsing under running water. Hands should be dried using a paper towel or air dryer, and a paper towel should be used to turn the faucet off. “This is kind of getting back to basics, but it's important, because when it's something we do all the time, we can get a little lax with it,” Dr. Archbald-Pannone said. Technique is also important when using gel sanitizer. It should not be used on wet hands or wiped off before the gel has dried, she said. Alcohol-based gels work by dehydrating denatured proteins, and water on the hands fights that process, she explained.

Review of the Evidence for the Use of Probiotics in Gastrointestinal Disorders

The gut microbiota fulfils important metabolic and immunological tasks, and floral imbalance may lead to the development of dysbiosis and microbiota-related diseases. The most common illnesses associated with dysbiosis include infections, inflammatory bowel disease, Irritable Bowel Syndrome (IBS), colorectal cancer, and other gastrointestinal functional diseases which cause diarrhoea directly, or indirectly through treatment. In theory, every disorder associated with dysbiosis might benefit from modulation of the gut microbiota. We review the evidence for probiotics in prevention and treatment in these gastrointestinal disorders. We found probiotic efficacy was strain specific. They are well tolerated with minimal toxicity. There appears to be selective benefit of Saccharomyces boulardii and a mixture of Lactobacillus acidophilus, Bifidobacterium bifidum, Lactobacillus bulgaricus and Streptococcus thermophilus probiotics as prophylaxis of travellers' diarrhoea. S. boulardii is useful in treating travellers' diarrhoea where other medical treatments have failed. For IBS, a mixture of bacterial strains including lactobacillus and bifidobacteria may be the most effective in IBS collective symptoms. Probiotics, especially those containing multiple strains can maintain remission in ulcerative colitis and also demonstrate efficacy in pouchitis. There is currently no evidence for probiotics in Crohn's disease. Lactobacillus species appear to be the most effective in preventing Clostridium difficile infections. For lactose intolerance there is most evidence for Lactobacillus rhamnosus and bifidobacterium usually in combination. Probiotics, in particular Lactobacillus and Bifidobacteria species have a beneficial role in the care of patients with diarrhoea associated chemotherapy and radiotherapy.

Commentary: the effects of probiotics on barrier function and mucosal pouch microbiota during maintenance treatment for severe pouchitis in patients with ulcerative colitis

Epithelial barrier function is likely to be critical in the initiation and persistence of intestinal inflammation. Impaired barrier function is present in Crohn’s, ulcerative colitis (UC) and pouchitis during active disease and remission. Strategies targeting restitution of barrier function are required for the treatment of inflammatory bowel diseases (IBD). Persborn et al. report the effects of the probiotic mixture Ecologic 825 on barrier function during maintenance treatment of pouchitis. Evidence for probiotics in the treatment, prevention and maintenance of remission of pouchitis is established. However, their mechanisms of action are as yet unknown. Probiotics increase bacterial diversity and alter innate and adaptive immune responses. In vitro and in animal models probiotics alter epithelial barrier function and the expression and distribution of epithelial tight junctions. In the study by Persborn et al., UC patients with pouchitis entering remission following 4 weeks of combination antibiotic therapy were treated with Ecologic 825 for 8 weeks. They demonstrated that probiotics may restore mucosal barrier function and that bacterial diversity correlates with barrier function. However, the probiotic supplement did not influence the composition of the mucosal pouch microbiota and, in the absence of a control or placebo group, these findings may represent consequences of mucosal healing following induction of remission with antibiotics. Larger studies are needed to assess whether, and by what mechanisms, probiotics affect epithelial barrier function in the maintenance of pouchitis and other types of IBD and whether this mechanism of action is linked to prevention of relapse. However, this study raises important issues regarding the use of probiotics in the treatment of IBD. It is essential to consider whether the probiotic is intended to affect a particular immunotherapeutic target, or to alter the mucosal or the luminal composition of the microbiota. It is also important to consider the phase of disease in which probiotic therapy may be most efficacious, perhaps depending on the intended therapeutic target.

Systematic review: the efficacy of nutritional interventions to counteract acute gastrointestinal toxicity during therapeutic pelvic radiotherapy

Radiotherapy-induced damage to noncancerous gastrointestinal mucosa has effects on secretory and absorptive functions and can interfere with normal gastrointestinal physiology. Nutrient absorption and digestion may be compromised. Dietary manipulation is an attractive option for the prevention and management of symptoms. To synthesise the evidence for the use of elemental formula low- or modified-fat diets, fibre, lactose restriction and probiotics, prebiotics and synbiotics to protect the gastrointestinal tract during pelvic radiotherapy. Four electronic databases were searched. Randomised controlled trials (RCT), controlled trials (CT) and case series in adult patients receiving radiotherapy for pelvic cancers employing nutritional interventions to reduce gastrointestinal toxicity were included. Methodological quality was assessed using a bespoke tool. Twenty-two original studies (2446 patients) were identified. Study quality was highly variable with only 37% scoring ≥10 points (maximum 17: bespoke scale). Few studies assessed compliance with the intervention. End-points varied and included symptom scales (IBDQ, CTC, Bristol Stool and RTOG). Evidence from RCTs was weak for elemental, low- or modified-fat, fibre and low-lactose interventions with 1/4, 3/4, 1/2, 0/1 trials respectively reporting favourable outcomes. Evidence for probiotics as prophylactic interventions was more promising (4/5 favourable), but dose, strains and methodologies varied. There is insufficient high-grade evidence to recommend nutritional intervention during pelvic radiotherapy. Total replacement of diet with elemental formula may be appropriate in severe toxicity. Probiotics offer promise, but cannot be introduced into clinical practice without rigorous safety analysis, not least in immunocompromised patients. The methodological quality of nutritional intervention studies needs to be improved.

Systematic Review: Effective Management Strategies for Lactose Intolerance

Lactose intolerance resulting in gastrointestinal symptoms is a common health concern. Diagnosis and management of this condition remain unclear. To assess the maximum tolerable dose of lactose and interventions for reducing symptoms of lactose intolerance among persons with lactose intolerance and malabsorption. Multiple electronic databases, including MEDLINE and the Cochrane Library, for trials published in English from 1967 through November 2009. Randomized, controlled trials of individuals with lactose intolerance or malabsorption. Three investigators independently reviewed articles, extracted data, and assessed study quality. 36 unique randomized studies (26 on lactase- or lactose-hydrolyzed milk supplements, lactose-reduced milk, or tolerable doses of lactose; 7 on probiotics; 2 on incremental lactose administration for colonic adaptation; and 1 on another agent) met inclusion criteria. Moderate-quality evidence indicated that 12 to 15 g of lactose (approximately 1 cup of milk) is well tolerated by most adults. Evidence was insufficient that lactose-reduced solution or milk with a lactose content of 0 to 2 g, compared with greater than 12 g, is effective in reducing symptoms of lactose intolerance. Evidence for probiotics, colonic adaptation, and other agents was also insufficient. Most studies evaluated persons with lactose malabsorption rather than lactose intolerance. Variation in enrollment criteria, outcome reporting, and the composition and dosing of studied agents precluded pooling of results and limited interpretation. Most individuals with presumed lactose intolerance or malabsorption can tolerate 12 to 15 g of lactose. Additional studies are needed to determine the effectiveness of lactose intolerance treatment.

Probiotics in Inflammatory Bowel Disease

Probiotics are biological control agents that usually take the form of food-grade or commensal bacteria that can be harnessed to confer a beneficial health effect. The promise of probiotics, at present, extends beyond the evidence base in many conditions. However, the efficacy of probiotics in management and prophylaxis of gastrointestinal infections has been confirmed, and there is sound evidence for a role for some but not all probiotics in irritable bowel syndrome. Whether probiotics have a role in other gastrointestinal conditions, such as postoperative wound healing and infections, Helicobacter pylori infection, colon cancer prevention, and inflammatory bowel disease, is less clear. Here we focus on the evidence for probiotics in Crohn's disease and ulcerative colitis. Results from studies in humans have not been as impressive as data from animal models, and clinical trials have generally had mixed results. Some of the variability may reflect differences in choice of bacterial strains and dosages. The most convincing evidence has been in pouchitis but genetically modified probiotic strains may be required for some patients in the future.

Evidence of Probiotics in Prevention of Allergy and Asthma

Previous research into the causes of allergic diseases was mostly focussed on potential risk factors in the environment, with little success, however. Over the past 10 years, focus has therefore more been directed against protective factors that could enhance the development of tolerance to allergens which were previously encountered early in life, but are now lost in modern affluent societies. In particular, the role of childhood infections has been discussed, but so far these studies have not been conclusive. Recent epidemiological studies and experimental research suggest that the microbial environment and exposure to microbial products in infancy modifies immune responses and enhances the development of tolerance to ubiquitous allergens. The intestinal microflora may play a particular role in this respect, as it is the major external driving force in the maturation of the immune system after birth and animal experiments have shown it to be a prerequisite for normal development of oral tolerance. The composition of the microflora differs between healthy and allergic infants and in countries with a high and low prevalence of allergies. These differences are apparent within the first week of life, or even in the maternal vaginal flora during pregnancy and thus precede clinical symptoms. The use of live microorganisms that might be beneficial to health has a long tradition and the safety is well documented. Prospective intervention studies, in which the gut flora was modified from birth have yielded encouraging results and may suggest a new mode of primary prevention of allergy in the future.