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Probiotics for gastrointestinal diseases

Author
R Balfour Sartor, MD
Section Editor
J Thomas Lamont, MD
Deputy Editor
Shilpa Grover, MD, MPH

INTRODUCTION

The intestinal tract is host to a vast ecology of microbes that are necessary for health, but also have the potential to contribute to the development of diseases by a variety of mechanisms. Perturbations in intestinal epithelial barrier function or innate immune bacterial killing, for example, can lead to an inflammatory response caused by increased uptake of bacterial and food antigens that stimulate the mucosal immune system [1-4]. (See "Immune and microbial mechanisms in the pathogenesis of inflammatory bowel disease".)

Interactions between intestinal microbes and the host are the subject of intensive ongoing research since they may influence a variety of diseases. Part of this research involves the deliberate manipulation of the intestinal microflora with a therapeutic intention. The greatest experience has been in the inflammatory bowel diseases, ulcerative colitis, Crohn disease, and pouchitis, although clinical trials are emerging in several other conditions.

There are four general methods by which the intestinal microflora can be altered: administration of antibiotics, prebiotics (ie, dietary components that promote the growth and metabolic activity of beneficial bacteria), probiotics (ie, beneficial bacteria), or fecal transplant (bacteriotherapy). Combination of these methods is also possible (synbiotics). Interest in these approaches has extended well beyond the clinical sciences since a role for intestinal microbes in health and disease has been recognized in alternative and complementary forms of medicine for many years [5]. In a case control study, 51 percent of ulcerative colitis patients and 43 percent of patients with Crohn disease used probiotics compared with 21 percent of healthy controls [6]. In comparison, systematic evaluation of the efficacy of probiotics is relatively recent. This topic review focuses on clinical trials of probiotics in gastrointestinal diseases.

DEFINITION

Probiotics are microorganisms that have beneficial properties for the host. Most commercial products have been derived from food sources, especially cultured milk products. The list of such microorganisms continues to grow and includes strains of lactic acid bacilli (eg, Lactobacillus and Bifidobacterium), a nonpathogenic strain of Escherichia coli (eg, E. coli Nissle 1917), Clostridium butyricum, Streptococcus salivarius, and Saccharomyces boulardii (a nonpathogenic strain of yeast). Also under development are strains of bacteria that have been genetically engineered to secrete immunomodulators (such as interleukin-10, trefoil factors, or defensins, or express altered surface proteins such as lipoteichoic acid), which have the potential to favorably influence the immune system [7-9]. More recently, the concept of restoring levels of protective commensal bacterial species that are diminished in certain disorders, such as Crohn disease, has been advanced [10-12].

Initial studies of selected probiotic species (given alone or in combination) have suggested potential efficacy in several gastrointestinal illnesses, the best studied of which are the inflammatory bowel diseases (particularly pouchitis) [13-19]. Therapeutic benefit has also been suggested in several other disorders, including antibiotic-related diarrhea, Clostridium difficile toxin-induced colitis, infectious diarrhea, hepatic encephalopathy, irritable bowel syndrome, and allergy [20,21].

                               

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Literature review current through: Nov 2016. | This topic last updated: Mon Aug 24 00:00:00 GMT 2015.
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