prebiotics & probiotics in pediatric practice New.pptx

1. PREBIOTICS & PROBIOTICS IN
PEDIATRIC PRACTICE
Dr Jo Martin Kuncheria
JR, Pediatrics

2. PREBIOTICS
Non digestible food components that beneficially affect the host by selectively
stimulating the growth and/or activity of one or a limited number of bacteria
in the colon and thereby improving host health
PROBIOTICS
Nutritional suppliments containing one or more cultures of living organisms
(bacteria /yeast),when introduced to a human have beneficial impact on the
host by improving endogenious microflora
SYMBIOTICS
Prebiotics in combination to probiotic bacteria, helps in survival of probiotic
bacteria
Eg. Bifidobacterium with fructo oligosaccharides, Lactobacilli with lactitol

3. PREBIOTICS
• Promote the growth of beneficial organisms
• Neither hydrolysed nor absorbed from the GI tract
• Usually are fermented by beneficial bacteria in colon
• Promote growth of bacteria including bifidobacteria & lactobacteria
• Include oligosaccharides selectively metabolized by constituents of the
microbiota
• Catabolise to beneficial end products like SCFA, utilize as energy substrate
by intestinal epithelium
• Naturally found in breast milk, used as suppliments to breast milk & formula
• PT have a benefit with increased bacterial population & decrease in NEC

4. PREBIOTIC FOOD INGREDIANTS
• Fructans (Inulin & oligofructans)
• Soyabean Oligosaccharides
• Galactooligosaccharides(present in Breast milk)
• Lactulose
• Lactitol

5. NATURAL SOURCES OF PREBIOTICS
Low molecular carbohydrate occur in-
- Onion
- Chicory
- Garlic
- Tomatoes
- Wheat
- Bananas

6. FUNCTIONS OF PREBIOTICS
• Fermented by Bifidobacteria in colon resulting in
production of short chain fatty acid that are absorbed
• SCFA are primary fuel for the colon
• Promote the absorption of sodium & water
• Protective effect against colorectal cancer & infectious
colitis
• Improve lipid metabolism
• Exhibit beneficial effects of fibre
• Increase the bioavailability of minerals
• Improve host defense
• Prevent NEC in preterm babies

7. PROBIOTICS
• Isolates from human microbiota (typically bacteria or
yeast)
• Its increase the level of an organism already present
within the microbiota
• Successful colonisation with a probiotic is usually
transient
• They must be human origin & have some health
promoting benefits

8. FACTORS INHIBIT PROBIOTIC COLONISATION
• Gastric acid
• Duodenal bile
• Mucin
• Gut immune system

9. PROBIOTICS Cont…..
• Commonly studied probiotics include:-
-Lactobacillus acidophilus
-Lactobacillus Rhamnosus
-Lactobacillus Reuteri
-Lactobacillus Plantarum
-Bifidobacteria bifidus & Longum
-Streptococcus Thermophilus
-Saccharomyces boulardii(Baker’s yeast)
• Bifidobacteria & Lactobacilli are common to breast
milk

10. FUNCTIONS OF PROBIOTICS
• 1.Probiotics in Gastrointestinal Ecosystem
• 2. Probiotics in Health
• 3. Probiotics in Intestinal disease
• 4. Probiotics in Allergy
• 5. Probiotics in Immune Regulation
• 6. Probiotics in Critical care

11. 1.PROBIOTICS IN GASTROINTESTINAL ECOSYSTEM
• At birth GI tract is sterile
• Bacteria ingested during birthing & Priming with breast milk
colonise the gut
• This helps in priming the GI immune system
• Once colonise it is difficult to permanently change this flora
• Constant intractions occures between endogenous flora &
potentially pathogenic microorganisms
• Probiotics plays a major role in keeping the integrity of
intestinal barrier

12. 2. PROBIOTICS IN HEALTH
• Fermentation of food when used for preserving food will
expose host to probiotic organisms
• Astronauts who receive a diet low in fibre & antioxidants
return to earth with decreased endogenous probiotic
bacteria
• Decreased probiotics will increase:-
- Inflammatory conditions
- Allergic disorders
-Obesity
-Heart disease
-Cancer

13. 3. PROBIOTICS IN INTESTINAL DISEASE
• Successful in the treatment & prevention of various types of
diarrhoea including rotavirus, Clostridium difficile &
Travellers diarrhoea
• Integrity of gastro Intestinal barrier is by secreated antibodies
,mucous layer & Immune systems
• Bacterial supplimentation to prevent infection with viral
agent show an immunomodulatory effect of probiotics
• Study done by Majamaa et al ,showed children receiving
Lactobacillus Rhamnosus had decreased duration of
diarrhoea , significant increase in number of cells secreating
IgA against Rota virus

14. PROBIOTICS IN INTESTINAL DISEASE cont…..
CLOSTRIDIUM DIFFICILE DIARRHOEA
-Usually ppt by antibiotic use
-Relapses are common & difficult to treat
- Saccharomyces boulardii (yeast) & Lactobacillus Rhamnosus used in
prevention of relapsing C. difficile diarrhoea
TRAVELLER’S DIARRHOEA
- Saccharomyces boulardii (yeast) have stronger effects on bacterial diarrhoea
- Probiotics have yet to be shown conclusively to decrease the incidence of
travellers diarrhoea
- Probiotics seem to prevent viral induced diarrhoea better than bacterial
diarrhoea
- Lactobacillus Rhamnosus more effective against viral & idiopathic diarrhoea

15. PROBIOTICS IN INTESTINAL DISEASE cont…..
INFLAMMATORY BOWEL DISEASE
Probiotic consisting of nonpathogenic strain of E coli &
Mezalazine has shown effectiveness in induction &
maintenance of remission in ulcerative colitis
Probiotic consisting of 3 strains of bifidobacteria, 4 strains of
lactobacilli & 1 strain of Streptococcus used to maintain
remission in ulcerative colitis & prevent pouchitis in UC

16. PROBIOTICS IN INTESTINAL DISEASE cont…..
Lactobacillus Rhamnosus cause increased number of IgA
secreating cells reducing antigenic stimulation and
reducing intestinal permeability & disease activity in
Crohn’s disease
Turbo probiotics – genetically engineered to deliver
active compounds
Lactococcus lactis genetically engineered to secrete IL -
10-anti inflammatory cytokine currently under trial to
treat acute crohns disease
• Helicobacter pylori:-
Lactobacillus salivarius inhibit the attachment of
H.pylori

17. 4. PROBIOTICS IN ALLERGY
• Reduce the symptoms of atopic dermatitis
• RCT among exclusively breast fed children with
Eczema – probiotic suppli. had significant to
complete resolution of Eczema, may be due to
increased production of IL10
• Studies shows a reduced incidence of milk allergy in
toddler given Lactobacillus Rhamnosus during early
infancy

18. 5. PROBIOTICS IN IMMUNE REGULATION
• Some probiotics can down regulate allergic response &
enhance immune response against potential pathogens
• Lactobacillus Rhamnosus increase antibody response to rora
virus infection and vaccine
• It enhance antibody response in adults given Typhoid vaccine
• Cystic fibrosis treated with Lactobacillus Rhamnosus has a
reduced incidence of severe respiratory infection
• Prevent respiratory infection
• Lactobacillus probiotic 70% reduction in LOS

19. 6. PROBIOTICS IN CRITICAL CARE
• Enteral nutrition comparable with parenteral
nutrition regarding delivery of nutrients
• Enteral nutrition enhance natural killer cell activity,
lymphocyte number & response to antigenic
stimulus
• Parenteral nutrition cause atrophy of mucosa &
colonic microflora – patients more susceptible to
infection due to microbial translocation and
systemic response

20. PROBIOTICS- ADVERSE EFFECTS
• Abdominal cramping
• Nausia
• Fever
• Soft stools
• Flatulence
• Taste difference
• Disseminated fungaemia with Saccharomyces boulardii(treated with anti
fungal)

21. REFERENCE
• Nutrition & Child development 5th edition by
Dr KE Elizabeth
• Nelson Text Book Of Pediatrics 21st Edition
Thank you