This document discusses the role of probiotics in adult gastroenterology. It provides a brief history of probiotics dating back to Elie Metchnikof in 1908. Probiotics are defined as live microorganisms that provide health benefits when consumed. The gut microbiota plays an important role in health, and probiotics may help treat or prevent conditions caused by microbial imbalances like infectious diarrhea, irritable bowel syndrome, inflammatory bowel disease, obesity, and liver diseases. Probiotics have demonstrated benefits, but their effects tend to be strain-specific and more research is still needed, especially for conditions like Crohn's disease. Safety concerns also exist for certain at-risk populations.
Probiotics for the Gut - A Guide for Primary Care PhysiciansJarrod Lee
Probiotics have been shown to be of benefit in several gut disorders. Today, probiotics are a multibillion dollar industry, with a myriad of options that can be confusing. This presentation introduces the fundamentals of probiotics to primary care doctors for use in their daily practice.
Biological diversity, or biodiversity, is the scientific term for the variety and variability of life on Earth. Biodiversity is the key indicator of the health of an ecosystem. Every living thing, including man, is involved in these complex networks of interdependent relationships, which are called ecosystems.
Like all healthy ecosystems, Richness of microbiota species characterizes the GI microbiome in healthy individuals. Conversely, a loss in species diversity is a common finding in several disease states. Microbiota Biodiversity helps us : 1- Combat aggressions from other microorganisms, 2- Maintaining the wholeness of the intestinal mucosa. 3- Plays an important role in the immune system, 4- Performing a barrier effect.5- A healthy and balanced gut microbiota is key to ensuring proper digestive functioning. A gut out of balance means a body out of balance which means illness including Inflammation, Allergies, Infections, Nutrient deficiencies, Weight Gain, Asthma-allergies – Autoimmunity
• Arthritis, Metabolic Bone disease, Skin problems e.g. eczema, rosacia, Mood disorders - Cognitive decline-Alzheimers and Cancer.
Probiotics for the Gut - A Guide for Primary Care PhysiciansJarrod Lee
Probiotics have been shown to be of benefit in several gut disorders. Today, probiotics are a multibillion dollar industry, with a myriad of options that can be confusing. This presentation introduces the fundamentals of probiotics to primary care doctors for use in their daily practice.
Biological diversity, or biodiversity, is the scientific term for the variety and variability of life on Earth. Biodiversity is the key indicator of the health of an ecosystem. Every living thing, including man, is involved in these complex networks of interdependent relationships, which are called ecosystems.
Like all healthy ecosystems, Richness of microbiota species characterizes the GI microbiome in healthy individuals. Conversely, a loss in species diversity is a common finding in several disease states. Microbiota Biodiversity helps us : 1- Combat aggressions from other microorganisms, 2- Maintaining the wholeness of the intestinal mucosa. 3- Plays an important role in the immune system, 4- Performing a barrier effect.5- A healthy and balanced gut microbiota is key to ensuring proper digestive functioning. A gut out of balance means a body out of balance which means illness including Inflammation, Allergies, Infections, Nutrient deficiencies, Weight Gain, Asthma-allergies – Autoimmunity
• Arthritis, Metabolic Bone disease, Skin problems e.g. eczema, rosacia, Mood disorders - Cognitive decline-Alzheimers and Cancer.
use and scope of preprobiotics in various diseases. it also includes the basic mechanism by which probiotics would contribute to disease prevention as well as cure. this presentation would provide the basic idea about the history, mechanism and the role of synbiotic therapy in various diseases.
Probiotics are live bacteria or yeasts that are good for the digestive system.
Prebiotics as non-digestible ingredients in the food that can stimulate the activity of desirable microbiota
Probiotics are live microorganism which when administrated in adequate amount confers health benefit in humans. Prebiotics are non-digestible Food ingredients which beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon and thus improving host health.
Probiotics – PrebioticsNovel Strategies That May Prevent Neonatal Disease
by
Richard J. Schanler, M.D.
Schneider Children’s Hospital at North Shore, Manhasset, NY
and Albert Einstein College of Medicine, Bronx, NY
schanler@nshs.edu
Presentation given at Eva Perry Library about the emerging information on the microbiome. Key highlights include definition of the microbiome, affect of microbiome on health, how to maintain a healthy/balanced microbiome.
This is the unedited version of the "Probiotics" presentation given at the University of Arizona's College of Medicine. Its intent was to demonstrate that even in the "hard sciences" base emotional biases can interfere with good scientific data and interpretation. To fully appreciate this presentation, you must be eating yogurt prior to beginning to view it, and proceed through the slides one at a time without skipping ahead. This is the actual slide show that was shown at the seminar and is not for the squeamish. I'll post a more benign version for those not wishing to test their boundaries and "good taste."
Beneficial Effects of Probiotics
Introduction: PROBIOTICS are living microorganisms, when taken by mouth, benefit your health by improving the balance of bacteria in the intestines.
Often bacteria, but also include some kinds of yeast.
PROBIOTICS are “good” bacteria or non-pathogenic in healthy people.
Gut contains over 500 different types of beneficial bacteria.
Beneficial functions such as inhibiting the growth of pathogenic bacteria, aiding in digestion, and vitamin-B synthesis.
To consider Bacterium as Probiotics, must meet the following criteria:
It is a microbial organism which is not harmful
It remains alive during processing and the shelf life of the food
It must survive digestion and remain alive in the gut
It is able to bring about a response in the gut
It is associated with health benefits
Common Probiotic Bacteria
Lactobacillus acidophilus
Lactobacillus casei
Lactobacillus reuteri
Lactobacillus plantarum
Lactobacillus rhamnosus
Bifidobacterium animalis
Bifidobacterium infantis
Bifidobacterium lactis
Bifidobacterium longum
Beneficial Effects of Probiotics
Absorbing and/or destroying toxins released by certain “bad” bacteria that can make you sick.
Producing substances that prevent infection.
Preventing harmful bacteria from attaching to the gut wall and growing there.
Boosting your immune system
Sending signals to your cells to strengthen the mucus in your intestine, which helps it act as a barrier against infection.
Production of B vitamins. Vitamin B is important in maintaining healthy skin, a healthy nervous system and preventing anemia
Decrease gas production and bloating
This is a presentation on probiotic foods, where I have described what probiotic food is, their mechanism of action, adequacy, and some popular forms of probiotic foods present in the market.
use and scope of preprobiotics in various diseases. it also includes the basic mechanism by which probiotics would contribute to disease prevention as well as cure. this presentation would provide the basic idea about the history, mechanism and the role of synbiotic therapy in various diseases.
Probiotics are live bacteria or yeasts that are good for the digestive system.
Prebiotics as non-digestible ingredients in the food that can stimulate the activity of desirable microbiota
Probiotics are live microorganism which when administrated in adequate amount confers health benefit in humans. Prebiotics are non-digestible Food ingredients which beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon and thus improving host health.
Probiotics – PrebioticsNovel Strategies That May Prevent Neonatal Disease
by
Richard J. Schanler, M.D.
Schneider Children’s Hospital at North Shore, Manhasset, NY
and Albert Einstein College of Medicine, Bronx, NY
schanler@nshs.edu
Presentation given at Eva Perry Library about the emerging information on the microbiome. Key highlights include definition of the microbiome, affect of microbiome on health, how to maintain a healthy/balanced microbiome.
This is the unedited version of the "Probiotics" presentation given at the University of Arizona's College of Medicine. Its intent was to demonstrate that even in the "hard sciences" base emotional biases can interfere with good scientific data and interpretation. To fully appreciate this presentation, you must be eating yogurt prior to beginning to view it, and proceed through the slides one at a time without skipping ahead. This is the actual slide show that was shown at the seminar and is not for the squeamish. I'll post a more benign version for those not wishing to test their boundaries and "good taste."
Beneficial Effects of Probiotics
Introduction: PROBIOTICS are living microorganisms, when taken by mouth, benefit your health by improving the balance of bacteria in the intestines.
Often bacteria, but also include some kinds of yeast.
PROBIOTICS are “good” bacteria or non-pathogenic in healthy people.
Gut contains over 500 different types of beneficial bacteria.
Beneficial functions such as inhibiting the growth of pathogenic bacteria, aiding in digestion, and vitamin-B synthesis.
To consider Bacterium as Probiotics, must meet the following criteria:
It is a microbial organism which is not harmful
It remains alive during processing and the shelf life of the food
It must survive digestion and remain alive in the gut
It is able to bring about a response in the gut
It is associated with health benefits
Common Probiotic Bacteria
Lactobacillus acidophilus
Lactobacillus casei
Lactobacillus reuteri
Lactobacillus plantarum
Lactobacillus rhamnosus
Bifidobacterium animalis
Bifidobacterium infantis
Bifidobacterium lactis
Bifidobacterium longum
Beneficial Effects of Probiotics
Absorbing and/or destroying toxins released by certain “bad” bacteria that can make you sick.
Producing substances that prevent infection.
Preventing harmful bacteria from attaching to the gut wall and growing there.
Boosting your immune system
Sending signals to your cells to strengthen the mucus in your intestine, which helps it act as a barrier against infection.
Production of B vitamins. Vitamin B is important in maintaining healthy skin, a healthy nervous system and preventing anemia
Decrease gas production and bloating
This is a presentation on probiotic foods, where I have described what probiotic food is, their mechanism of action, adequacy, and some popular forms of probiotic foods present in the market.
Neutraceuticals - Probiotics, Prebiotics & SynbioticsMayur D. Chauhan
The following presentation is only for quick reference. I would advise you to read the theoretical aspects of the respective topic and then use this presentation for your last minute revision. I hope it helps you..!!
Mayur D. Chauhan
Gasbarrini A. Microbiota, Antibiotici e Probiotici in Gastroenterologia. ASMa...Gianfranco Tammaro
PROF. ANTONIO GASBARRINI - 3° Giornata Master ECM in Gastroenterologia 2016 (25/11/2016) - Fondazione Santa Lucia - Sala Congressi - Roma
Sito: www.asmad.net
Canale Youtube: https://youtu.be/ouYcXg_ZtJM
Microbiota, leaky gut syndrome and gut-related diseasesMaurizio Salamone
Lecture on "Microbiota, Leaky gut Syndrome and gut-related disease" at the 7° International workshop on Immunonutrition "Eating for preventing" Carovigno (BA) May 1st-3th 2014
Dieta e Microbiota intestinale: quale rapportoASMaD
Presentazione a cura del Professor Davide Festi - M.A.S.T.E.R. ECM in Gastroenterologia Focus on: Microbiota e dintorni - Fondazione Santa Lucia - Roma
1. ROLE OF PROBIOTICS IN ADULT
GASTROENTEROLOGY
Dr Ajay Bhalla
Principal Consultant &
HOD Gastroenterology
Fortis Hospital Noida
2. PROBIOTICS
For life
“You’ve been fooling around with alternative medicine, haven’t you?”
3. HISTORY OF PROBIOTICS
Elie Metchnikof (1845-1916)
Lactic acid bacteria can render a great
service in the fight against intestinal
putrefaction‟
„Postpone and ameliorate old age‟
The Prolongation of Life (1908)
4. PROBIOTICS: DEFINITIONS
World Health Organization:
“live microorganisms which when administered in
adequate amounts confer a health benefit on the host”
A bacterial strain that:
Survives the stomach acid and bile
Adheres to intestinal lining
Grows and establishes temporary residence in the
intestines
Imparts health benefits
R Fuller. Probiotics: The Scientific Basis. London: Chapman and Halls. 1992
5. PROBIOTICS
Colonization at birth
Similar to maternal species
Specific organisms vary by age in first year
but become established by 1 year
No. of bacteria in gut 10 times the total no.
of body cells.
Composition of each individuals microbiota
is so distinctive…..it could be used as an
alternative to fingerprints..!
Composition also influenced by age,socio-
economic srroundings & use of antibiotics
6. THE GUT MICRO BIOTA AND ITS
INFLUENCE ON HEALTH
O’Hara A.M. et al. EMBO reports 2006; 7: 688-693.
7. DISTRIBUTION OF MICROBES IN THE GUT
Present in all parts of the intestinal tract
Increase from esophagus to colon
acid production
bile
motility
ileocecal valve
Surface-lumen axis: more anaerobes in the outer mucus
Bacteria are not in direct contact with the mucosa – at
least, in healthy subjects
Microbes in Intestinal Health and Disease; A.S. Neish Gastroenterology
2009;136:65-80
8. Dysbiosis in the Gut
Disturbance of the
balance of the
intestinal microbiota
Stress Diet
Ageing Infection
Medication
(Antibiotics)
Increasingly recognized as a risk factor for human
disease: Infections, Obesity, Diabetes, NEC, IBS, IBD
PNAS March 15, 2011 Suppl.
10. DESIRABLE CHARACTERISTICS OF A
PROBIOTIC STRAIN
Stable and well-described microbe
Non-toxic, non-pathogenic
Able to survive and multiply in desired location
Able to combat pathogens
Efficacious in promoting specific health claim
Scalable production
Easy to distribute
12. Scientific Evidence for Probiotics
In vitro studies, In vivo animal studies, Human
observational/epidemiology studies ,Human experimental
studies, Randomized Double Blind Placebo Controlled studies
with validated biomarkers
In 2010, there were 1158 articles: in high ranking peer-reviewed
journals; increasing DBPCRTs ….
Meta-analyses are usually based on a generic probiotic benefit
Reviews and meta-analyses will include relevant trials with
different strains but generic conclusions may not be true for
individual strains
Each Probiotic strain to be supported by its own dossier of
scientific evidence…
13. Benefits and Application
Preventive and therapeutic modality for
gastrointestinal disorders such as Antibiotic
associated & infectious diarrhoea, IBS, IBD,
Management of NAFLD,MHE & Hepatitis
Immune stimulation
Prevention of allergic disorders
Prevention of chronic inflammatory diseases
Prevention of cancers
Reduction of respiratory diseases
14. INFECTIOUS DIARRHOEA – PROBIOTICS AS A TREATMENT ?
Allen et al (2010) Cochrane Systematic Review
Used alongside rehydration therapy, probiotics appear to be safe and
have clear beneficial effects in shortening the duration and reducing
stool frequency in acute infectious diarrhoea.
Wolvers et al (2010) Review
Moderate to significant benefit of many probiotic strains in management
of acute watery diarrhoea (RV infections) in children.
• Moderate improvements in acute infections (~1 day ↓ duration
diarrhoea)
• Significant improvements in watery diarrhoea and viral gastroenteritis
• More evident when intervention started early in course of infection
The use of probiotics for acute infectious diarrhoea in children is an
accepted therapy in Europe
Recommended by the European Society for Paediatric Gastroenterology, Hepatology and
Nutrition & European Society of Paediatric Infectious Diseases Expert Working Group
15. Functional Constipation(IBS) – probiotics as a
treatment?
Chimielewska et al (2010) Systematic Review
5 RCT‟s , N= 377 ( 266 adults , 3 RCT‟s and 111 children, 2 RCT‟s)
Bifidobacterium lactis DN-173 010, Lactobacillus casei Shirota,
Escherichia coli Nissle 1917, Lactobacillus casei rhamnosus Lcr 35,
Lactobacillus rhamnosus GG
Results
Bifidobacterium lactis DN-173 010, Lactobacillus casei Shirota and
Escherichia coli Nissle 1917 are effective in improving defecation
frequency and stool consistency in adults.
In children, Lactobacillus casei rhamnosus Lcr 35 shows a
beneficial effect.
Lactobacillus rhamnosus GG did not demonstrate any benefit
16. Probiotics and Constipation
Rationale
Some evidence of
- Aberrant microbiota
- Antibiotic benefit
- Link with methane oxidation
Up to 66% of the dry weight of stool is bacteria
Microbial production of SCFA and metabolism of bile acids help
lower gut pH and stimulate motility
- Some metabolic products act as neurotransmitters
which affects motility.
•Research
•Endpoints: symptom questionnaires-pain,
bloating, completeness of evacuation, stool
consistency defecation frequency, transit time
measurements
•Hoveyda & Whorwell et al-improvement in 3D
with Bifidobacterium infantis 35624(BMC
Gastrointestinal-2009)
•Evidence is accumulating for some other
strains also
17. CONSTIPATION
Krammer HJ Coloproctology 2011, 33: 109-113
Double blind Randomized Placebo Controlled trial
(n=24)
Yakult or placebo daily for period of 4 weeks
Significant acceleration of the total colonic transit
time from 95.6 h to 76.5 h (p=0.05) in probiotic group;
No statistically significant change in the total colonic
transit time (before: 95.8 h, after: 87.1 h, p=0.282) in
the placebo group
18. Probiotics in IBD
Still evolving and contentious..microbiota as cause??
Pouchitis: positive reports (in adults), with a mixture of
bacterial strains(VSL3)-85% remission vs 6%(Mimura et
al 2004 GUT)
Ulcerative Colitis: some positive effects
- maintenance of remission
- induction of remission in mild-mod flare ups
Crohn disease:minimal- no benefit
Choice of strain, dosing, and disease activity severity
might well account for variable results
Conclusion?: more high quality data (RCT‟s) are required!
Eamonn et al Nutr clin Pract 2012
19. INFLAMMATORY BOWEL DISEASE
Mitsuyama K et al J Clin Biochem Nutr 2008, 43 (Suppl.1):78-81
An open label preliminary trial conducted on 10 patients with
mildly to moderately active Ulcerative Colitis (UC)
Intervention: LcS (8x1010 CFU/day) in addition to conventional
therapy daily for 8 weeks
Significantly better clinical activity index score seen after LcS
treatment as compared with pre-treatment and control group
LcS effectively treats UC at least in part through the
inhibition of interleukin-6 signalling
20. MICROBIOTA & DISEASE
Antibiotic associated diarhhoea:Normal
microbiota eliminated by antibiotics helps other
disease causing bacteria to proliferate(Cl.diff.)
Necrotizing Enteroclotitis in premature infants
Small Intestinal bacterial overgrowth
Bacterial translocation from Gut flora in
- Critically ill
- Surgery or Trauma
- CLD with SBP
21. PROBIOTICS & LIVER DISEASES
NAFLD/OBESITY:Qualitative change in Gut
microbiota with more avid extractors of absorbale
nutrients…hence more Cal. to host(Iacano et al J
Nutr Biochem 2010)
Hepatic Encephalopathy(MHE):As effective as
Lactulose in decreasing Blood Ammonia levels
(Changing gut pH by SCFA,decreasing Bacterial
urease activity & decreasing intestinal permeability to
ammonia)-Shukla et al Aliment Pharmacol Ther 2011.
Salmonella induced liver damage prevented by
probiotics by decreasing bacterial translocation to
liver(Rishi et al FEMS Microbiol Ecol 2009)
22. SAFETY/CAUTION
Premature neonates or Immunodef. Infants
Short bowel syndrome-Septicemia
Severe acute Pancreatitis-Increased
Mortality
??? Etiology
23. CONCLUSIONS
•Role of Probiotics well established in
Infective & antibiotic ass. diarrhoea.
•+ve Role of Probiotics in Pouchitis & UC but
in Crohn‟s??
•MicrObesity- a new concept about microbial
community participating in development of
fat deposition,insulin resisitence & NAFLD
•Pre/pro/symbiotics improve MHE
significantly(almost as good as lactulose)
•Biologic effects of probiotics are likely to be
strain specific.