Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Probiotics

Probiotics

  • Be the first to comment

Probiotics

  1. 1. PROBIOTCSPROBIOTCS ByBy Dr. Tarek ShetaDr. Tarek Sheta Lecturer of internal medicineLecturer of internal medicine Mansoura Faculty of MedicineMansoura Faculty of Medicine
  2. 2.  First described byFirst described by Metchnikoff (a RussianMetchnikoff (a Russian scientist and professorscientist and professor at the Pasteur Instituteat the Pasteur Institute in Paris) inin Paris) in 19081908.. “Live microbial food“Live microbial food ingredients that alteringredients that alter the microflora andthe microflora and confer health benefit”confer health benefit” ProbioticsProbiotics  First described byFirst described by Metchnikoff (a RussianMetchnikoff (a Russian scientist and professorscientist and professor at the Pasteur Instituteat the Pasteur Institute in Paris) inin Paris) in 19081908.. “Live microbial food“Live microbial food ingredients that alteringredients that alter the microflora andthe microflora and confer health benefit”confer health benefit”
  3. 3. PROBIOTICS (BACTERIOTHERAPY)PROBIOTICS (BACTERIOTHERAPY) FAO/WHO DefinitionFAO/WHO Definition  NonNon--pathogenic livingpathogenic living organisms that exert aorganisms that exert a positive influence on thepositive influence on the health of the host animal.health of the host animal.  Administered in both drugAdministered in both drug form and as components ofform and as components of foods and beverages.foods and beverages.  NonNon--pathogenic livingpathogenic living organisms that exert aorganisms that exert a positive influence on thepositive influence on the health of the host animal.health of the host animal.  Administered in both drugAdministered in both drug form and as components ofform and as components of foods and beverages.foods and beverages.
  4. 4. Prebiotics: definitionPrebiotics: definition  NonNon--digestible fooddigestible food supplements or ingredients.supplements or ingredients.  Not absorbed or degradedNot absorbed or degraded in the intestine.in the intestine.  NonNon--digestible fooddigestible food supplements or ingredients.supplements or ingredients.  Not absorbed or degradedNot absorbed or degraded in the intestine.in the intestine.
  5. 5. PrebioticsPrebiotics  They stimulate the growth and activity of certainThey stimulate the growth and activity of certain species of bacteria in the colon.species of bacteria in the colon.  OligosaccheridesOligosaccherides  InulinInulin  garlicgarlic  onionsonions  Asparagus,Asparagus,  whole wheatwhole wheat  Fiber supplementsFiber supplements  They stimulate the growth and activity of certainThey stimulate the growth and activity of certain species of bacteria in the colon.species of bacteria in the colon.  OligosaccheridesOligosaccherides  InulinInulin  garlicgarlic  onionsonions  Asparagus,Asparagus,  whole wheatwhole wheat  Fiber supplementsFiber supplements
  6. 6. Prebiotics: Health benefitsPrebiotics: Health benefits  Promotion of growth of probiotics.Promotion of growth of probiotics.  Production of short chain fatty acids.Production of short chain fatty acids.  Increase of calcium absorption.Increase of calcium absorption.  Decrease glucose absorption.Decrease glucose absorption.  Promotion of growth of probiotics.Promotion of growth of probiotics.  Production of short chain fatty acids.Production of short chain fatty acids.  Increase of calcium absorption.Increase of calcium absorption.  Decrease glucose absorption.Decrease glucose absorption.
  7. 7. Prebiotic vs ProbioticPrebiotic vs Probiotic PrebioticPrebiotic  Usually carbohydrateUsually carbohydrate  Not aliveNot alive  Beneficial health effectBeneficial health effect  Food ingredientFood ingredient  Act on microbiotaAct on microbiota  Focus is colonFocus is colon, but broader, but broader effects also seeneffects also seen ProbioticProbiotic  MicroorganismMicroorganism  AliveAlive  Beneficial health effectBeneficial health effect  Food, dietary supplement,Food, dietary supplement, drugsdrugs  May act on microbiota, butMay act on microbiota, but other mechanismsother mechanisms  Can act on numerous sitesCan act on numerous sites around the bodyaround the body  Usually carbohydrateUsually carbohydrate  Not aliveNot alive  Beneficial health effectBeneficial health effect  Food ingredientFood ingredient  Act on microbiotaAct on microbiota  Focus is colonFocus is colon, but broader, but broader effects also seeneffects also seen  MicroorganismMicroorganism  AliveAlive  Beneficial health effectBeneficial health effect  Food, dietary supplement,Food, dietary supplement, drugsdrugs  May act on microbiota, butMay act on microbiota, but other mechanismsother mechanisms  Can act on numerous sitesCan act on numerous sites around the bodyaround the body
  8. 8. Synbiotic = Probiotic + PrebioticSynbiotic = Probiotic + Prebiotic
  9. 9. SynbioticsSynbiotics  A combination between a probioticA combination between a probiotic organism in combination with itsorganism in combination with its prebiotic food.prebiotic food.  Improves survivaImproves survivall and colonization byand colonization by probioticsprobiotics..  More effective than probiotics aloneMore effective than probiotics alone..  A combination between a probioticA combination between a probiotic organism in combination with itsorganism in combination with its prebiotic food.prebiotic food.  Improves survivaImproves survivall and colonization byand colonization by probioticsprobiotics..  More effective than probiotics aloneMore effective than probiotics alone..
  10. 10. Characteristics of EffectiveCharacteristics of Effective ProbioticsProbiotics  Survive the stomach acid and bile.Survive the stomach acid and bile.  Adhere to intestinal mucosal lining.Adhere to intestinal mucosal lining.  non pathogenic and non toxic.non pathogenic and non toxic.  Grow and establish temporaryGrow and establish temporary residence in the intestineresidence in the intestine  Import health benefitsImport health benefits Characteristics of EffectiveCharacteristics of Effective ProbioticsProbiotics  Survive the stomach acid and bile.Survive the stomach acid and bile.  Adhere to intestinal mucosal lining.Adhere to intestinal mucosal lining.  non pathogenic and non toxic.non pathogenic and non toxic.  Grow and establish temporaryGrow and establish temporary residence in the intestineresidence in the intestine  Import health benefitsImport health benefits
  11. 11. Different types of bacteria used asDifferent types of bacteria used as probioticsprobiotics Lactobacillus speciesLactobacillus species  L. acidophilusL. acidophilus  L. plantarumL. plantarum  L. casei subspecies rhamnosusL. casei subspecies rhamnosus  L. brevisL. brevis  L. delbreuckii subspecies bulgaricusL. delbreuckii subspecies bulgaricus Bifidobacterium speciesBifidobacterium species  B. adolescentisB. adolescentis  B. bifidumB. bifidum  B. longumB. longum  B. infantisB. infantis  B. breveB. breve Lactobacillus speciesLactobacillus species  L. acidophilusL. acidophilus  L. plantarumL. plantarum  L. casei subspecies rhamnosusL. casei subspecies rhamnosus  L. brevisL. brevis  L. delbreuckii subspecies bulgaricusL. delbreuckii subspecies bulgaricus Bifidobacterium speciesBifidobacterium species  B. adolescentisB. adolescentis  B. bifidumB. bifidum  B. longumB. longum  B. infantisB. infantis  B. breveB. breve
  12. 12. Other speciesOther species  Escherichia coliEscherichia coli  StreptococcusStreptococcus  SaccharomycesSaccharomyces  Several combinationsSeveral combinations on the marketon the market  Escherichia coliEscherichia coli  StreptococcusStreptococcus  SaccharomycesSaccharomyces  Several combinationsSeveral combinations on the marketon the market
  13. 13. Clinical Effects are strainClinical Effects are strain-- specificspecific •• Different strains of the same species can beDifferent strains of the same species can be different.different.
  14. 14. Potential Mechanisms of Action of ProbioticsPotential Mechanisms of Action of Probiotics
  15. 15. Levels of Probiotic ActivityLevels of Probiotic Activity Interfere with growth or survival of bacteria in gut lumen Improve mucosal barrier function and mucosal immune system Adapted from Rijkers GT, et al. J Nutr. 2010;140:671S-676S. Improve mucosal barrier function and mucosal immune system Affect systemic immune system
  16. 16. CLINICAL APPLICATIONS OF PROBIOTICS H. pylori Eradication Diarrhea Acute infectious Antibiotic-associated C. difficile IBD Ulcerative colitis Crohn’s disease Pouchitis Constipation Lactose Intolerance
  17. 17. DiarrheaDiarrhea  Treatment of acute diarrhea: It has been confirmed that different probiotic strains are useful in reducing the severity and duration of acute infectious diarrhea in children.  The evidence from studies on viral gastroenteritis is more convincing than the evidence on bacterial or parasitic infections. PROBIOTICS IN GI DISEASES DiarrheaDiarrhea  Treatment of acute diarrhea: It has been confirmed that different probiotic strains are useful in reducing the severity and duration of acute infectious diarrhea in children.  The evidence from studies on viral gastroenteritis is more convincing than the evidence on bacterial or parasitic infections.
  18. 18. Control (Control (1919)) L. reuteri/L. reuteri/ L. rhamnosusL. rhamnosus ((2424)) PP--valuevalue Duration of diarrheaDuration of diarrhea (hours)(hours) 115115..77 7575..99 00..0505 Treatment of Acute DiarrheaTreatment of Acute Diarrhea 5 Day Therapy in Danish Children (9 to 44 months) in Day Care with Acute Diarrhea Duration of diarrheaDuration of diarrhea (hours)(hours) 115115..77 7575..99 00..0505 Duration of wateryDuration of watery diarrheadiarrhea 3737 3838..11 00..9494 Duration of fever (days)Duration of fever (days) 11..11 11..44 00..5959 Diarrhea afterDiarrhea after 120120 hourshours 77 22 00..0303 V Rosenfeldt, et al. Pediatr Infect Dis J 21:417-9, 2002
  19. 19. Prevention of acute diarrhea:Prevention of acute diarrhea:  RadiationRadiation--induced diarrheainduced diarrhea  Traveller’s diarrhea.  In the prevention of adult andadult and childhood diarrheachildhood diarrhea, there is only suggestive evidence that Lactobacillus GG, L. casei DN-114 001, and S. boulardii are effective in some specific settings  RadiationRadiation--induced diarrheainduced diarrhea  Traveller’s diarrhea.  In the prevention of adult andadult and childhood diarrheachildhood diarrhea, there is only suggestive evidence that Lactobacillus GG, L. casei DN-114 001, and S. boulardii are effective in some specific settings
  20. 20. Yogurt (Yogurt (364364)) Yogurt+Yogurt+ L. caseiL. casei ((360360)) PP--valuevalue Children withChildren with diarrheadiarrhea 8787 ((2222%)%) 6161 ((1616%)%) 00..029029 Prevention of Diarrheal IllnessPrevention of Diarrheal Illness 18 Week Therapy in French Children (6-24 months) in Day Care Children withChildren with diarrheadiarrhea 8787 ((2222%)%) 6161 ((1616%)%) 00..029029 Duration ofDuration of diarrhea (days)diarrhea (days) 33..9595 33..5353 00..2424 Rotavirus positiveRotavirus positive stoolstool 22..22%% 00..33%% CA Pedone, et al. Int J Clin Pract 54(9):568-71, 2000
  21. 21. AntibioticAntibiotic--associated diarrhea:associated diarrhea:  One study indicated that L. casei DN-114 001 is effective in hospitalized adult patients for preventing antibiotic-associated diarrhea and C. difficile diarrhea.  One study indicated that L. casei DN-114 001 is effective in hospitalized adult patients for preventing antibiotic-associated diarrhea and C. difficile diarrhea.
  22. 22. Probiotics for the Prevention ofProbiotics for the Prevention of Antibiotic Associated DiarrheaAntibiotic Associated Diarrhea Mixtures included: Lactinex = L. acidophilus and L. bulgaricus; Lactobacillus acidophilus and Bifidobacterium lactis; Lactobacillus acidophilus and Bifidobacterium infantis. McFarland, Am J Gastroenterol 2006; 101(4): 812-822.
  23. 23. S. boulardii Is Effective in Patients with Recurrent C. difficile Disease Initial CDD CDDrecurrence,% P=NS Recurrent CDD P=0.04 CDDrecurrence,% CDD=Clostridium difficile-associated disease McFarland L, et al. JAMA. 1994;271:1913-1918. CDDrecurrence,% S. boulardii (n=31) Placebo (n=33) Control (n=34) Patients received standard antibiotics (vancomycin or metronidazole) and S. boulardii 1 g/day or placebo for 4 weeks. CDDrecurrence,% S. boulardii (n=26)
  24. 24. Probiotics in C. Difficile-Associated Disease RCTs of Probiotics for Treatment of C. difficile Disease BB=Bifidobacterium bifidum; LA=Lactobacillus acidophilus; LGG=Lactobacillus rhamnosus GG; LP=Lactobacillus plantarum 299v; SB=Saccharomyces boulardii MacFarland LV. Am J Gastroenterol. 2006;101:812-822.
  25. 25. Eradication ofEradication of Helicobacter pyloriHelicobacter pylori  Certain probiotics may be helpful as adjuvant therapy with antibiotics in the eradication of H. pylori infection.  Several lactobacilli and bifidobacterial strains reduce the side effects of antibiotic therapies and improve patient compliance.  Certain probiotics may be helpful as adjuvant therapy with antibiotics in the eradication of H. pylori infection.  Several lactobacilli and bifidobacterial strains reduce the side effects of antibiotic therapies and improve patient compliance.
  26. 26.  A meta-analysis of 14 randomized trials suggests that supplementation of anti–H. pylori antibiotic regimens with certain probiotics may be effective in increasing eradication rates.  There is no evidence to support that a probiotic alone, without concomitant antibiotic therapy, would be effective.  A meta-analysis of 14 randomized trials suggests that supplementation of anti–H. pylori antibiotic regimens with certain probiotics may be effective in increasing eradication rates.  There is no evidence to support that a probiotic alone, without concomitant antibiotic therapy, would be effective.
  27. 27. Probiotics in irritable bowel syndrome (IBS)  IBS includes a range of symptoms, such as abdominal pain, altered bowel habits, bloating and flatulence in the absence of structural abnormalities in the intestine.  IBS includes a range of symptoms, such as abdominal pain, altered bowel habits, bloating and flatulence in the absence of structural abnormalities in the intestine.
  28. 28.  Studies have observed alterations in intestinal microflora in patients and increased symptoms following enteric infections, therefore probiotics might be a useful tool to improve symptoms.  A reduction in abdominal bloating and flatulence as a result of probiotic treatments is a consistent finding in published studies; some strains may ameliorate pain and provide global relief (B. infantis 35624). Lactobacillus reuteri may improve colicky symptoms within one week of treatment.  Studies have observed alterations in intestinal microflora in patients and increased symptoms following enteric infections, therefore probiotics might be a useful tool to improve symptoms.  A reduction in abdominal bloating and flatulence as a result of probiotic treatments is a consistent finding in published studies; some strains may ameliorate pain and provide global relief (B. infantis 35624). Lactobacillus reuteri may improve colicky symptoms within one week of treatment.
  29. 29. Summary of Key Randomized ControlledSummary of Key Randomized Controlled Trials of Probiotics in IBSTrials of Probiotics in IBS William D Chey, Reviews in Gastroenterol 2010
  30. 30. Probiotics after gut surgery  Roux-en Y gastric bypass surgery (one type of bariatric surgery) is an effective treatment of morbid obesity.  Problems that occur post operatively are alteration of microflora with bacterial overgrowth (BO) in the blind sac of the intestine, intestinal pain, and possibly impaired vitamin B12 status (due to lack of intrinsic factor production from the stomach).  Roux-en Y gastric bypass surgery (one type of bariatric surgery) is an effective treatment of morbid obesity.  Problems that occur post operatively are alteration of microflora with bacterial overgrowth (BO) in the blind sac of the intestine, intestinal pain, and possibly impaired vitamin B12 status (due to lack of intrinsic factor production from the stomach).
  31. 31.  Probiotic treatment (6 mo) in 44 post operational patients. BO improved only after 6 mo, but not earlier.  Vitamin B12 status improved, gastrointestinal symptoms remained unchanged, but post operational weight loss was significantly increased in the probiotic group.  Probiotic treatment (6 mo) in 44 post operational patients. BO improved only after 6 mo, but not earlier.  Vitamin B12 status improved, gastrointestinal symptoms remained unchanged, but post operational weight loss was significantly increased in the probiotic group.
  32. 32. Lactose intolerance  Streptococcus thermophilus and Lactobacillus delbrueckii subsp. Bulgaricus improve lactose digestion and reduce symptoms related to lactose intolerance.  Streptococcus thermophilus and Lactobacillus delbrueckii subsp. Bulgaricus improve lactose digestion and reduce symptoms related to lactose intolerance.
  33. 33. Necrotizing enterocolitis  Probiotics supplementation reduces the risk of necrotizing enterocolitis in preterm neonates.  Systematic reviews of randomized controlled trials have also shown a reduced risk of death in probiotic treated groups.  Probiotics supplementation reduces the risk of necrotizing enterocolitis in preterm neonates.  Systematic reviews of randomized controlled trials have also shown a reduced risk of death in probiotic treated groups.
  34. 34. Probiotics in Ulcerative Colitis  Various probiotic species have shown promise inVarious probiotic species have shown promise in management of ulcerative colitis.management of ulcerative colitis.  Prevention of relapse is more clinicalyPrevention of relapse is more clinicaly documented than the treatment of active disease.documented than the treatment of active disease.
  35. 35.  The following are illustrative controlled trials:The following are illustrative controlled trials:  E. coli was as effective as lowE. coli was as effective as low--dosedose 55-- aminosalicylic acid (aminosalicylic acid (55--ASA) in preventingASA) in preventing relapse of ulcerative colitis.relapse of ulcerative colitis.  The combination of VSL#The combination of VSL#33 plus mesalazineplus mesalazine was slightly more effective than mesalazinewas slightly more effective than mesalazine alone in mildalone in mild--toto--moderate ulcerative colitis.moderate ulcerative colitis.  The combination of a prebiotic and a probioticThe combination of a prebiotic and a probiotic ( Bifidobacterium) was associated with( Bifidobacterium) was associated with improvement in histologic scores and immuneimprovement in histologic scores and immune activation in a oneactivation in a one--month randomizedmonth randomized controlled trial.controlled trial.  The following are illustrative controlled trials:The following are illustrative controlled trials:  E. coli was as effective as lowE. coli was as effective as low--dosedose 55-- aminosalicylic acid (aminosalicylic acid (55--ASA) in preventingASA) in preventing relapse of ulcerative colitis.relapse of ulcerative colitis.  The combination of VSL#The combination of VSL#33 plus mesalazineplus mesalazine was slightly more effective than mesalazinewas slightly more effective than mesalazine alone in mildalone in mild--toto--moderate ulcerative colitis.moderate ulcerative colitis.  The combination of a prebiotic and a probioticThe combination of a prebiotic and a probiotic ( Bifidobacterium) was associated with( Bifidobacterium) was associated with improvement in histologic scores and immuneimprovement in histologic scores and immune activation in a oneactivation in a one--month randomizedmonth randomized controlled trial.controlled trial.
  36. 36. Maintaining remission of ulcerativeMaintaining remission of ulcerative colitis withcolitis with Escherichia coli NissleEscherichia coli Nissle 19171917 Kruis et al., Gut. 2004 Nov;53(11):1617-23
  37. 37. Probiotics in Crohn's Disease  Studies proved the preventive effect ofStudies proved the preventive effect of Lactobacillus on the appearance of recurrentLactobacillus on the appearance of recurrent lesions of CD after surgery.lesions of CD after surgery.  Studies proved the preventive effect ofStudies proved the preventive effect of Lactobacillus on the appearance of recurrentLactobacillus on the appearance of recurrent lesions of CD after surgery.lesions of CD after surgery.
  38. 38.  A combination of three BifidobacteriumA combination of three Bifidobacterium species, four Lactobacillus species has beenspecies, four Lactobacillus species has been evaluated for the prevention of recurrentevaluated for the prevention of recurrent inflammation after surgery.inflammation after surgery.  After one year, there was a significantly lowerAfter one year, there was a significantly lower rate of severe endoscopic recurrence in patientsrate of severe endoscopic recurrence in patients treated with the antibiotic and probiotictreated with the antibiotic and probiotic combination.combination.  A combination of three BifidobacteriumA combination of three Bifidobacterium species, four Lactobacillus species has beenspecies, four Lactobacillus species has been evaluated for the prevention of recurrentevaluated for the prevention of recurrent inflammation after surgery.inflammation after surgery.  After one year, there was a significantly lowerAfter one year, there was a significantly lower rate of severe endoscopic recurrence in patientsrate of severe endoscopic recurrence in patients treated with the antibiotic and probiotictreated with the antibiotic and probiotic combination.combination.
  39. 39. Probiotics and Pouchitis  PouchitisPouchitis is a nonspecific inflammation of theis a nonspecific inflammation of the ileal reservoir after ileoileal reservoir after ileo--anal anastomosis foranal anastomosis for ulcerative colitis.ulcerative colitis.  Disturbances in the intestinal micro flora mayDisturbances in the intestinal micro flora may be the triggering factor in its pathogenesis.be the triggering factor in its pathogenesis.  PouchitisPouchitis is a nonspecific inflammation of theis a nonspecific inflammation of the ileal reservoir after ileoileal reservoir after ileo--anal anastomosis foranal anastomosis for ulcerative colitis.ulcerative colitis.  Disturbances in the intestinal micro flora mayDisturbances in the intestinal micro flora may be the triggering factor in its pathogenesis.be the triggering factor in its pathogenesis.
  40. 40.  There is good evidence for the usefulness of probiotics in preventing an initial attack of pouchitis (VSL#3), and in preventing further relapse of pouchitis after the induction of remission with antibiotics.  Probiotics can be recommended to patients with pouchitis of mild activity, or as maintenance therapy for those in remission.  There is good evidence for the usefulness of probiotics in preventing an initial attack of pouchitis (VSL#3), and in preventing further relapse of pouchitis after the induction of remission with antibiotics.  Probiotics can be recommended to patients with pouchitis of mild activity, or as maintenance therapy for those in remission.
  41. 41.  The SYNCAN study tested the effect of oligofructoseoligofructose plus two probiotic strainsplus two probiotic strains in patients at risk of developing colonic cancer.  The results of the study suggest that a synbiotic preparation can decrease the expression of biomarkers for colorectal cancer. Colon cancer  The SYNCAN study tested the effect of oligofructoseoligofructose plus two probiotic strainsplus two probiotic strains in patients at risk of developing colonic cancer.  The results of the study suggest that a synbiotic preparation can decrease the expression of biomarkers for colorectal cancer.
  42. 42. PROBIOTICS IN HEPATOLOGY  A major aspect of liver disease is abnormal gutA major aspect of liver disease is abnormal gut flora.flora.  A balanced and healthy gut prevents a highA balanced and healthy gut prevents a high percentage of pathological liver conditions.percentage of pathological liver conditions.  The term “gut liver axis” has been used toThe term “gut liver axis” has been used to suggest that the microflora affect the liver andsuggest that the microflora affect the liver and acts as a cofactor in aetiology of chronic liveracts as a cofactor in aetiology of chronic liver damage.damage.  A major aspect of liver disease is abnormal gutA major aspect of liver disease is abnormal gut flora.flora.  A balanced and healthy gut prevents a highA balanced and healthy gut prevents a high percentage of pathological liver conditions.percentage of pathological liver conditions.  The term “gut liver axis” has been used toThe term “gut liver axis” has been used to suggest that the microflora affect the liver andsuggest that the microflora affect the liver and acts as a cofactor in aetiology of chronic liveracts as a cofactor in aetiology of chronic liver damage.damage.
  43. 43.  Probiotic actions most relevant to liverProbiotic actions most relevant to liver disease are modification of intestinal barrierdisease are modification of intestinal barrier function and prevention of BT.function and prevention of BT.  GramGram--negative BO, increased permeability,negative BO, increased permeability, and impaired immunity all contribute toand impaired immunity all contribute to increased BT, and there is a strongincreased BT, and there is a strong correlation between the rate of BT and thecorrelation between the rate of BT and the severity of cirrhosis.severity of cirrhosis.  Probiotics might alter gut flora towardsProbiotics might alter gut flora towards protective organisms and increase barrierprotective organisms and increase barrier functionfunction  Probiotic actions most relevant to liverProbiotic actions most relevant to liver disease are modification of intestinal barrierdisease are modification of intestinal barrier function and prevention of BT.function and prevention of BT.  GramGram--negative BO, increased permeability,negative BO, increased permeability, and impaired immunity all contribute toand impaired immunity all contribute to increased BT, and there is a strongincreased BT, and there is a strong correlation between the rate of BT and thecorrelation between the rate of BT and the severity of cirrhosis.severity of cirrhosis.  Probiotics might alter gut flora towardsProbiotics might alter gut flora towards protective organisms and increase barrierprotective organisms and increase barrier functionfunction
  44. 44. NAFLD  Improved the hepatic inflammatory, steatotic, peroxidative factors, serum aminotransferase Levels.  (L. acidophilus, L. bulgaricus)  Improved the hepatic inflammatory, steatotic, peroxidative factors, serum aminotransferase Levels.  (L. acidophilus, L. bulgaricus)
  45. 45. Alcoholic Liver Disease  Improving the liver transaminases, total bilirubin, ameliorating hepatic inflammation and histological grade are results from probiotic therapy
  46. 46.  Bacteriotherapy with probiotic in patients with cirrhosis modulates bioecological system in the intestinal tract via prevention of the growth of pathogens, improvement to the mucosal layer, preservation of intestinal epithelia cells, and BT reduction.  All of these mechanisms decrease portal hypertension due to inhibition of NO production  Incidence of HE, hospital admission, plasma- ammonia level, serum bilirubin level Cirrhosis  Bacteriotherapy with probiotic in patients with cirrhosis modulates bioecological system in the intestinal tract via prevention of the growth of pathogens, improvement to the mucosal layer, preservation of intestinal epithelia cells, and BT reduction.  All of these mechanisms decrease portal hypertension due to inhibition of NO production  Incidence of HE, hospital admission, plasma- ammonia level, serum bilirubin level
  47. 47. Hepatic Encephalopathy  Evidence obtained from clinical trials suggest that probiotics were able to decrease serum ammonia levels and improve neuropsychological symptoms  Possible mechanisms include:  Reduction of bacterial urease activity  Alleviation of pH and ammonia absorption  Decreased intestinal permeability  Evidence obtained from clinical trials suggest that probiotics were able to decrease serum ammonia levels and improve neuropsychological symptoms  Possible mechanisms include:  Reduction of bacterial urease activity  Alleviation of pH and ammonia absorption  Decreased intestinal permeability
  48. 48. Viral Hepatitis  Loguerico et al. treated 20 patients with HCV chronic hepatitis and 16 with HCV-related cirrhosis withVSL#3 (Streptococcus thermophilus, Bifidobacterium berve, Bifidobacterium longum, Bifidobacterium infanti, Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus casei, and Lactobacillus bulgaricus) for four months.  ALT, and AST levels improved in two groups, and gamma glutamyl transferase improvement was observed only in HCV-related chronic hepatitis group.  Loguerico et al. treated 20 patients with HCV chronic hepatitis and 16 with HCV-related cirrhosis withVSL#3 (Streptococcus thermophilus, Bifidobacterium berve, Bifidobacterium longum, Bifidobacterium infanti, Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus casei, and Lactobacillus bulgaricus) for four months.  ALT, and AST levels improved in two groups, and gamma glutamyl transferase improvement was observed only in HCV-related chronic hepatitis group.
  49. 49. Hepatocellular Carcinoma  Studies were performed to assess probiotic effects on toxicity of aflatoxin in liver dysfunction and hepatocellular carcinoma.  In a recent study (2012), diminution of aflatoxin concentration was observed in fecal samples after the administration of Lactobacillus rhamnosus LC705  Studies were performed to assess probiotic effects on toxicity of aflatoxin in liver dysfunction and hepatocellular carcinoma.  In a recent study (2012), diminution of aflatoxin concentration was observed in fecal samples after the administration of Lactobacillus rhamnosus LC705
  50. 50. Liver transplantation  Infection in a postoperative period is usuallyInfection in a postoperative period is usually very prevalent in patients who havevery prevalent in patients who have undergone liver transplantation.undergone liver transplantation.  The most causative agents involved in theseThe most causative agents involved in these types of infections originate from thetypes of infections originate from the digestive tract.digestive tract.  Infection in a postoperative period is usuallyInfection in a postoperative period is usually very prevalent in patients who havevery prevalent in patients who have undergone liver transplantation.undergone liver transplantation.  The most causative agents involved in theseThe most causative agents involved in these types of infections originate from thetypes of infections originate from the digestive tract.digestive tract.
  51. 51. Clinical Trials Assessed Probiotics Roles onClinical Trials Assessed Probiotics Roles on Postoperative Infections in Liver TransplantationPostoperative Infections in Liver Transplantation Four clinical trials performed on liver transplant patients confirmed the inhibitory nature of probiotic consumption on postoperative infections.
  52. 52. Probiotics to bind toxins and carcinogens  Some experimental evidence suggests that probiotics could be used to bind and immobilise toxic compounds within the gut lumen.
  53. 53.  Through this process, the negative effects of dietary toxins could be reduced and gut and liver health improved. In vitro, L. rhamnosus GG is able to bind mycotoxins known to interfere with intestinal mucosal barrier.  Through this process, the negative effects of dietary toxins could be reduced and gut and liver health improved. In vitro, L. rhamnosus GG is able to bind mycotoxins known to interfere with intestinal mucosal barrier.
  54. 54. PROBIOTICS IN TREATMENT OF ALLERGY 1.1. Prevents food allergy by promotingPrevents food allergy by promoting endogenous barrier mechanisms andendogenous barrier mechanisms and alleviating intestinal inflammation.alleviating intestinal inflammation. 2.2. Reduction of serum IgEReduction of serum IgE levels leading tolevels leading to improvement of cases of atopic dermatitis.improvement of cases of atopic dermatitis. PROBIOTICS IN TREATMENT OF ALLERGY 1.1. Prevents food allergy by promotingPrevents food allergy by promoting endogenous barrier mechanisms andendogenous barrier mechanisms and alleviating intestinal inflammation.alleviating intestinal inflammation. 2.2. Reduction of serum IgEReduction of serum IgE levels leading tolevels leading to improvement of cases of atopic dermatitis.improvement of cases of atopic dermatitis.
  55. 55. Impact of Probiotics onImpact of Probiotics on prevention of eczemaprevention of eczema Wickenset et al. 2008. J Allergy Clin Immunol. 6 mo treatment of mother from 35 wks gestation to 6 months of age; infants through 2 years of age
  56. 56. Probiotics as Immune Enhancers  There is evidence that several probiotic strains and the prebiotic oligofructose are useful in boosting the immune response.
  57. 57.  Evidence was obtained in studies aimed at preventing acute infectious disease (nosocomial diarrhea in children, influenza episodes in winter) and studies that tested antibody responses to vaccines.  Evidence was obtained in studies aimed at preventing acute infectious disease (nosocomial diarrhea in children, influenza episodes in winter) and studies that tested antibody responses to vaccines.
  58. 58. L. acidophilus NCFM and/or B. animalis BiL. acidophilus NCFM and/or B. animalis Bi--0707 reducesreduces symptoms of colds/flusymptoms of colds/flu in Chinese childrenin Chinese children ..  DBPC studyDBPC study  N=N=326326 children (children (33––55 years ofyears of age)age)  Probiotic: NCFM orProbiotic: NCFM or NCFM+BiNCFM+Bi--0707, dried powder, dried powder mixed in milkmixed in milk  Daily doseDaily dose 10101010cfu/dcfu/d  66 months administrationmonths administration  DBPC studyDBPC study  N=N=326326 children (children (33––55 years ofyears of age)age)  Probiotic: NCFM orProbiotic: NCFM or NCFM+BiNCFM+Bi--0707, dried powder, dried powder mixed in milkmixed in milk  Daily doseDaily dose 10101010cfu/dcfu/d  66 months administrationmonths administration Leyer et al. 2009. Pediatrics;124(2):e172-9
  59. 59. Lowering of Blood Cholesterol  Animal studies have demonstrated the efficacy ofAnimal studies have demonstrated the efficacy of some strains of LAB at being able tosome strains of LAB at being able to lowerlower serum cholesterol levels, presumably by breakingserum cholesterol levels, presumably by breaking down bile in the gut, thus inhibiting itsdown bile in the gut, thus inhibiting its reabsorptionreabsorption ..
  60. 60. Reduction of Blood pressure  Although not a confirmedAlthough not a confirmed effect, some studies haveeffect, some studies have indicated that consumption ofindicated that consumption of milk fermented with variousmilk fermented with various strains of LABstrains of LAB may result inmay result in modest reductions in bloodmodest reductions in blood pressure, an effectpressure, an effect possiblypossibly related to the ACE inhibitorrelated to the ACE inhibitor-- like peptides produced duringlike peptides produced during fermentationfermentation  Although not a confirmedAlthough not a confirmed effect, some studies haveeffect, some studies have indicated that consumption ofindicated that consumption of milk fermented with variousmilk fermented with various strains of LABstrains of LAB may result inmay result in modest reductions in bloodmodest reductions in blood pressure, an effectpressure, an effect possiblypossibly related to the ACE inhibitorrelated to the ACE inhibitor-- like peptides produced duringlike peptides produced during fermentationfermentation
  61. 61. Vitamin production  Probiotics have the capacity to synthesizeProbiotics have the capacity to synthesize vitamins. In vitro studies and in humans havevitamins. In vitro studies and in humans have documented the capacity ofdocumented the capacity of some probioticsome probiotic strains to synthesize Vitamin k, folic Acid, andstrains to synthesize Vitamin k, folic Acid, and BB1212..  Probiotics have the capacity to synthesizeProbiotics have the capacity to synthesize vitamins. In vitro studies and in humans havevitamins. In vitro studies and in humans have documented the capacity ofdocumented the capacity of some probioticsome probiotic strains to synthesize Vitamin k, folic Acid, andstrains to synthesize Vitamin k, folic Acid, and BB1212..
  62. 62. Other uses of probioticsOther uses of probiotics  Dental caries.  Urinary Tract Infections  Candida vaginal infections.  Dental caries.  Urinary Tract Infections  Candida vaginal infections.
  63. 63. AVAILABLE FORMS OF PROBIOTICS
  64. 64. Probiotic FoodsProbiotic Foods YogurtYogurt  UsuallyUsually mademade fromfrom milkmilk (rarely,(rarely, fromfrom cream)cream) inoculatedinoculated withwith StreptococcusStreptococcus thermophilusthermophilus andand eithereither LactobacillusLactobacillus acidophilusacidophilus oror LactobacillusLactobacillus bulgaricusbulgaricus..  TurkishTurkish inin originorigin  AvailableAvailable inin innumerableinnumerable formsforms andand flavorsflavors 11.. LowfatLowfat chocolatechocolate yogurtyogurt 22.. DrinkableDrinkable fruitfruit--flavoredflavored goatgoat yogurtyogurt 33.. NeonNeon--coloredcolored yogurtyogurt inin squeezesqueeze tubestubes YogurtYogurt  UsuallyUsually mademade fromfrom milkmilk (rarely,(rarely, fromfrom cream)cream) inoculatedinoculated withwith StreptococcusStreptococcus thermophilusthermophilus andand eithereither LactobacillusLactobacillus acidophilusacidophilus oror LactobacillusLactobacillus bulgaricusbulgaricus..  TurkishTurkish inin originorigin  AvailableAvailable inin innumerableinnumerable formsforms andand flavorsflavors 11.. LowfatLowfat chocolatechocolate yogurtyogurt 22.. DrinkableDrinkable fruitfruit--flavoredflavored goatgoat yogurtyogurt 33.. NeonNeon--coloredcolored yogurtyogurt inin squeezesqueeze tubestubes
  65. 65. FrozenFrozen YogurtYogurt LaLoo’s Goat’s MilkLaLoo’s Goat’s Milk Frozen Yogurt,Frozen Yogurt, naturally chocknaturally chock--full offull of S. Thermophilus, L.S. Thermophilus, L. Bulgaricus, L.Bulgaricus, L. AcidophilusAcidophilus andand Bifidus.Bifidus. FrozenFrozen YogurtYogurt LaLoo’s Goat’s MilkLaLoo’s Goat’s Milk Frozen Yogurt,Frozen Yogurt, naturally chocknaturally chock--full offull of S. Thermophilus, L.S. Thermophilus, L. Bulgaricus, L.Bulgaricus, L. AcidophilusAcidophilus andand Bifidus.Bifidus.
  66. 66. JuiceJuice  FirstFirst probioticprobiotic juicejuice launchedlaunched inin thethe fallfall ofof 20072007 byby NextNext FoodsFoods..  Goodbelly,Goodbelly, organicorganic fruitfruit juicejuice--basedbased probioticprobiotic beveragebeverage ,, containscontains LL..PlantarumPlantarum 299299 hashas effectseffects onon irritableirritable bowelbowel syndromesyndrome  ThreeThree initialinitial flavorsflavors includeinclude BrilliantBrilliant Blueberry,Blueberry, PeachPeach MangoMango andand StrawberryStrawberry RosehipRosehip
  67. 67. DairyDairy DrinkDrink  Probiotic,Probiotic, culturedcultured dairydairy beveragebeverage  HasHas citruscitrus flavorflavor  SoldSold inin singlesingle--shotshot containerscontainers thatthat containcontain aroundaround 88 billionbillion livelive andand activeactive LactobacillusLactobacillus caseicasei ShirotaShirota cellscells perper bottlebottle DairyDairy DrinkDrink  Probiotic,Probiotic, culturedcultured dairydairy beveragebeverage  HasHas citruscitrus flavorflavor  SoldSold inin singlesingle--shotshot containerscontainers thatthat containcontain aroundaround 88 billionbillion livelive andand activeactive LactobacillusLactobacillus caseicasei ShirotaShirota cellscells perper bottlebottle
  68. 68. Rice YogurtRice Yogurt An organic, nonAn organic, non--dairy, rice “yogurt” with whole grains and live,dairy, rice “yogurt” with whole grains and live, active cultures, includingactive cultures, including Lactobacillus bulgaricus, StreptococcusLactobacillus bulgaricus, Streptococcus thermophilus, Lactobacillus acidophilusthermophilus, Lactobacillus acidophilus andand BifidobacteriumBifidobacterium bifidum.bifidum.
  69. 69. Chocolate barsChocolate bars  AttuneAttune makesmakes WellnessWellness BarsBars inin threethree chocolatechocolate varietiesvarieties andand threethree yogurtyogurt andand granolagranola varietiesvarieties..  AllAll productsproducts containcontain “more“more thanthan 55 timestimes thethe livelive activeactive culturescultures inin yogurt,yogurt, withwith lessless sugarsugar.. KashiKashi ViveVive ProbioticProbiotic DigestiveDigestive WellnessWellness CerealCereal ViveVive containscontains oneone billionbillion CFUsCFUs ofof LactobacillusLactobacillus acidophilusacidophilus perper servingserving.. Chocolate barsChocolate bars  AttuneAttune makesmakes WellnessWellness BarsBars inin threethree chocolatechocolate varietiesvarieties andand threethree yogurtyogurt andand granolagranola varietiesvarieties..  AllAll productsproducts containcontain “more“more thanthan 55 timestimes thethe livelive activeactive culturescultures inin yogurt,yogurt, withwith lessless sugarsugar.. KashiKashi ViveVive ProbioticProbiotic DigestiveDigestive WellnessWellness CerealCereal ViveVive containscontains oneone billionbillion CFUsCFUs ofof LactobacillusLactobacillus acidophilusacidophilus perper servingserving..
  70. 70. PROBIOTICPROBIOTIC CANDYCANDY
  71. 71. Drug FormsDrug Forms CapsulesCapsules Powder blendsPowder blends Chewable tabletsChewable tablets CapsulesCapsules Powder blendsPowder blends Chewable tabletsChewable tablets
  72. 72. PROBIOTICS AVAILABLE INPROBIOTICS AVAILABLE IN EGYPTEGYPT
  73. 73. ProbioticsProbiotics DRAWBACKSDRAWBACKS
  74. 74. ProbioticsProbiotics DRAWBACKSDRAWBACKS  Not FDA regulated:Not FDA regulated: Quality control is poorQuality control is poor  Not FDA regulated:Not FDA regulated: Quality control is poorQuality control is poor
  75. 75. 8080% of commercial preparations tested had% of commercial preparations tested had 11%% or less of the bacterial concentration on theor less of the bacterial concentration on the labellabel
  76. 76. ProbioticsProbiotics DRAWBACKSDRAWBACKS Numerous preparations on the market ?Numerous preparations on the market ?  Which species is best?Which species is best?  Are combination agents better?Are combination agents better?  What is the appropriate dose?What is the appropriate dose?  What is the appropriate duration ofWhat is the appropriate duration of treatment?treatment? Numerous preparations on the market ?Numerous preparations on the market ?  Which species is best?Which species is best?  Are combination agents better?Are combination agents better?  What is the appropriate dose?What is the appropriate dose?  What is the appropriate duration ofWhat is the appropriate duration of treatment?treatment?
  77. 77. ProbioticsProbiotics DRAWBACKSDRAWBACKS  Probiotics taken orally can be destroyed byProbiotics taken orally can be destroyed by the acidic conditions of the stomach.the acidic conditions of the stomach.  Food forms should be kept in fridge.Food forms should be kept in fridge.  To date, no generalisation can be made from health effects of one probiotic strain to another one and this remains a serious problem within the probiotic research field and its applications.  Probiotics taken orally can be destroyed byProbiotics taken orally can be destroyed by the acidic conditions of the stomach.the acidic conditions of the stomach.  Food forms should be kept in fridge.Food forms should be kept in fridge.  To date, no generalisation can be made from health effects of one probiotic strain to another one and this remains a serious problem within the probiotic research field and its applications.
  78. 78. ProbioticsProbiotics DRAWBACKSDRAWBACKS  Difficult to determine pathogenicity:Difficult to determine pathogenicity:  Virulence factors for pathogensVirulence factors for pathogens (adherence, colonization) are common(adherence, colonization) are common in probiotic bacteria.in probiotic bacteria.  The required dose of probiotics varyThe required dose of probiotics vary greatly for different strains and thegreatly for different strains and the specific desired health effect .specific desired health effect .  May need several months of therapyMay need several months of therapy to see an effect .to see an effect .  Likely stop its action once discontinued.Likely stop its action once discontinued.  Difficult to determine pathogenicity:Difficult to determine pathogenicity:  Virulence factors for pathogensVirulence factors for pathogens (adherence, colonization) are common(adherence, colonization) are common in probiotic bacteria.in probiotic bacteria.  The required dose of probiotics varyThe required dose of probiotics vary greatly for different strains and thegreatly for different strains and the specific desired health effect .specific desired health effect .  May need several months of therapyMay need several months of therapy to see an effect .to see an effect .  Likely stop its action once discontinued.Likely stop its action once discontinued.
  79. 79. Side Effects of ProbioticsSide Effects of Probiotics  Probitics are generally safe andProbitics are generally safe and well tolerated.well tolerated.  Rare cases reported bloating,Rare cases reported bloating, flatulence, diarrhea, abdominalflatulence, diarrhea, abdominal pain (pain (22%).%).  People having on underlyingPeople having on underlying disease or compromiseddisease or compromised immune system cause potentialimmune system cause potential health problems.health problems.  Probitics are generally safe andProbitics are generally safe and well tolerated.well tolerated.  Rare cases reported bloating,Rare cases reported bloating, flatulence, diarrhea, abdominalflatulence, diarrhea, abdominal pain (pain (22%).%).  People having on underlyingPeople having on underlying disease or compromiseddisease or compromised immune system cause potentialimmune system cause potential health problems.health problems.
  80. 80. Invasivesive LactobacillusLactobacillus InfectionInfection  Occasional reports ofOccasional reports of invasive infectionsinvasive infections  BacteremiaBacteremia  skin rashskin rash  feverfever  bloody stoolsbloody stools  EndocarditisEndocarditis  Liver abscessLiver abscess  Occasional reports ofOccasional reports of invasive infectionsinvasive infections  BacteremiaBacteremia  skin rashskin rash  feverfever  bloody stoolsbloody stools  EndocarditisEndocarditis  Liver abscessLiver abscess
  81. 81.  Mostly reported in immunecompromisedMostly reported in immunecompromised patients or uncontrolled medical disorders.patients or uncontrolled medical disorders.
  82. 82. Probiotics: What’s neededProbiotics: What’s needed  Standardized protocolsStandardized protocols  Larger studiesLarger studies  Defined outcomesDefined outcomes  Correlation with symptoms? Or cytokineCorrelation with symptoms? Or cytokine levels? Or rectal biopsies? Or…levels? Or rectal biopsies? Or…  Standardized protocolsStandardized protocols  Larger studiesLarger studies  Defined outcomesDefined outcomes  Correlation with symptoms? Or cytokineCorrelation with symptoms? Or cytokine levels? Or rectal biopsies? Or…levels? Or rectal biopsies? Or…
  83. 83. TAKE HOME MESSAGETAKE HOME MESSAGE  Probiotics are living microorganisms with multiple mechanisms of action.  Good safety profile  Many beneficial effects in gastroenterology, hepatology and many other potential uses.  Probiotics are living microorganisms with multiple mechanisms of action.  Good safety profile  Many beneficial effects in gastroenterology, hepatology and many other potential uses.
  84. 84. TAKE HOME MESSAGETAKE HOME MESSAGE  to confirm the viability of probiotics, more clinical trials in various countries with disparate races, ethnicity, and lifestyles would be required.  to confirm the viability of probiotics, more clinical trials in various countries with disparate races, ethnicity, and lifestyles would be required.
  85. 85. THANK YOU

    Be the first to comment

    Login to see the comments

  • 8747967066

    Sep. 28, 2016
  • PriyankaMehta74

    Feb. 16, 2017
  • marjozaka1

    Mar. 7, 2017
  • stassen74

    Oct. 30, 2017
  • MimansaSura

    Nov. 19, 2017
  • HanyMahmoud17

    Dec. 13, 2018
  • PeterYing2

    Jun. 23, 2019
  • HaniaElsamad

    Nov. 20, 2019
  • DimpalAghera

    Dec. 3, 2019
  • omaramohamed31

    Mar. 5, 2020
  • SubhadarsiniDash1

    Mar. 7, 2020
  • MuskanS2

    Mar. 11, 2020
  • DrVikrantNarwal

    Apr. 5, 2020
  • HaifaaNajee

    May. 3, 2020
  • HetviShah4

    May. 20, 2020
  • SMRITIJAIN47

    Oct. 16, 2020
  • arjunbalram

    Nov. 1, 2020
  • MonikaSingh516

    Nov. 24, 2020
  • JoelLopezMDCNSDABAAR

    Dec. 27, 2020

Probiotics

Views

Total views

2,463

On Slideshare

0

From embeds

0

Number of embeds

10

Actions

Downloads

232

Shares

0

Comments

0

Likes

19

×