Probiotics for the Management of Pediatric Gastrointestinal Disorders: Position Paper of the ESPGHAN Special Interest Group on Gut Microbiota and Modifications

Journal of Pediatric Gastroenterology and Nutrition, Journal Year: 2022, Volume and Issue: 76(2), P. 232 - 247

Published: Oct. 11, 2022

Background: Probiotics, defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host, are widely used despite uncertainty regarding their efficacy and discordant recommendations about use. The European Society for Paediatric Gastroenterology, Hepatology Nutrition (ESPGHAN) Special Interest Group Gut Microbiota Modifications provides updated use of probiotics management selected pediatric gastrointestinal disorders. Methods: All systematic reviews and/or meta-analyses, well subsequently published randomized controlled trials (RCTs) (until December 2021), that compared all delivery vehicles formulations, at any dose, with no probiotic (ie, placebo or treatment), were eligible inclusion. formulated only if least 2 RCTs similar well-defined strain available. modified Delphi process was to establish consensus recommendations. Results: Recommendations specific strains made acute gastroenteritis, prevention antibiotic-associated diarrhea, nosocomial diarrhea necrotizing enterocolitis, Helicobacter pylori infection, functional abdominal pain disorders infant colic. Conclusions: Despite evidence support some clinical situations, further studies confirming effect(s) defining type, timing still often required. documented benefits should be discouraged.

Language: Английский

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AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Diarrhea

Gastroenterology, Journal Year: 2022, Volume and Issue: 163(1), P. 137 - 151

Published: June 20, 2022

Language: Английский

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The Influence of Gut Microbiota on Oxidative Stress and the Immune System

Biomedicines, Journal Year: 2023, Volume and Issue: 11(5), P. 1388 - 1388

Published: May 8, 2023

The human gastrointestinal tract is home to a complex microbial community that plays an important role in the general well-being of entire organism. gut microbiota generates variety metabolites and thereby regulates many biological processes, such as regulation immune system. In gut, bacteria are direct contact with host. major challenge here prevent unwanted inflammatory reactions on one hand other ensure system can be activated when pathogens invade. Here REDOX equilibrium utmost importance. This controlled by either directly or indirectly via bacterial-derived metabolites. A balanced microbiome sorts for stable balance, whereas dysbiosis destabilizes this equilibrium. An imbalanced status affects disrupting intracellular signaling promoting responses. we (i) focus most common reactive oxygen species (ROS) (ii) define transition from state oxidative stress. Further, (iii) describe ROS regulating Thereafter, (iv) examine influence homeostasis how shifts pro- anti-oxidative cellular conditions suppress promote responses inflammation.

Language: Английский

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World Gastroenterology Organisation Global Guidelines: Probiotics and Prebiotics

Journal of Clinical Gastroenterology, Journal Year: 2024, Volume and Issue: 58(6), P. 533 - 553

Published: June 13, 2024

The concept of beneficial microbes was first suggested by Elie Metchnikoff who postulated that lactic acid bacteria offered health benefits capable promoting longevity. Disorders the intestinal tract were frequently treated with viable nonpathogenic to change or replace microbiota. German professor Alfred Nissle isolated a strain Escherichia coli from feces First World War soldier did not develop enterocolitis during severe outbreak shigellosis. In Japan, Dr. Minoru Shirota Lacticaseibacillus paracasei battle diarrheal outbreaks. Today, search human clinical trials in PubMed shows over 1500 have been published on probiotics. Although these studies are heterogeneous regard strains and populations included, accumulated evidence supports view measurable across many different outcomes assessed. This article is an update previous publication Journal Clinical Gastroenterology,1 based guideline recently posted WGO website. Probiotics live microorganisms that, when administered adequate amounts, confer benefit host.2 Our glossary terms definitions proposed International Scientific Association Prebiotics. Lactobacilli, along species Bifidobacterium, historically common 2020, genus Lactobacillus underwent major restructuring better address wide diversity assigned genus. Twenty-three new genera defined, including some well-studied probiotic (Table 1). TABLE 1 - New Names for Some Prominent Former Probiotic Species. Still Included Genus acidophilus, L. gasseri, crispatus, johnsonii, helveticus, delbrueckii subsp. bulgaricus (Sometimes Abbreviated as bulgaricus). name casei rhamnosus plantarum Lactiplantibacillus brevis Levilactobacillus salivarius Ligilactobacillus fermentum Limosilactobacillus reuteri From Prebiotics (ISAPP), "The big breakup Lactobacillus," available at https://www.nestlenutrition-institute.org/infographics/big-breakup-lactobacillus. GLOSSARY OF TERMS Live host Prebiotic A selectively fermented ingredient results specific changes composition and/or activity gastrointestinal microbiota, thus conferring benefit(s) upon Synbiotics mixture comprising substrate(s) utilized confers host. There 2 types synbiotic: complementary (mixtures probiotics prebiotics) synergistic selected utilize coadministered substrate effect) Postbiotic preparation inanimate their components yeast Saccharomyces boulardii E. Bacillus also used. Newcomers ranks include Clostridium butyricum, approved novel food European Union. Lactic Acid Bacteria, which used preservation fermentation thousands years, may potentially impart benefits. However, term "probiotic" should be reserved shown controlled benefit. Fermentation globally applied range raw agricultural materials, such cereals, roots, tubers, fruit vegetables, milk, meat, fish. prebiotic concept, Gibson Roberfroid 1995,3 more recent one than key aspects it nondigestible leads consumer through positive influence resident microbes. administration use prebiotics intended gut environment, inhabited trillions microbes, health. Both effects extend beyond gut, but this will focus effects. typically consist nonstarch polysaccharides oligosaccharides, although other substances being studied candidate prebiotics—such resistant starch, conjugated linoleic acid, polyphenols. Most ingredients foods biscuits, chocolate, spreads, dairy products. Commonly known are: Oligofructose (fructooligosaccharide, FOS) Inulin Galactooligosaccharides (GOSs) Lactulose Breast milk oligosaccharides (human HMOs) synthetic disaccharide drug treatment constipation hepatic encephalopathy. oligofructose found naturally foods, wheat, onions, bananas, honey, garlic, leeks. can chicory root synthesized enzymatically sucrose. colon result several physiologic effects, including: Increasing numbers bifidobacteria calcium absorption fecal weight Shortening transit time Lowering blood lipid levels extent physiological experienced varies due number factors, baseline microbiota diet. It has hypothesized increase colonic producing compounds inhibit potential pathogens, reducing ammonia levels, vitamins digestive enzymes. originally described appropriate combinations More recently, synbiotics evolved both synbiotics. synbiotic defined simply probiotic(s) prebiotic(s), where meet criteria each, proper characterization, dose provide microbe substrate, together documented do need independently (Fig. 1).FIGURE 1: Composition combines probiotic, work elicit functions modulating composed microorganism, enhancing its functionality. Components (not independently) bring about resulting (Reproduced Swanson et al4 CC BY 4.0).Genera, Species, Strains Used identified genus, species, subspecies (if applicable), alphanumeric designation identifies 2). scientific community, there agreed nomenclature names. Strain designations, product names, trade names community. According guidelines Health Organization (WHO) Food Agriculture (FAO; http://www.fao.org/3/a-a0512e.pdf), manufacturers deposit internationally recognized culture collection. Such depositories give additional strains. Table 3 few examples commercial associated them. Nomenclature Microorganisms Species Subsp. depository nickname Product None GG ATCC 53103 LGG Culturelle Bifidobacterium animalis lactis DN-173 010 CNCM I-2494 Bifidus regularis Activia yogurt longum 35624 NCIMB 41003 Bifantis Align (Manassas, Virginia, USA); (Institut Pasteur, Paris, France); (Aberdeen, Scotland). table only countries. indicates American Type Culture Collection; CNCM, Collection Nationale de Cultures Microorganismes; NCIMB, National Industrial, Marine Bacteria. Mechanisms Host Interaction. Symbiosis Between Microbiota Optimized Pharmacological Nutritional Interventions Gut Microbial Ecosystem Using Immunologic • Activate local macrophages antigen presentation B lymphocytes secretory immunoglobulin (IgA) production locally systemically Modulate cytokine profiles Induce tolerance antigens Nonimmunologic Digest compete nutrients pathogens Alter pH create unfavorable environment Produce bacteriocins Scavenge superoxide radicals Stimulate epithelial mucin Enhance barrier function Compete adhesion Modify pathogen-derived toxins Metabolic effects: short-chain fatty acids, ions (Ca, Fe, Mg) Enhancing immunity (IgA production, modulation, etc.) designations important because most robust approach link (such targets discussed guideline) effective dose. Recommendations probiotics, especially setting, tie claimed studies. unique properties account certain neurological, immunological, antimicrobial activities. emerging field recognize mechanisms likely shared among strains, even genera. Many similar manner ability foster colonization resistance, regulate transit, normalize perturbed For example, enhance reduce luminal core expressed Thus, delivered now systematic reviews meta-analyses multiple valid if action included demonstrated responsible Otherwise, efforts strain-specific evidence. Colonizing end points interwoven reside gut. members commensal microbial thereby Crosstalk between cells provides mechanism influencing host's intestine contains large located mainly hundreds species. Estimates suggest 40 trillion bacterial harbored adult (including small proportion Archaea, less 1%). Fungi protists present, negligible contribution cell numbers, whereas viruses/phages outnumber cells. add average 600,000 genes each being.5 At level individuals quite remarkable: individual harbors his her own distinctive pattern composition, determined partly genotype, initial birth vertical transmission, dietary habits. healthy adults, stable time. ecosystem, divisions, Bacteroidetes Firmicutes, predominate 90% rest Actinobacteria, Proteobacteria, Verrucomicrobia, Fusobacteria. normal interaction symbiotic relationship. An immune presence organized lymphoid structures mucosa (Peyer's patches) (isolated follicles). epithelium those specialized uptake sampling antigens, they contain germinal centers induction adaptive responses. colon, proliferate fermenting substrates diet endogenous secretions contribute nutrition. colonizing differ others disease unhealthy conditions. researchers able define Certain Roseburia, Akkermansia, Faecalibacterium prausnitzii) seem commonly health, currently active area research determine whether supplementation improve reverse disease. Action affect activities bacteria. decreasing population pathogenic deleterious metabolic impact function. mediate mechanisms. ecosystem impacting mucosal mechanisms, interacting generating products communicating chemical signaling 2; 3). These lead antagonism improved bolstering barrier, downregulation inflammation, upregulation response antigenic challenges. phenomena thought reduction incidence severity diarrhea, widely uses probiotics.FIGURE 2: interact prevent opportunistic microorganisms. permission Blackwell Publishing Ltd.; journal Copyright Clearance Center).Understanding Marketplace Probiotic-containing successfully marketed regions world. types—from conventional prescription drugs—is commercially 4). 4 Categories Products Containing type Target claim possible Generally Improves maintains Meal replacement People nutritional requirements Healthy target Dietary supplement* General Natural product† nonsevere medical conditions treats mild Over-the-counter needing treat Treats diseases Prescription prevents *Typically tablets, capsules, sachets containing freeze-dried form.†This category Canada. claims made differ, depending regulatory oversight region. commonly, sold supplement-type Typically, no mention illness allowed, tend general, targeted generally population. represent Canada, authorities approve labeling managing allowed. perspective, suitable descriptions reflected label include: Genus, (and subspecies, applicable) identification, consistent current scientifically Viable count shelf-life Recommended storage recommended dose, effect accurate description effect, allowable law Contact information post-market surveillance Products: Dosages Quality global market valued US$ 32.1 billion 2013, according 2015 Grand View Research report. predicted worldwide progress rapidly annual growth rate 8.1% reach 85.4 2027 ("Probiotics Market," https://www.marketsandmarkets.com/). Wading multitude supplements, pharmaceutical daunting task. guidance organizations rather geographical difficult match products, all suitably labeled. effort accomplish undertaken Canada United States, funded unrestricted grants entities, does (see http://www.probioticchart.ca/ http://usprobioticguide.com/). quality depends manufacturer concerned. Since standards, oversee adherence standards. issues specifically assurance potency (maintenance viability, indicated colony-forming units, shelf-life), purity (manufacturing processes sufficiently any concern), identity (current specify applicable, product). needed product. over-the-counter deliver 1–10 cfu/dose, efficacious lower while require substantially more. alleviating symptoms IBS 100 million cfu/day, 300 450 cfu times daily. state general probiotics; dosage showing Because alive, susceptible die-off storage. Manufacturers build overages so product's shelf-life, fall below declared label. Responsible indicate expected use-by date manufacture). Spore-forming advantage superior resistance environmental stress shelf-life. efficacy spore-formers lags behind non–spore-forming cases fail regarding present Purchasing reliable therefore essential. Safety today derived either decades. On basis prevalence lactobacilli food, colonizers body, low infection attributed them, deemed experts field. enjoy safety record. design population, persons compromised serious underlying restricted indications proven patient populations, section below. Microbiological standards needs at-risk patients, reviewed Sanders al6. Testing newly acceptable after scrutiny approval independent ethics committee. Traditional LAB, long fermentation, considered safe oral consumption part supplements traditionally CLINICAL APPLICATIONS Current insights into applications (in alphabetical order) gastroenterology summarized noted overview efficacy. dose-specific, prebiotics, particular formulation. recommendations graded evidence, Tables 6 7 consulted. Meta-analyses regarded providing highest evaluating applying meta-analysis fraught problems heterogeneity trial designs, interventions used, studied, relatively trial. plague conducted intervention, strain-specificity carefully taken Combining data without rationale driving observed avoided using make recommendations. While deals situations, detail preparations situations effective. Treatment Acute Diarrhea useful duration acute infectious diarrhea children. Oral shortens children ~1 day. Several testing show results, suggesting Prevention prevention childhood settings. Cochrane risk bias7 concluded probably little difference lasting 48 hours longer. Early needed. Antibiotic-Associated antibiotic-associated adults receiving antibiotic therapy. moderate preventing children,8 adults,9 elderly adults.10 C. difficile 2017 certainty difficile-associated patients antibiotics.11 immunocompromised severely debilitated appeared safe. authors cited further research, high developing would informed harms Radiation-induced play role radiation-induced reinforcing function, improving innate immunity, stimulating repair 2013 possibly diarrhea.12 Helicobacter Pylori Eradication 2022 Maastricht VI/Florence Consensus Report management H. pylori side caused eradication therapies treatment. weak, grade recommendation moderate.13 support alone, concomitant therapy, Instead, appear related therapy direct pylori. Hepatic Encephalopathy lactulose Evidence suggests minimal people encephalopathy quality.14 mortality observed, recovery, life, plasma concentrations. Immune Response suggestive response. enhanced responses obtained aimed (nosocomial children, influenza episodes winter) tested antibody vaccines. Pouchitis usefulness mix attack pouchitis relapse remission antibiotics. maintenance remission.15 Ulcerative Colitis Individual rates moderately ulcerative colitis pediatric populations. 2020 certainty, diseases.16 Crohn's Disease Studies Irritable Bowel Syndrome (IBS) abdominal bloating flatulence treatments finding studies; ameliorate pain relief. literature alleviate life functional pain. Strain-specific 7. Infant Colic DSM 17938 B. ssp. BB12 crying breastfed infants colic 7). Lactose Malabsorption Streptococcus thermophilus improves lactose digestion reduces intolerance.

Language: Английский

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Probiotics in Functional Foods: Survival Assessment and Approaches for Improved Viability

Applied Sciences, Journal Year: 2022, Volume and Issue: 12(1), P. 455 - 455

Published: Jan. 4, 2022

Nowadays, food is no longer just for nutrition. Consumers are more demanding and expect to get health benefits from their daily meals. Various areas of the industry in great demand functional chemicals enhance taste nutritional value products. Probiotic bacteria have already been part human’s routine good gut microbiota maintenance terms pharmaceutical Their incorporation however a challenging task that offers opportunities but has limitations as well. Specifically, purpose this review emphasize importance probiotics food, assess survival through gastrointestinal tract, highlight recent advances approaches improved viability.

Language: Английский

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Irritable Bowel Syndrome and the Gut Microbiome: A Comprehensive Review

Journal of Clinical Medicine, Journal Year: 2023, Volume and Issue: 12(7), P. 2558 - 2558

Published: March 28, 2023

Irritable Bowel Syndrome (IBS) is a functional disorder of the gastrointestinal tract characterized by abdominal pain and altered bowel habits. It has prevalence 10 to 25% in United States high disease burden, as evidenced reduced quality life, decreased work productivity increased healthcare utilization costs. IBS been associated with several intra-intestinal extra-intestinal conditions, including psychiatric comorbidities. Although pathophysiology not fully elucidated, it involves dysregulation communication between brain gut (brain–gut axis) which alterations intestinal motility, permeability, visceral hypersensitivity microbiota composition. The purpose this article review role plays IBS, understand factors that affect microbiome explore target treatment.

Language: Английский

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Utilization of the microbiome in personalized medicine

Nature Reviews Microbiology, Journal Year: 2023, Volume and Issue: 22(5), P. 291 - 308

Published: Dec. 18, 2023

Language: Английский

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Prebiotics and Probiotics for Gastrointestinal Disorders

Nutrients, Journal Year: 2024, Volume and Issue: 16(6), P. 778 - 778

Published: March 9, 2024

The complex role of the gut microbiome in pathogenesis gastrointestinal (GI) disorders is an emerging area research, and there considerable interest understanding how diet can alter composition function microbiome. Prebiotics probiotics have been shown to beneficially modulate microbiome, which underlies their potential for benefit GI conditions. Formulating specific recommendations public regarding these dietary supplements has difficult due significant heterogeneity between strains, doses, duration treatment investigated across studies, as well safety concerns with administering live organisms. This review aims summarize existing evidence use prebiotics various disorders, paying special attention strain-specific effects that emerged any adverse noted.

Language: Английский

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Gut-liver axis: Pathophysiological concepts and medical perspective in chronic liver diseases

Seminars in Immunology, Journal Year: 2024, Volume and Issue: 71, P. 101859 - 101859

Published: Jan. 21, 2024

Language: Английский

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Vitamin D Modulates Intestinal Microbiota in Inflammatory Bowel Diseases

International Journal of Molecular Sciences, Journal Year: 2020, Volume and Issue: 22(1), P. 362 - 362

Published: Dec. 31, 2020

Inflammatory bowel disease (IBD) is a chronic inflammation of the gastrointestinal tract (GIT), including Crohn's (CD) and ulcerative colitis (UC), which differ in location lesion extensions. Both diseases are associated with microbiota dysbiosis, reduced population butyrate-producing species, abnormal inflammatory response, micronutrient deficiency (e.g., vitamin D hypovitaminosis). Vitamin (VitD) involved immune cell differentiation, gut modulation, gene transcription, barrier integrity. receptor (VDR) regulates biological actions active VitD (1α,25-dihydroxyvitamin D3), genetic, environmental, immune, microbial aspects IBD. correlated activity its administration targeting concentration 30 ng/mL may have potential to reduce activity. Moreover, VDR functions T cells Paneth modulates release antimicrobial peptides microbiota-host interactions. Meanwhile, beneficial metabolites, e.g., butyrate, upregulate signaling. In this review, we summarize clinical progress mechanism studies on VitD/VDR related modulation We also discuss epigenetics IBD probiotic regulation VDR. Furthermore, existing challenges future directions. There lack well-designed trials exploring appropriate dose influence gender, age, ethnicity, genetics, microbiome, metabolic disorders subtypes. To move forward, need therapeutic examine whether enhanced will restore microbiome inhibiting inflammation.

Language: Английский

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