Journal of clinical gastroenterology
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Severe sepsis with associated multisystem organ dysfunction is a leading cause of death in patients hospitalized in intensive care units. The gastrointestinal system plays a key role in the pathogenesis of multisystem organ dysfunction owing to a breakdown of intestinal barrier function and increased translocation of bacteria and bacterial components into the systemic circulation. During critical illness, alterations occur in gut microflora owing to several factors, including changes in circulating stress hormones, gut ischemia, immunosuppression, the use of antibiotics, and lack of nutrients. ⋯ Recent studies have shown treatment of patients with multiple trauma or acute pancreatitis with synbiotic preparations resulted in reduced rates of infection, sepsis, and mortality in patients. Enterally fed patients in the intensive care unit treated with a probiotic compound demonstrated enhanced immune function and decreased incidence of diarrhea. Results from these clinical trials are encouraging, and warrant further investigation to clarify which probiotic bacterial strains are of most benefit to this population.
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J. Clin. Gastroenterol. · Sep 2008
Randomized Controlled TrialA new chance of preventing winter diseases by the administration of synbiotic formulations.
The efficacy of probiotics is currently well documented with regard to the improvement of gastrointestinal functions, whereas their potential role in the prevention of infectious respiratory diseases has not been sufficiently analyzed. PURPOSE OF THE STUDY AND METHODS: A 3-stage prospective, randomized, double blind, placebo-controlled study was carried out with several synbiotic preparations containing 3 to 5 strains of Lactobacillus plantarum, Lactobacillus rhamnosus, and Bifidobacterium lactis, lactoferrin and prebiotics such as either FOS (short-chain fructooligosaccharides) or GOS (galactooligosaccharides). The study was performed over 3 different winter seasons between 2003 and 2007, and was aimed at assessing the ability of the different preparations to improve intestinal functions and to increase the body's defences against respiratory infections. In 2003/04 (stage 1; 237 healthy volunteers) an active formulation (A) containing 3 probiotic strains and FOS was used versus placebo; in 2005/06 (stage 2; 234 healthy volunteers) the same formulation versus a similar preparation enriched with lactoferrin (B), and versus placebo; in 2006/07 (stage 3; 250 healthy volunteers), 2 new synbiotic formulations each containing 5 probiotics and FOS (C) or GOS (D), respectively, versus placebo. ⋯ These results demonstrate that a regular, long-term intake of various synbiotics may improve health by reducing the incidence and severity of respiratory diseases during the cold season.
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Acute pancreatitis (AP) is an acute inflammatory process ranging from mild forms to severe disease with high rates of mortality. In this disease, enteral nutrition helps in maintaining the integrity of the gut barrier, with consequent decreased bacterial translocation, a key factor in limiting the complications in severe AP. Modulation of the intestinal flora through the administration of probiotics (PBs) has thus an intriguing rationale as possible treatment option. ⋯ An interesting scenario emerges from the the papers that have been evaluated. The adjunct of PBs in the treatment of AP may show some advantage in terms of the reduction of infectious complications. Nevertheless, more data on efficacy and safety from a larger and stringently designed study are eagerly waited.
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J. Clin. Gastroenterol. · Sep 2008
ReviewUnderstanding why probiotic therapies can be effective in treating IBD.
Probiotics, for the treatment of inflammatory bowel disease, are a group of specific nonpathogenic bacteria that are functionally and genetically defined by their ability to reduce inflammation in the intestine. Although probiotics also seem to have broad beneficial effects in humans, both as a food and as a therapeutic agent, there are specific identified mechanisms in some, but not all, of these bacteria that are important relative to the pathogenesis of inflammatory bowel disease. ⋯ In this regard, the role of probiotics for the clinical treatment of inflammatory bowel disease is emerging as the mechanisms and pathogenesis are being unraveled. It remains clear that probiotics are able to reduce gastrointestinal inflammation by exerting positive effects on epithelial cell and mucosal immune dysfunction.
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J. Clin. Gastroenterol. · Sep 2008
Randomized Controlled TrialUse of VSL[sharp]3 in the treatment of rotavirus diarrhea in children: preliminary results.
We conducted a double-blind randomized placebo-controlled study to evaluate efficacy and tolerability of VSL[sharp]3 (CD Pharma India) in the treatment of acute rotavirus diarrhea in children. The patients were randomly assigned to receive 4 days of oral treatment with VSL[sharp]3 probiotic mixture or placebo in addition to usual care for diarrhea. ⋯ Out of 230 rotavirus-positive acute diarrhea children, 224 children completed the study, (113 in the drug group and 111 in the placebo group). At recruitment on Day 1, there were no significant differences between the 2 groups in terms of frequency of vomiting, mean loose stool frequency, stool consistency, and mean frequency of oral rehydration salts (ORS) and intravenous fluids administered. On Day 2, a lower mean stool frequency and improved stool consistency was noted in the drug group, which achieved statistical significance. This was also reflected in the lower volume of ORS administration in the drug group. Even on Day 3, mean loose stool frequency and frequency of ORS use and frequency of intravenous fluid use was significantly lower in the drug group. The differences in the frequency of loose stools persisted till 8 hours of Day 4. After this, as the placebo group also showed spontaneous improvement the difference between the 2 groups in terms of the overall stools frequency became comparable. However, the overall ORS requirement continued to be significantly lower in the drug group even on Day 4. The overall recovery rates were significantly better in the drug group compared with placebo. No side effects were noted with the use of the probiotic mixture. Use of probiotic mixture VSL[sharp]3 in acute rotavirus diarrhea resulted in earlier recovery and reduced frequency of ORS administration reflecting decreased stool volume losses during diarrhea.