160_4.Probiotics and Irritable bowel.pdf

40 , - 2557

Probiotics and Irritable bowelsyndrome

,

Review Article

..1908 Ellie Metchnikoff

Lactobacillus bulgaricus

probiotics

Probiotics1 (for life)

probiotics

41Probiotics and Irritable bowel syndrome

(cocktails probiotic)

probiotics

( 1)

prebiotics

(fermented)

prebiotics oligosaccharides

Bifidobacteria Lactobacilli

inulin-type fructans, fructo-oligosaccharide

lactulose

Synbiotics probiotics

prebiotics probiotics

1 Probiotics

(/)

Lactomin Lactobacillus acidophilus 16 / sachet

2 x109 CFU

Intestis-flora7 109 CFU 40 / stick

Lactobacillus spp.

Bifidobacterium spp.

Streptococus spp.

Pro-digest Lactobacillus spp. 25 / capsule


TS6 2 x1010 CFU 38 / sachet

Lactobacillus spp.


42 , - 2557


(Microbiota)

300-500 (microbiota) 200

(microbiosome)

(peristalsis)

33

109 CFU/mL (terminal ileum) 1012 CFU/

mL

1 ( 1)

1


1. (nutrition)

lactose alcohol

bacterial disaccharidases short chain fatty acids

(SCFAs)

2.

(integrity of epithelial barrier and mucosal immunity)

peroxides bac-

teriocin

2,3

Rome III4

3

5

44 , - 2557

(flatulence)

(bloating) (fermentation)

( 2)

(luminal microbiota)

Kassinen 22

27 real-time PCR

Lactobacilli Bifidobacteria

IBS-D IBS-C Enterobacteraciaceae,

Coliform Bacteroides IBS6

IBS IBS

2


Lactobacilli Bifidobacteria

IBS 2

(mucosa-associated microbiota)

biofilm glycosylated

polysaccharides glycocalyx

pattern recognition re-

ceptors (PRRs) toll-like receptors (TLRs) apical basolateral

membrane enterocytes laminar propria den-

dritic cell


anti-inflammatory cytokines interleukin (IL-10) transforming

growth factor beta (TGF-) proinflammatory cytokines

7

1. bacte-

riocin

2. mucin

defensins

3. TLRs (

3)

probiotics

probiotics

46 , - 2557

3 probiotics

meta-analysis systematic review ( 2)

Hoyveda9 meta-analysis probiotics

(overall improve-

ments) (95% CI = 1.23-2.17)

( 4)

probiotics

probiotics


2 Meta-analysis systematic reviews probiotics

()

Mc Farland et al8 2008 20 (1,414) global IBS symptoms: RR 0.77 (0.6-0.94)

abdominal pain: RR 0.78 (0.69-0.88)

Hoyveda et al9 2009 14 (1,593) dichotomous variable

7 RCTs (n=936)

OR=1.6 (95%CI, 1.2-2.2)

continuous variable

6 RCTs (n=657)

SMD=0.23 (95%CI,

0.07-0.38)

Brenner et al10 2009 16 (1,342) Bifidobacterium infantis 35624

RCT

Moayyedi et al11 2010 20 (1628) dichotomous variable

11 RCTs (n=936)

RR=0.71 (95%CI, 0.57-0.87),

NNT=4

continuous variable

15 RCTs (n=1,351)

SMD= -0.34 (95%CI, -0.60

to -0.07)

RCT, randomized control trial; RR, relative risk; OR, odds ratio; SMD, standardized mean difference

Bifidobacterium infantis 35624

OMahoney12 double blind RCT IBS

75 probiotics Lactobacillus UCC4331

Bifidobacterium infantis 35624 1x1010 cellsday

8 12

48 , - 2557

(bloating/distension)

IL-10:IL-12

B. infantis probiotics

OMahoney

Whorwell13 double blind RCT 293

B. infantis 35624 106, 108

1010 CFU/mL 4 6

6-point Likert scale B.

infantis 108 CFU/mL

1010 CFU/mL

B. infantis 35624

IBS 108 CFU/mL

Bifidobacterium animalis

Guyonnet14 double blind RCT IBD-C

267 B. animalis 1.25x1010 CFU

4 Forest plot probiotics


125 S. thermophilus L. bulgaricus

6 discomfort dimen-

sion score probiotics

IBS placebo effect

probiotics

IBS 3

(p

50 , - 2557

nitric oxide

VSL number 3

VSL No.3 probiotics cocktail

lyophilized Bifidobacterium (B.

longum, B. infantis, B. breve) Lactobacillus (L. acidophilus, L. casei, L.

bulgaricus, L. plantarum) Streptococcus sailvarious thermophilus

Kim16 parallel group, double blind RCT

IBS 48 ( 100-mm visual ana-

logue scale (VAS) abdominal bloating 24) VSL No.3

450 /

4 8 VAS

probiotics

(flatulence) 4 (p=0.014)

(p=0.011) colonic transit

111In charcoal (p=0.05)

probiotics pro-inflammatory cytokines

Bifidobacteria infantis B5624 VSL No.3 B

Bifidobacterium animalis Lactobacillus

plantarum 299V C

probiotics


1.

2. probiotics

3. probiotics

probiotics

probiotics

Boyle, Robins-Browne Tang ..200618

systematic review probiotics

.. 201019 probiotics

Lactobacillus rhamnosus20

Lactobacillus rhamnosus 21

probiotics

inflammatory bowel disease

short bowel syndrome

probiotics

probiotics

probiotics

probiotics

Lactobacillus reuteri

22

52 , - 2557

probiotics

cen-

tral venous catheter probiotics jejun-

ostomy broad spectrum antibiotic probiotics

Lactobacillus

Probiotics

probiotics Bifidobacterium infantis

35624, Lactobacillus plantarum Bifidobacterium

animalis IBS-C

3 / VSL No.3

probiotics

1. Quigley EM. Therapies aimed at the gut microbiota and inflammation: antibiot-ics, prebiotics, probiotics, synbiotics, anti-inflammatory therapies. GastroenterolClin North Am. 2011;40:207-22.

2. Parkes GC, Brostoff J, Whelan K, Sanderson JD. Gastrointestinal microbiota inirritable bowel syndrome: their role in its pathogenesis and treatment. Am JGastroenterol. 2008;103:1557-67.

3. Bolino CM, Bercik P. Pathogenic factors involved in the development of irritablebowel syndrome: focus on a microbial role. Infect Dis Clin North Am. 2010;24:961-75, ix.

4. Halder SL, Talley NJ. Functional Dyspepsia: A New Rome III Paradigm. CurrTreat Options Gastroenterol. 2007;10(4):259-72.


5. Kellow JE, Azpiroz F, Delvaux M, Gebhart GF, Mertz HR, Quigley EM, et al.Applied principles of neurogastroenterology: physiology/motility sensation. Gas-troenterology. 2006;130:1412-20.

6. Kassinen A, Krogius_Kurikka L, Makivuokko H, Rinttila T, Paulin L, Corander J,et al. The fecal microbiota of irritable bowel syndrome patients differs signifi-cantly from that of healthy subjects. Gastroenterology. 2007;133:24-33.

7. Shanahan F. Probiotics in perspective. Gastroenterology. 2010;139:1808-12.8. McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irri-

table bowel syndrome. World J Gastroenterol. 2008;14:2650-61.9. Hoveyda N, Heneghan C, Mahtani KR, Perera R, Roberts N, Glasziou P. A

systematic review and meta-analysis: probiotics in the treatment of irritablebowel syndrome. BMC Gastroenterol. 2009;9:15.

10. Brenner DM, Moeller MJ, Chey WD, Schoenfeld PS. The utility of probiotics inthe treatment of irritable bowel syndrome: a systematic review. Am JGastroenterol. 2009;104:1033-49; quiz 1050.

11. Moayyedi P, Ford AC, Talley NJ, Cremonini F, Foxx-Orenstein AE, Brandt LJ, etal. The efficacy of probiotics in the treatment of irritable bowel syndrome: asystematic review. Gut. 2010;59:325-32.

12. OMahony L, McCarthy J, Kelly P, Hurley G, Luo F, Chen K, et al. Lactobacillusand bifidobacterium in irritable bowel syndrome: symptom responses and rela-tionship to cytokine profiles. Gastroenterology. 2005;128:541-51.

13. Whorwell PJ, Altringer L, Morel J, Bond Y, Charbonneau D, OMahony L, et al.Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in womenwith irritable bowel syndrome. Am J Gastroenterol. 2006;101:1581-90.

14. Guyonnet D, Chassany O, Ducrotte P, Picard C, Mouret M, Mercier CH, et al.Effect of a fermented milk containing Bifidobacterium animalis DN-173 010 onthe health-related quality of life and symptoms in irritable bowel syndrome inadults in primary care: a multicentre, randomized, double-blind, controlled trial.Aliment Pharmacol Ther. 2007;26:475-86.

15. Niedzielin K, Kordecki H, Birkenfeld B. A controlled, double-blind, randomized

54 , - 2557

study on the efficacy of Lactobacillus plantarum 299V in patients with irritablebowel syndrome. Eur J Gastroenterol Hepatol. 2001;13:1143-7.

16. Kim HJ, Vazguez Rogue MI, Camilleri M, Stephens D, Burton DD, Baxter K, etal. A randomized controlled trial of a probiotic combination VSL No.3 and pla-cebo in irritable bowel syndrome with bloating. Neurogastroenterol Motil.2005;17:687-96.

17. Floch MH, Walker WA, Madsen K, Sanders ME, Macfarlane GT, Flint HJ, et al.Recommendations for probiotic use-2011 update. J Clin Gastroenterol. 2011;45Suppl:S168-71.

18. Boyle RJ, Robins-Browne RM, Tang MA. Probiotic use in clinical practice: whatare the risks? Am J Clin Nutr. 2006;83:1256-64.

19. Whelan K, Myers CE. Safety of probiotics in patients receiving nutritional sup-port: a systematic review of case reports, randomized controlled trials, andnonrandomized trials. Am J Clin Nutr. 2010;91:687-703.

20. Rautio M, Jousimies-Somer H, Kauma H, Pietarinen I, Saxelin M, Tynkkynen S,et al. Liver abscess due to a Lactobacillus rhamnosus strain indistinguishablefrom L. rhamnosus strain GG. Clin Infect Dis. 1999;28:1159-60.

21. Mackay AD, Taylor MB, Kibbler CC, Hamilton-Miller JMT. Lactobacillus en-docarditis caused by a probiotic organism. Clin Microbiol Infect. 1999;5:290-2.

22. Elias J, Bozzo P, Einarson A. Are probiotics safe for use during pregnancy andlactation? Can Fam Physician. 2011;57:299-301.

/ColorImageDict > /JPEG2000ColorACSImageDict > /JPEG2000ColorImageDict > /AntiAliasGrayImages false /CropGrayImages true /GrayImageMinResolution 300 /GrayImageMinResolutionPolicy /OK /DownsampleGrayImages true /GrayImageDownsampleType /Bicubic /GrayImageResolution 300 /GrayImageDepth -1 /GrayImageMinDownsampleDepth 2 /GrayImageDownsampleThreshold 1.50000 /EncodeGrayImages true /GrayImageFilter /DCTEncode /AutoFilterGrayImages true /GrayImageAutoFilterStrategy /JPEG /GrayACSImageDict > /GrayImageDict > /JPEG2000GrayACSImageDict > /JPEG2000GrayImageDict > /AntiAliasMonoImages false /CropMonoImages true /MonoImageMinResolution 1200 /MonoImageMinResolutionPolicy /OK /DownsampleMonoImages true /MonoImageDownsampleType /Bicubic /MonoImageResolution 1200 /MonoImageDepth -1 /MonoImageDownsampleThreshold 1.50000 /EncodeMonoImages true /MonoImageFilter /CCITTFaxEncode /MonoImageDict > /AllowPSXObjects false /CheckCompliance [ /None ] /PDFX1aCheck false /PDFX3Check false /PDFXCompliantPDFOnly false /PDFXNoTrimBoxError true /PDFXTrimBoxToMediaBoxOffset [ 0.00000 0.00000 0.00000 0.00000 ] /PDFXSetBleedBoxToMediaBox true /PDFXBleedBoxToTrimBoxOffset [ 0.00000 0.00000 0.00000 0.00000 ] /PDFXOutputIntentProfile () /PDFXOutputConditionIdentifier () /PDFXOutputCondition () /PDFXRegistryName () /PDFXTrapped /False

/Description > /Namespace [ (Adobe) (Common) (1.0) ] /OtherNamespaces [ > /FormElements false /GenerateStructure true /IncludeBookmarks false /IncludeHyperlinks false /IncludeInteractive false /IncludeLayers false /IncludeProfiles true /MultimediaHandling /UseObjectSettings /Namespace [ (Adobe) (CreativeSuite) (2.0) ] /PDFXOutputIntentProfileSelector /NA /PreserveEditing true /UntaggedCMYKHandling /LeaveUntagged /UntaggedRGBHandling /LeaveUntagged /UseDocumentBleed false >> ]>> setdistillerparams> setpagedevice

160_4.Probiotics and Irritable bowel.pdf

Documents

Transcript of 160_4.Probiotics and Irritable bowel.pdf