Notes from the World Congress of Pediatric Gastroentology, Hepatology and Nutrition, Iguassu Falls, Brazil, 16-20 August 2008.
FAO Definition of Probiotics

“Live microorganism administered in adequate amounts which offer a beneficial health effect on the host”

Criteria fro Probiotics – Probiotics must have the following: (1) human origin, (2) non-pathogen, (3) resistance to processing, that is viability in delivery vehicles, (4) stability in acid and bile, (5) adhesion to target epithelial tissue, (6) ability to persist in GIT, (7) production of antimicrobial substances, (8) ability to modulate the immune system and (9) ability to influence metabolic activities.

Breast milk modulates the intestinal microbiota with increase in Bifidobacteria  and Lactobacilli. The most common in breast milk are B. Longum, L., Bifidum, etc.

Probiotics modulates enterocyte and modify composition of eukaryotics cells which may play a role in cancer prevention. They stimulate the gut Th1 cell immune response and gut barrier protection by decreasing mucosal premeability, producing IgA, antioxidants molecules, mucin production, bacteriocin, etc.

PROBIOTICS

Mother Nature's live “friendly bacteria” is scientifically proven to provide healthful benefits like GUT IMMUNITY and GUT BARRIER protection.

GUT IMMUNITY – Probiotics  stimulate specific immune cells in the intestinal mucosa that modulate and strengthen the body's immune system and down-regulate allergic and inflammatory reactions from birth to old age.

GUT BARRIER – At birth, trillions of probiotics naturally colonize the intestines from the mother's vaginal microflora and breast milk to provide a protective shield against disease-causing harmful viruses and bacteria.

HEALTH BENEFITS

-As a immunomodulator that helps enhance the gut's anti-inflammatory and anti-allergic actions.

-Downregulate allergic/inflammatory disorders like eczema , atopic dermatitis, allergic rhinitis, bronchial asthma, inflammatory bowel disease, and rheumatoid arthritis.

-Control viral diarrhea, antibiotic-induced diarrhea and pseudomembranous colitis.

-Restore intestinal microflora with "good bacteria" to maintain normal gut health.

CLINICAL STUDIES ON PROBIOTICS

Infectious diarrhea - based on more than 100 papers, a meta-analyis ( 2002) showed that specific strains of probiotics can reduce the duration of diarrhea by 1 day.

A meta-analysis on Lactobacillus GG( LGG ) showed favorable effect especially against rotavirus but not for invasive pathogens.

Against GI/Respiratory Infections- based on an Australian meta-analysis of seven RCT's, there was a modest effect of some probiotic strains in reducing Gi and respiratory infections in a day care center.

Against necrotizing enterocolitis - A meta- analysis (by Peshpande , published in Lancet, 2007) of four studies support probiotics for NEC.

Against atopic dermatitis- A study by Vilianen (2005) improved atopic dermatitis and reduced its incidence using LGG but no effect on sensitization.

Against antibiotic-associated diarrhea ( AAD)- A Cochrane database study ( 10 RCT's in 2007 ) showed significant decrease in incidence from 37.5% to 9% . The duration of AAD is similar in both LGG and S. boulardi.

Against nosocomial diarrhea - A study ny Saavedra showed a significant difference in incidence of 7% in supplemented group vs. 31% control, but one study in Italy showed no effect in LGG.

Adjuvant effect in vaccination- probiotics enhance IgA immune response.

Effect of probiotics in dose-dependent and strain-specific

The therapeutic dose vs. infectious diarrhea -5 billion CFU's or more.Less than 5 billion , no difference.

Maintenance dose- variable, strain-specific.

Probiotics strains must be administered in a continous basis to establish its own ecological niches.

" Not all probiotics are created equal. Effects are strain-specific."

SUMMARY OF EFFICACY

-Notes compiled by Dr. Arturo C. Ludan