The Role of Probiotics in the Treatment of Acute Gastroenteritis

Abstract

Abstract

Acute gastroenteritis can cause significant morbidity and mortality in childhood. Breastfeeding is the most important factor as a preventive strategy in reducing mortality. Gut microbiota is very important to defense with the pathogens. A healthy mucus layer on the gut mucosa plays an important role in preventing inflammatory and infectious diseases. Probiotics have been demonstrated to regulate mucin expression and influencing the properties of the mucus layer and indirectly regulate the gut immune system. After having demonstrated the favorable effects of probiotics on the gut mucosa especially during viral gastroenteritis and antibiotic related gastroenteritis, they are associated with many gastrointestinal conditions including invasive gastroenteritis, inflammatory bowel diseases and necrotizing enterocolitis. Although the potential of probiotics to prevent or reverse intestinal damage during infection was demonstrated, there are some conflict about the possible septicemia risk especially in immunocompromise patients. Therefore, a combination of in vitro and in vivo models is essential to investigate the mechanisms of septicemia in risky groups.

Keywords

• Probiotic,infectious,diarr-hea,breast milk

Akut Gastroenteritlerin Tedavisinde Probiyotiklerin Rolü

Öz

Öz

Akut gastroenteritler çocukluk çağında önemli morbidite ve mortalite nedenidir. Mortaliteyi azaltmada koruyucu önlem olarak en önemli faktör anne sütü alımıdır. Bağırsak mikrobiyotası patojenlere karşı savunmada oldukça önemlidir. Bağırsak mukozasını örten sağlıklı bir mukus tabakası varlığı inflamatuvar ve enfeksiyöz hastalıkları önlemede önemli bir rol üstlenmektedir. Probiyotiklerin müsin ekspresyonunu düzenleyerek ve müsin tabakasını etkileyerek bağırsak immün sistemini dolaylı olarak etkiledikleri gösterilmiştir. Özellikle antibiyotik ilişkili ishallerde ve viral gastroenteritlerin seyrinde bağırsak mukozası üzerine yararlı etkileri olduğu gösterildikten sonra invazif gastroenterit, inflamatuvar bağırsak hastalığı ve nekrotizan enterokolit dahil birçok gastrointestinal durumla ilişkilendirilmektedirler. Probiyotiklerin enfeksiyon seyri sırasında intestinal hasarı önleyici ya da koruyucu potansiyel etkileri gösterilmiş olmasına rağmen özellikle immün yetersizlik hastalarında olası septisemi riski konusunda bazı çekinceler mevcuttur. Bu nedenle riskli gruplarda septisemi mekanizmasını araştıracak in vitro ve in vivo çalışmaların yapılması gereklidir.

Anahtar Kelimeler

• Probiyotik,enfeksiyöz,diyare,anne sütü

References

1. Kaynaklar 1.Bhutta ZA. Acute gastroenteritis in children. In: Kliegman RM,Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbookof Pediatrics, 18th ed. Philadelphia: Saunders Elsevier,2007: 1605-21. 2.Ochoa TJ, Zambruni M, Chea-Woo E. Approach to patientswith gastrointestinal tract infections and food poisoning. In:Cherry JD, Harrison GJ, Kaplan SL, et al eds. Feigin andCherry’s Textbook of Pediatric Infectious Diseases, 7th ed. Phi-ladelphia: Saunders Elsevier, 2014: 598-632. 3.Lopman BA, Bresee JS. Viral gastroenteritis. In: Long SS, Pic-kering LK, Prober CG, eds. Principles and Practice of Pedi-atric Infectious Diseases, 4th ed. Edinburgh: Saunders Els-evier, 2012: 377-88. 4.Bobak DA, Guerrant RL. Nausea, Vomiting, and Noninflam-matory Diarrhea. In: Mandell GL, Bennett JE, Dolin R, Bla-ser MJ, eds. Mandell, Douglas and Bennett’s Principles andPractice of Infectious Diseases, 8th ed. Philadelphia: Elsevi-er Saunders, 2015: 1253-62. 5.Centers for Disease Control and Prevention (CDC). Surveil-lance for Foodborne Disease Outbreaks, United States,2012, Annual Report. CDC 2014; 1-14. 6.Denno DM, Stapp JR, Boster DR, et al. Etiology of diarrheain pediatric outpatient settings. Pediatr Infect Dis J 2005; 24:142-48. 7.O’Ryan M, Prado V, Pickering L. Millennium update on pe-diatric diarrheal illness in the developing world. Semin Pe-diatr Infect Dis 2005; 16: 125-36. 8.Lehert P, Chéron G, Calatayud GA, et al. Racecadotril forchildhood gastroenteritis: an individual patient data meta-analysis. Dig Liver Dis 2011; 43: 707-13. 9.Thomas DW, Greer FR. Probiotics and prebiotics in pediat-rics. Pediatrics 2010; 126: 1217-31. 10.La Fata G, Weber P, Mohajeri MH. Probiotics and the Gut Im-mune System: Indirect Regulation. Probiotics Antimicrob Pro-teins 2017; 31. doi: 10.1007/s12602-017-9322-6. 11.Land MH, Rouster-Stevens K, Woods CR, Cannon ML, Cno-ta J, Shetty AK. Lactobacillus sepsis associated with probio-tic therapy. Pediatrics 2005; 115: 178-81. 12.Goldenberg JZ, Ma SS, Saxton JD, et al. Probiotics for the pre-vention of Clostridium difficile-associated diarrhea in adultsand children. Cochrane Database Syst Rev 2013; 5: CD006095. 13.Allen SJ, Martinez EG, Gregorio GV, Dans LF. Probiotics fortreating acute infectious diarrhoea. Cochrane Database SystRev 2010; 11: CD003048. 14.Szymański H1, Pejcz J, Jawień M, Chmielarczyk A, Strus M,Heczko PB. Treatment of acute infectious diarrhoea in infantsand children with a mixture of three Lactobacillus rhamno-sus strains--a randomized, double-blind, placebo-controlledtrial. Aliment Pharmacol Ther 2006; 23: 247-53. 15.Floch MH. Recommendations for probiotic use in humans-a2014 update. Pharmaceuticals (Basel) 2014; 7: 999-1007. 16.Naidoo K, Gordon M, Fagbemi AO, Thomas AG, Akobeng AK.Probiotics for maintenance of remission in ulcerative colitis.Cochrane Database Syst Rev 2011; 12: CD007443. 17.Sartor RB. Therapeutic manipulation of the enteric microflo-ra in inflammatory bowel diseases: antibiotics, probiotics, andprebiotics. Gastroenterology 2004; 126: 1620-33. 18.Bousvaros A, Guandalini S, Baldassano RN, et al. A rando-mized, double-blind trial of Lactobacillus GG versus place-bo in addition to standard maintenance therapy for childrenwith Crohn's disease. Inflamm Bowel Dis 2005; 11: 833-39. 19.Bausserman M, Michail S. The use of Lactobacillus GG in ir-ritable bowel syndrome in children: a double-blind randomi-zed control trial. J Pediatr 2005; 147: 197-201. 20.Dinleyici EC; PROBAGE Study Group, Vandenplas Y. Lac-tobacillus reuteri DSM 17938 effectively reduces the durati-on of acute diarrhoea in hospitalised children. Acta Paediatr2014; 103: 300-305. 21.Wilkins T, Sequoia J. Probiotics for Gastrointestinal Condi-tions: A Summary of the Evidence. Am Fam Physician 2017;96: 170-78. 22.Xu HB, Jiang RH, Sheng HB. Meta-analysis of the effects ofBifidobacterium preparations for the prevention and treatmentof pediatric antibiotic-associated diarrhea in China. Comple-ment Ther Med 2017; 33: 105-113. 23.Derwa Y, Gracie DJ, Hamlin PJ, Ford AC. Systematic reviewwith meta-analysis: the efficacy of probiotics in inflammatorybowel disease. Aliment Pharmacol Ther 2017; 46: 389-400. 24.Wojtyniak K, Szajewska H. Systematic review: probiotics forfunctional constipation in children. Eur J Pediatr 2017. doi:10.1007/s00431-017-2972-2. 25.Lin HC, Hsu CH, Chen HL, et al. Oral probiotics prevent nec-rotizing enterocolitis in very low birth weight preterm infants:a multicenter, randomized, controlled trial. Pediatrics 2008;122: 693-700.