World Digestive Health Day WDHD – May 29, 2016 YEONG YEH LEE, MD, PHD, FRCP, FACG School of Medical Sciences Universiti Sains Malaysia Kota Bharu, Malaysia MIN TZE LIONG, PHD School of Industrial Technology Universiti Sains Malaysia Penang, Malaysia PROBIOTICS AND PREBIOTICS FOR GUT HEALTH: THE ESSENTIALS Table 1: Clinical indications of probiotics for gut health KHEAN LEE GOH, MBBS, MD, FRCP, FASGE, FACG Faculty of Medicine Universiti of Malaya Kuala Lumpur, Malaysia Probiotics, defined by the World Health Organization (WHO), are “live microorganisms that when administered in adequate amounts, confer a health benefit on the host.”1 It is specified by genus, species, and strain (using an alphanumeric designation) for example Bifidobacterium infantis 35624. Common probiotic species include Lactobacillus, Bifidobacterium, Saccharomyces (a yeast), and some E. coli and Bacillus species. Probiotic strains must be assessed for biosafety based on the seven criteria listed by the European Union (EU).2 Clinical indications of probiotics for gut health are given in Table 1. Prebiotics are “selectively fermented ingredients that allow specific changes, both in the composition and/or activity in the gastrointestinal microflora that confers benefits upon host well-being and health.”2 The common prebiotics include the fructooligosaccharides (FOS), galactooligosaccharides (GOS), lactulose, and inulin. Given together (synbiotics), prebiotics can enhance the gut effects of probiotics. PEDIATRIC Acute infectious diarrhea Prevention of antibiotic-associated diarrhea Prevention of nosocomial diarrhea Adjuvant therapy for Helicobacter pylori eradication Alleviate some symptoms of functional bowel disorders Infantile colic Prevention of necrotizing enterocolitis in preterm infants Mildly active ulcerative colitis ADULTS Acute onset infectious diarrhea Prevention of antibiotic-associated diarrhea Prevention of Clostridium difficile-associated diarrhea Adjuvant therapy for Helicobacter pylori eradication Irritable bowel syndrome Ulcerative colitis (maintenance of remission, treatment of mildly active colitis and pouchitis, and prevention and maintenance of remission in pouchitis) Constipation Hepatic encephalopathy VIABILITY OF PROBIOTICS Probiotic bacteria exert their effects by transiently adhering to the intestinal mucosa and eventually the strains would pass out in the feces. Fecal recovery is useful as an indirect measure of gut colonization. The half-life of a probiotic can vary from strain-to-strain, but it has been established that certain microbial strains survive and remain detectable in stools for up to four weeks after discontinuation of intake. Survival in the host for a longer period may require continuous intake, but whether prolonged colonization is beneficial remains unclear. A third of probiotics are estimated to survive in adequate numbers in order to affect gut microbial metabolism and exert its intended clinical responses. The probiotic preparations available in the market include capsules, sachets, yogurts, and fermented milk or fruit drinks. There are also external factors that affect viability of probiotics, including storage (refrigeration or shelf) and transportation. Microbial strains are sensitive to external environment (in particular to oxygen, moisture, and heat). Furthermore, in order to be viable in the gut, probiotics should be able to tolerate gastric acid, bile, and pancreatin; adhere to mucus and/or 46 WGO Handbook on DIET AND THE GUT World Digestive Health Day WDHD May 29, 2016
WGO Handbook on Diet and the Gut_2016_Final
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