World Digestive Health Day WDHD – May 29, 2016 infective endocarditis and liver abscess in immuno-compromised hosts. Several cases of fungal sepsis have been documented in relation to Saccharomyces boulardii in patients with central venous catheters.7 Although the exact mechanisms for bacterial translocation remain unknown, host factors such as intestinal mucosal injury, immunodeficiency, and abnormal intestinal flora are likely important reasons. The following risk factors for sepsis are associated with probiotic, namely: (1) major risk factors - immunocompromised host and premature infants; (2) minor risk factors - presence of a central venous catheter, history of cardiac valvular disease, impaired intestinal epithelial barrier, concomitant administration of broad spectrum antibiotics to which probiotic is resistant, administration by jejunostomy tube, and probiotics with properties of high mucosal adhesion. Premature infants, patients with chronic diseases, and/or debilitation are also considered as high-risk populations. Probiotics, though generally safe, should be used in caution in these specific patient groups. PROBIOTICS AND PREBIOTICS FOR GUT HEALTH: THE ESSENTIALS, continued Some resistance traits are in-borne chromosomal and nonplasmid associated and thus are allowed as a natural trait in certain genera of probiotics. These are allowed within certain resistance allowance limits. Another debatable issue is the inhibitory effect that antibiotics have on probiotics. Probiotics have been used as an adjunct to prevent antibiotic-induced super-infections. For example, Saccharomyces boulardii has protective effect for antibioticassociated diarrhea. Likewise, concomitant probiotics and antibiotics can reduce the incidence of Clostridium difficileassociated diseases in high-risk patients. Studies, however, differed in the timing of probiotic administration after antibiotics. Some patients are given probiotics within 48 hours of antibiotic initiation up to the entirety of antibiotic course and some up to seven to 10 days after. It is recommended that Lactobacilli probiotic strains be given at least two to four hours after antibiotic, unlike S. boulardii. Figure 1 summarizes the factors affecting the probiotic life cycle and current challenges in the use of probiotics. ROLE OF PREBIOTICS All prebiotics are fibers but not vice versa. Some prebiotics (e.g. galacto-oligosaccharides or inulin-type fructans) exert similar functions as the human milk oligosaccharides (HMO) and are important for the development of metabolic, immune, and nervous systems of infants.9 A specific mixture of shortchain galactooligosaccharides (scGOS) and long-chain fructooligosaccharides (lcFOS) in a 9:1 ratio has been suggested for infant use. Generally, prebiotics improves gut metabolism, stool consistency, and stool transit by increasing bacterial mass and osmotic water-binding capacity in the gut lumen, thereby reducing the risk of constipation.10 Other gut modulatory benefits of prebiotic supplementation include alleviation of GI discomfort (e.g. bloating, flatulence and abdominal pain) and reduction of the risk of immune-related diseases, infection, and inflammation. Fermentation of prebiotics in the colon generates short-chain fatty acids in particular butyrate. Colonic inflammation is associated with low production of butyrate. Prebiotics can also enhance calcium absorption, mainly the fructans. SUMMARY Probiotics, like any live microorganisms, are affected by ex vivo and in vivo conditions. Much clinical evidence has shown that probiotics and/or prebiotics can be used as a natural Figure 1: Factors affecting the probiotic life cycle and current challenges in the use of probiotics PROBIOTICS-ANTIBIOTICS INTERACTIONS A theoretical interaction is the potential for antibiotic-resistance transfer between probiotics and pathogenic bacteria, as a result of chromosomal mutations or horizontal gene transfer. Antibiotic resistance to vancomycin, chloramphenicol, and erythromycin have been identified in Lactobacillus species. Again, this emphasizes the importance of appropriate regulation with proper strain identification, in vitro evaluation, and antimicrobial susceptibility testing of probiotic strains.8 48 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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