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J Clin Gastroenterol. 2006 Mar;40(3):275-278.Recommendations for Probiotic Use.Floch MH, Madsen KK, Jenkins DJ, Guandalini S, Katz JA, Onderdonk A, Walker WA, Fedorak RN, Camilleri M.*Yale University School of Medicine, New Haven, CT daggerUniversity of Alberta, Canada double daggerUniversity of Toronto, Canada section signDepartment of Pediatrics, University of Chicago, IL parallelDivision of Gastroenterology, Case Western Reserve School of Medicine, Cleveland, University Hospitals of Cleveland, OH paragraph signDepartment of Pathology **Department of Medicine and Physiology, Department of Gastroenterology, Harvard Medical School, Harvard, UK daggerdaggerMayo Clinic, Rochester, MN.Probiotics are live microbial organisms that are administrated as supplements or in foods to benefit the host. It is the recommendation that they may be helpful in the prevention and treatment of acute diarrhea in adults and children, the prevention of antibiotic-associated diarrhea in adults and children, and the maintenance of remission and prevention of pouchitis. Although early results indicate that probiotics may also be useful in immunologic modulation to prevent atopy, treatment of radiation intestinal disease, vaginosis, ulcerative colitis, and the irritable bowel syndrome, the studies available are not sufficient to say they are definitely helpful. Even fewer data are available to recommend probiotics for the treatment of H pylori and Crohn disease and for the prevention of cardiovascular risk factors or other degenerative diseases. Clearly, larger and better-designed studies of probiotics are necessary, including comparative and dose-ranging trials.J Clin Gastroenterol. 2006 Mar;40(3):270-274. Probiotics and Chronic Disease.Broekaert IJ, Walker WA.*Mucosal Immunology Laboratory, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA daggerDr von Hauner Children's Hospital, University of Munich, Munich, Germany.In today's climate, changed lifestyles and the increased use of antibiotics are significant factors that affect the preservation of a healthy intestinal microflora. The concept of probiotics is to restore and maintain a microflora advantageous to the human body. Probiotics are found in a number of fermented dairy products, infant formula, and dietary supplements. Basic research on probiotics has suggested several modes of action beneficial for the human body and clinical research has proven its preventive and curative features in different intestinal and extraintestinal diseases. Chronic diseases cause considerable disablement in patients and represent a substantial economic burden on healthcare resources. Research has demonstrated a crucial role of nutrition in the prevention of chronic disease. Thus, positive, strain-specific effects of probiotics have been shown in diarrheal diseases, inflammatory bowel diseases, irritable bowel syndrome, and Helicobacter pylori-induced gastritis, and in atopic diseases and in the prevention of cancer. As the majority of probiotics naturally inhabit the human intestinal microflora, their use has been regarded as very safe. However, in view of the range of potential benefits on health that might be achieved by the use of some probiotic bacteria, major and thorough evaluation is still necessary. In conclusion, probiotics act as an adjuvant in the prevention and treatment of a wide variety of chronic diseases.
 

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J Clin Gastroenterol. 2006 Mar;40(3):264-9. Probiotics and irritable bowel syndrome: rationale, putative mechanisms, and evidence of clinical efficacy.Camilleri M.Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN.The irritable bowel syndrome (IBS) follows an acute, presumably infectious diarrheal illness in approximately 15% of patients. There may be a persistent, mild inflammatory state with changes in mucosal function or structure. Changes in the colonic bacterial flora reported in IBS seem related to predominant bowel. Colonic bacteria normally metabolize nutrients with the formation of gas and short chain fatty acids. The latter may induce propulsive contractions and accelerate colonic transit or they may enhance fluid and sodium absorption in the colon. This review addresses the mechanisms, rationale and current evidence for the efficacy of probiotics, including Lactobacilli, Bifidobacteria, and VSLmusical sharp3, in the treatment of IBS. The mechanisms influenced by probiotics include immune function, motility, and the intraluminal milieu. Probiotics may suppress the low-grade inflammation associated with IBS or restore normal local immune function. Lactobacilli and Bifidobacteria subspecies are able to deconjugate and absorb bile acids, potentially reducing the colonic mucosal secretion of mucin and fluids that may contribute to functional diarrhea or IBS with diarrhea. Therapeutic trials show the potential benefit of Bifidobacteria or Lactobacilli species alone or in the specific probiotic combination, VSLmusical sharp3, on symptoms in IBS. Colonic transit was retarded in IBS patients treated with VSLmusical sharp3 without induction of significant changes in bowel function. In summary, probiotics are promising therapies in IBS.
 
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