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The GP Show


Join GP and Medical Educator Dr Sam Manger MBBS BSc FRACGP FASLM covering a variety of topics with case studies, guideline reviews, guest interviews and more for medical doctors and allied health including general practitioners, family physicians, specialists, allied health, nurses, registrars/residents, medical students and anybody interested in health, science and medicine.

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Mar 11, 2018

Surrounded by the familiar beeps and glow of the hospital surgical theatres I had a thoroughly enjoyable chat with scrubs-donned Dr Johan Van Den Bogaerde Gastroenterologist and researcher.  We discuss probiotics and the various relevant themes around them.  
 
Topics we discuss include:
- What are probiotics and some important principles
- How do they work?
- Evidence for different conditions - IBD, IBS, diarrhoeal disorders, helicobacter pylori, atopic eczema and others
- Research bias 
- Working with real people who are suffering but that don't fit the guidelines = the clinicians dilemma
 
Summary of the POSSIBLE uses:
IBD Ulcerative Colitis and Pouchitis - VSL3, E. coli nissle and saccharomyces boulardi may help for remission.  No clear evidence for chron's disease
IBS - VSL3, bifido infantis - mixed studies, some positive and some only as good as placebo (~50% reduction in pain)
Diarrhoeal disorders (antibiotics associated, childrens diarrhoea, c.dif and preventing travellors diarrhoea) = Lacto. rhamnosus, saccharomyces boulardii and Lacto. reuteri may be of assistance e.g. reduce duration of infectious diarrhoea by <1 day
Helicobacter pylori - Saccharomyces boulardii and Lacto. reuteri - may reduce side effects to antibiotics and improve eradication rate
Atopic eczema - Lacto. rhamonsus and Bifido. lactis reduce rate of atopic eczema in children by 80% if taken by mother during pregnancy and breastfeeding
Atopic eczema - not clear, mixed studies as a treatment of atopic eczema 
Other possible use though studies are limited and early - bacterial vaginosis, major depression disorder, autism spectrum disorder, other CNS disorders, hepatic encephalopathy
 
Doses and duration's vary
 
Risks:
Do not use in critically unwell or marked immunosuppression
Side effects may include - constipation, flatulence, nausea, rash and others
Don't forget the price tag
 
Some of the many references:
IBD - https://www.ncbi.nlm.nih.gov/pubmed?term=20517305https://www.ncbi.nlm.nih.gov/pubmed?term=14684584https://www.ncbi.nlm.nih.gov/pubmed?term=22161412
IBS - https://www.ncbi.nlm.nih.gov/pubmed/25780308
Diarrhoeal disorders - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748908/ , 
H pylori - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4588086/
Atopic disease pregnancy - https://www.racgp.org.au/your-practice/guidelines/handi/interventions/children/probiotics-in-pregnancy-for-infant-atopic-eczema/
Eczema in children - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828648/ 

Probiotics and intestinal permeability-- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4253991/

CNS disorders = https://www.ncbi.nlm.nih.gov/pubmed/27413138