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