Probiotics

Question 1

How does gut microflora affect the guts barrier function?

Answer 1

Competes with pathogenic bacteria
Decrease gut permeability
Modulating gut immune function
Increasing mucin production

Question 2

Why is breastfeeding good for gut microflora?

Answer 2

There is lactobacilli and bifidobacteria in breast milk, so the infants have more lactobacilli and bifidobacteria in their gut.

Question 3

When do infants have adult type microflora?

Answer 3

When they introduce solids into diet.

Question 4

What is the role of colonic bacteria?

Answer 4

Metabolise carbohydrates into short chain fatty acids ?

Question 5

What is the role of short chain fatty acids?

3

Answer 5

They are the preferable source of energy for enterocytes
They acidity colonic content
They increase water absorption

Question 6

How do probiotics modify gut microflora?

Answer 6

Produce short chain fatty acids, lowering PH
Produce antimicrobial compounds and toxins
Compete with other bacteria for nutrients and adhesion receptors
Enhance gut barrier function
Have a role in immunomodulation

Question 7

How do you define antibiotic associated diarrhoea?

How common is it?

Answer 7

3 or more stools for 2 or more days
Occurring up to 2 weeks after antibiotics

30% of patients

Question 8

Do probiotics reduce antibiotic associated diarrhea?

Answer 8

Yes.
Meta analysis showed a RR 0.47 and NNT 10
Intention to treat analysis showed less favourable results, with compliance is likely a problem.

Question 9

Do probiotics reduce antibiotic associated diarrhea?

Answer 9

Yes.
Meta analysis showed a RR 0.47 and NNT 10
Intention to treat analysis showed less favourable results, with compliance is likely a problem.

Question 10

Is there a role for probiotics with preventing or treating C Dif?

Answer 10

There are no Pediatric RCTs

No role in preventing or treating initial C Dif episodes
There may be a role in treating relapse of C Dif

Question 11

Do probiotics have a role in treating acute infectious gastroenteritis?

Answer 11

Bacterial: No

Viral: probiotics may reduce the duration of diarrhea, although this is dose dependent and strain depended. More effective in rota virus and if early (

Question 12

Can probiotics prevent infections gastroenteritis?

Answer 12

It may have a role in preventing infectious diarrhea, especially in non breastfed babies.

Question 13

Is there a role for probiotics in the management of IBS?

Answer 13

The data comes from the adult world but does show some symptom improvement.

Question 14

Is there a role for probiotics in the treatment of infantile colic?

Answer 14

Lower counts of lactobacilli have been found in infants with colic. But the evidence is limited although there is some reduction in crying if receiving probiotics.

CPS: insufficient evidence to draw a conclusion.

Question 15

Is there a role for probiotics in the management of IBS?

Answer 15

The data comes from the adult world but does show some symptom improvement.

Question 16

What is the role of probiotics in preventing NEC and why?

Can you give it to all preterm neonates?

Answer 16

Probiotics may help prevent NEC. The pathogensis involves increased intestinal permeability and intestinal bacteria. Probiotics likely help because it decreases intestinal permeability.

Can give to kids > 1kg and promote EBM

Question 17

Is there a role for probiotics preventing travellers diarrhea?

Answer 17

Unclear.

The evidence of a potential preventative effect comes from adult literature with significant study limitations.

Question 18

Do probiotics have a role in preventing infections in general (ie not just gastro)?

Answer 18

Probiotics may have a role in decreasing respiratory illnesses and AOM, Decreasing courses of antibiotics and decreasing absences from daycare for illnesses.

BUT evidence is very limited and therefore no firm recommendation can be made

Question 19

Is there a theoretical and/or clinical role for probiotics preventing atopic conditions?

Answer 19

Theoretical:

1. Probiotics decreased gut permeability ➡️ decrease absorption of large molecules ➡️ allergen uptake
2. Probiotics change the interaction with gut-associates lymphoid tissue ➡️ changing the balance of Th1 versus Th2 and thus allergy.

Clinical:
No evidence to support probiotics in moms p

Question 20

Is there a role for the treatment of atopic dermatitis with probiotics?

Answer 20

There were two RCTs that showed potential benefit although s meta analysis said that these improvements were unlikely clinically significant.

Question 21

Is there a role for probiotics with CMPA?

Answer 21

Giving probiotics to breast fed babies had no clinical improvement in their symptoms.

Giving probiotics to kids on puramino gave better results re symptoms

BUT further research is needed.

Question 22

What are the potential adverse effects of probiotics?

Answer 22

Local and systemic infections.

Especially in kids who are immunocompromised or has CVL.

Question 23

There is good evidence for using probiotics with what conditions? (3)

Answer 23

Antibiotic associated diarrhea
Preventing NEC
Viral diarrhea

Question 24

When should physicians consider using probiotics? (5)

Answer 24

Antibiotic associated diarrhea - prevent 
Viral gastro - shorter duration 
NEC - prevent 
Colic - decrease symptoms 
IBS - decrease symptoms