Probiotics Flashcards
How does gut microflora affect the guts barrier function?
Competes with pathogenic bacteria
Decrease gut permeability
Modulating gut immune function
Increasing mucin production
Why is breastfeeding good for gut microflora?
There is lactobacilli and bifidobacteria in breast milk, so the infants have more lactobacilli and bifidobacteria in their gut.
When do infants have adult type microflora?
When they introduce solids into diet.
What is the role of colonic bacteria?
Metabolise carbohydrates into short chain fatty acids ?
What is the role of short chain fatty acids?
3
They are the preferable source of energy for enterocytes
They acidity colonic content
They increase water absorption
How do probiotics modify gut microflora?
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
How do you define antibiotic associated diarrhoea?
How common is it?
3 or more stools for 2 or more days
Occurring up to 2 weeks after antibiotics
30% of patients
Do probiotics reduce antibiotic associated diarrhea?
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.
Do probiotics reduce antibiotic associated diarrhea?
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.
Is there a role for probiotics with preventing or treating C Dif?
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
Do probiotics have a role in treating acute infectious gastroenteritis?
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 (
Can probiotics prevent infections gastroenteritis?
It may have a role in preventing infectious diarrhea, especially in non breastfed babies.
Is there a role for probiotics in the management of IBS?
The data comes from the adult world but does show some symptom improvement.
Is there a role for probiotics in the treatment of infantile colic?
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.
Is there a role for probiotics in the management of IBS?
The data comes from the adult world but does show some symptom improvement.
What is the role of probiotics in preventing NEC and why?
Can you give it to all preterm neonates?
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
Is there a role for probiotics preventing travellers diarrhea?
Unclear.
The evidence of a potential preventative effect comes from adult literature with significant study limitations.
Do probiotics have a role in preventing infections in general (ie not just gastro)?
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
Is there a theoretical and/or clinical role for probiotics preventing atopic conditions?
Theoretical:
- Probiotics decreased gut permeability ➡️ decrease absorption of large molecules ➡️ allergen uptake
- 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
Is there a role for the treatment of atopic dermatitis with probiotics?
There were two RCTs that showed potential benefit although s meta analysis said that these improvements were unlikely clinically significant.
Is there a role for probiotics with CMPA?
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.
What are the potential adverse effects of probiotics?
Local and systemic infections.
Especially in kids who are immunocompromised or has CVL.
There is good evidence for using probiotics with what conditions? (3)
Antibiotic associated diarrhea
Preventing NEC
Viral diarrhea
When should physicians consider using probiotics? (5)
Antibiotic associated diarrhea - prevent Viral gastro - shorter duration NEC - prevent Colic - decrease symptoms IBS - decrease symptoms
