Applications of probiotics for human use

Evidences of probiotic effectiveness in necrotizing enterocolitis (NE)

NE is one devastating intestinal disorder that a preterm infant may face in a neonatal intensive care unit (NICU). Low-birth-weight preterm infants delivered by cesarean section often require intensive care and are breastfed only after several days. The normal process by which microorganisms, such as lactobacilli, are ingested via vaginal birth and propagated by the mother’s milk does not take place in these infants. A human trial with 2.5 × 10⁸ CFU of live Lactobacillus acidophilus and 2.5 × 10⁸ CFU of live Bifidobacterium infantis given to 1237 newborns in Columbia resulted in 60% reduction in NE and overall mortality.

Diarrhea

Probiotics can prevent or ameliorate diarrhea through their effects on the immune system. Moreover, probiotics might prevent infection because they compete with pathogenic viruses or bacteria for binding sites on epithelial cells. Probiotics might also inhibit the growth of pathogenic bacteria by producing bacteriocins. A Cochrane review on the efficacy of probiotics for treating infectious diarrhoea, including both adults and children, evaluated 63 studies with a total of 8014 participants. No adverse events were attributed to probiotic intervention. The use of probiotics reduced the duration of diarrhoea, although the size of the effect varied considerably between studies. Probiotics have preventive as well as curative effects on several types of diarrhea of different etiologies.

There is ample evidence that probiotics reduce the duration and severity of rotavirus diarrhea.

At least two systematic reviews suggest that probiotics, including various bacterial species and the yeast Saccharomyces boulardii, effectively reduce the incidence of diarrhea in patients who are taking antibiotics (antibiotic-associated diarrhea [AAD]). While research using probiotics has extended to a vast array of diseases, the most investigated field continues to remain infectious diarrhea.

Helicobacter pylori infection

H. pylori is a major cause of chronic gastritis and peptic ulcer and a risk factor for gastric malignancies. Antibiotics directed towards H. pylori eradication are 90% effective. However, these treatments are expensive and can cause side effects, along with antibiotic resistance. Probiotic treatment can also reduce the side effects associated with H. pylori therapy.

Constipation

In adults, data suggest a favorable effect of treatment with Bifidobacterium lactis DN-173 010, Lactobacillus casei Shirota, and Escherichia coli Nissle 1917 on the frequency of defecation and stool consistency.

Role in lactose intolerance

This condition results from an insufficient activity of the lactose-cleaving enzyme lactase (β-galactosidase) in the small intestine. The health effect associated with the consumption of fermented milk products is the enhancement of lactose digestion and avoidance of intolerance symptoms in lactose malabsorbers. Yoghurt commonly made from Lactobacillus bulgaricus and Streptococcus salivarius subsp. thermophilus is usually effective.

Inflammatory bowel disease (IBD)

Inflammatory bowel disease classically includes ulcerative colitis, Crohn’s disease, and chronic pouchitis, representing different patterns of chronic inflammation of the gastrointestinal tract. Recent clinical and experimental observation implicates an imbalance in the intestinal mucosa with relative predominance of aggressive bacteria and relative paucity of protective bacteria and an increase in fungal and a decrease in methanogen diversity; also there is stimulation of proinflammatory immunologic mechanisms, based on the activation of the pattern recognition receptors in the gastrointestinal tract of IBD patients.

Various preliminary studies suggest a positive response to probiotics in patients with IBD and pouchitis.

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