Probiotics

Probiotics :
Effects on Diarrhea
The Journal of Nutrition137: 803S–811S, 2007.
Michael de Vrese and Philippe R. Marteau
Institute of Physiology and Biochemistry of Nutrition, Germany
Digestive Diseases, Hopital Lariboisie`re, France
Ri 李彥臻
Probiotics
Lactobacillus rhamnosus GG,
L. reuteri,
certain strains of L. casei,
L. acidophilus,
Escherichia coli strain Nissle 1917,
certain bifidobacteria
enterococci (Enterococcus faecium SF68)
probiotic yeast Saccharomyces boulardii
Probiotics in prevention and treatment of diarrhea
Potential mechanisms of probiotics for
prevention or treatment of diarrhea
Protection of intestinal epithelial barrier function
Regulation of intestinal epithelial homeostasis
Regulation of intestinal microbial environment
Modifications to commensal and probiotic bacteria to enhance diarrhea prevention


Protection of intestinal epithelial barrier function
integrity of the gastrointestinal epithelium
L. acidophilus; S. thermophilus, prevent enteroinvasive E. coli disruption of intestinal epithelial barrier function
VSL#3 enhances T84 tight junctions
－Salmonella dublin
L. acidophilus－ p38 mitogen activated protein kinase and Akt signal transduction pathways
prevent cytokine-induced increases in
intestinal epithelial paracellular permeability
Regulation of intestinal epithelial homeostasis
Inflammatory cytokines and chemokines
－intestinal epithelial cell injury.
L. casei －downregulates Shigella flexneri
by inhibition of NFκB-dependent transcription
LGG － prevents cytokine-induced intestinal
epithelial injury
1.by preventing apoptosis and promoting cell growth
2.cytoprotective shock proteins
Regulation of intestinal microbial environment
Disturbing the balance between the host and commensal bacterial flora in GI tract is associated with antibiotic-associated diarrhea
fungal infections

L. acidophilus and Bifidobacterium spp.
1.prevent antibiotic treatment-induced
increases in facultative anaerobic bacteria
2.decrease antibiotic-resistant enterococci.
Modifications to commensal and probiotic bacteria to enhance diarrhea prevention
toxin-receptor blockade strategy
recombinant E. coli is able to produce a lipopolysaccharide, which can bind heat-labile enterotoxin, induces traveler’s diarrhea
virulent V. cholerae－ cholera toxin



Clinical applications
of probiotics for diarrhea
Antibiotic-associated diarrhea (AAD)
and Clostridium difficile infection major
pathological bacteria

Lactobacillus GG (LGG)
Saccharomyces boulardii
1.significantly reduced the incidence of antibiotic-
associated diarrhea
from 18.9% (placebo) to 5.7% (P < 0.05)
2.combination with susceptible antibiotics
decreases recurrence of C. difficile infection
Administration of LGG, Saccharomyces boulardii,
before and during antibiotic treatment reduced
the frequency and/or duration of episodes and
the severity of symptoms in many cases but
was not always effective
Eradication Helicobacter pylori using clarithromycin, amoxicillin, and omeprazol leads to diarrheas
Coadministration of S. boulardii during H. pylori
eradication did reduce AAD from 11.5 to 6.9%
Acute infectious diarrhea and
rotavirus infection
LGG / S. boulardii
shortening the duration of acute diarrhea in children and in adults
majority of successful treatments －
young children. Many of them suffered from
nosocomial rotavirus infections.
meta-analysis of 23 randomized controlled
studies in adults and children with a total of 1917
subjects probiotics reduce the mean duration of
diarrheal episodes by 30.5 h
severe infectious diarrhea？
1) moderate,
2) strain- (LGG, L. reuteri, B. lactis Bb12)
3) dose-dependent,
4) more evident when probiotics are applied
early in the episode,
5) significant only in watery diarrhea
viral gastroenteritis but not in invasive
bacterial diarrhea
Traveler’s diarrhea

either LGG or Bifidobacterium animalis MB5
inhibited both neutrophil transmigration and cytokine induction by enterotoxic E. coli
Irritable bowel syndrome
functional GI disorder
diarrhea, constipation, abdominal pain, flatulence
and bloating
fecal samples －significantly lower
Lactobacillus strains and mild reduction of
Bifidobacterium strains

B. infantis reducing the symptom scores for
abdominal pain, bloating
normalized IL-10/IL-12 ratio, which suggests
inhibition of a proinflammatory state
Diarrhea in immunocompromised subjects
Chemo- and radiotherapy
－ diarrhea
－ increased Candida albicans in the GI tract
Side effects were ameliorated by the administration of probiotic bacteria

Small bowel bacterial overgrowth
1.insufficient production of gastric acid
2.extented gastrointestinal transit time
3.terminal renal failure
excessive growth of single bacterial strains

decreased frequency of diarrheas following administration of L. acidophilus and L. casei

Reduced diarrhea and other gastrointestinal symptoms in lactose intolerance
insufficient activity of the lactose-cleaving
enzyme β-galactosidase in the small intestine
enhancement of lactose digestion, avoidance of intolerance symptoms in lactose malabsorbers.
Yogurt is usually more effective



Efficacy of probiotics in prevention of acute diarrhea a meta-analysis of masked, randomised, placebo-controlled trials

DrSunil Sazawal MD Girish Hiremath MD
Department of International Health,
Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, USA

Lancet Infectious Disease 2006; 6: 374–82
34 trials comprised 4844 patients.

Biofermin-R Powder
Antibiotics-Resistant Lactic Acid Bacteriae



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