Sixty seconds on . . . probiotics
BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3134 (Published 17 July 2018) Cite this as: BMJ 2018;362:k3134
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An important function of friendly organisms is to repair the bowel microbial flora and enhance it in order to protect the host against colonization and infection by other harmful organisms such as Clostridium difficile. This is referred as “colonization resistance” whereby organisms which constitute the normal bowel microbial flora prevent colonization of alien organisms which can potentially lead to bowel or other infections (1).
To date the only known evidence-based intervention that can repair a disturbed bowel microbiota is by transplanting an external microbiota into that of the host’s faecal flora (2). What appears to work as research has demonstrated and as adopted by the NICE guidance is when the whole of the microbial population constituting the faecal flora - i.e. microbiota - are transplanted then protection against invasion by other organisms is conferred. The oral administration of specific organisms such as Lactobacillus spp., Bifidobacterium spp. and Saccharomyces spp. in various combinations and in diverse vehicle formats is not to-date shown to be uniformly effective as demonstrated by inconsistency of research evidence (3-5).
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3533696/ 2.
2. https://www.nice.org.uk/guidance/IPG485 3.
3. https://onlinelibrary.wiley.com/doi/full/10.1111/nbu.12149
4. Guarner F, Khan AG, Garisch J, et al. World Gastroenterology Organisation Global Guidelines. Probiotics and Prebiotics. October 2011. Journal of Clinical Gastroenterology.2012;46(6):468–481.
5. Hempel S, Newberry SJ, Maher AR, et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis. JAMA. 2012;307(18):1959–1969.
Competing interests: No competing interests
From the erstwhile understanding that considered the gastrointestinal tract almost a mechanical conduit for processes from digestion, absorption, assimilation to excretion , it has come someway to knowing about the 'microbiome'
. Targeting the human microbiome with probiotics and probiotics was lauded as gastroenterology entering a new era. (1) Approaches for therapeutic modulation (2) have been identified and are subject of study. In short ,the area is vibrant and implications are probably under evolution .Nonetheless , rigorous assessment of probiotics , prebiotics and combination synbiotics is called for considering the potential and promise this area of interest , gut ecology holds. Dr ME Yeolekar. Mumbai References : 1. Preidis GA, Versalovic CJ .Targeting the human microbiome with antibiotics, probiotics and probiotics : gastroenterology enters the metagenomic era. Gastroenterology. 2009 . 136 : 6 ; 2015-31. 2.Langdon A ,Crook N, Dantas G. The effects of antibiotics on the microbiome throughout development and alternative approaches for therapeutic modulation. Genome Medicine .2016 : 8; 39. PMID 27074706.
Competing interests: No competing interests
Re: Sixty seconds on . . . probiotics
In clinical practice as a GP, I have not seen the benefits of prescribing either a probiotic or a prebiotic. I think there is no evidence for writing these expensive supplements. They just add costs to the prescription. Some of them are designer bacteria, with copyrights!
Except for Inflammatory Bowel Disease, wherein fecal transplant has evidence, prebiotics/probiotics have no role. Though of late there is lot of research going on the intestinal microbiome, including its relation to a neurological condition (Parkinson's), one should not be influenced by industry information. Till there is enough evidence one should be cautious of prescribing (? chance of mutation) probiotics/prebiotics. Naturally occurring probiotics (curds) are the best and the cheapest source.
Competing interests: No competing interests