WAPA SPRING 2016 Probiotics: What we know and what we would like to discover

Transcription

1 WAPA SPRING 2016 Probiotics: What we know and what we would like to discover Betty White NP-C Manager Crohns and Colitis Center Digestive Health Specialists Tacoma, WA

2 What we know At birth the GI tract is sterile Within hours of birth humans become colonized from surroundings and mothers fecal flora Bacteria is different based on caesarian vs vaginal delivery Exposure to antibiotics, neonatal care Whether mothers breast or bottle feed

3 Common bacteria Common bacteria include; Bifidobacterium Bacteroides Lactobacillus Clostridium Peptococcus Enterococcus Staphylococcus Levy J Am J gastro 95 sup 1)58,2000

4 Homeostasis In a healthy adult gastric acid inhibits or kills swallowed microorganisms Intestinal secretions also help maintain normal gut flora In patients with malabsorption the small bowel bacteria will be more consistent with large bowel bacteria which may be the cause of distention and bloating We know that small bowel bacteria changes may add to poor digestion of carbohydrates and increase osmolarity causing diarrhea

5 Homeostasis We also know that stagnation also accounts for abnormal high bacterial counts Antibiotic therapy alters gut flora Surgery also is know to alter bacteria

6 Why does it matter Most common symptoms: abdominal pain (distention) Bloating Diarrhea Labs can be normal But patients may have B12 deficiency, vit A,D,E,K. iron deficiency, hypoalbuminemia, fat malabsorption

7 What do probiotics do? Mechanism is not completely understood Suppression of pathogenic bacteria Improvement of the barrier function Induce protective cytokines and suppress pro-inflammatory cytokines like TNF Modulate pain, inducing of opioid and cannabinoid receptors, similar to morphine Uptodate.com

8 Probiotics vs Prebiotics Probiotics are good bacteria Prebiotics are undigested carbohydrates that feed probiotics

9 Probiotics Most commercial sources are derived from milk Lactobacillus Bifidobacterium Escherichia E.coli Saccharomyces

10 Food source Yogurt is often pasteurized which kills the good bacteria Fermented products like kombucha, kefir or kimchi maybe best The problems with commercial products is shelf life studies have shown levels of active bacteria differ dependent on environmental exposure

11 What we know Probiotics may be effective for Pouchitis Ulcerative colitis/crohns Small bowel bacterial overgrowth Diverticulitis Infectious diarrhea Collagenous colitis Celiac constipation

12 Decrease inflammation After antibiotic treatment, probiotics have been shown to decrease relapse Ulcerative colitis studies did not show probiotics effective in remission but maybe helpful as adjunct therapy Some small studies have shown a benefit in mild colitis Radiation: small study showed no benefit

13 Diarrhea Antibiotics disrupt colonic microflora which leads to diarrhea (c-difficile) Probiotics may help maintain the gut flora and inhibit growth of pathogens May reduce the duration of infectious diarrhea, and stool frequency

14 Celiac Lactobacillus and Bifidobacterium are decreased in celiac patients Unfortunately studies did not show a decrease in diarrhea, patient did report less constipation, reflux, bloating

15 Constipation Bifidobacterium, lactobacillus Studies did show an improvement in frequency but not significant change in severe constipation

16 Irritable Bowel Syndrome Multiple studies Most showed modest improvement in gas, abdominal pain and bloating Lactobacillus, VSL#3, Bifidobacterium showed the best results Rifaximin a antimicrobial which inhibits RNA synthesis of bacteria has shown benefit as well

17 Probiotics-what we hope for the future Multiple studies ongoing To produce strains that act like immunmodulators Or have the ability to alter surface proteins That could influence inflammatory conditions like Crohns or colitis

18 What we would like to discover How to effectively measure what types of bacteria in a particular patient How much probiotic is needed to alter a patients flora How long does a patient need to take probiotics Can probiotics prevent infections What role do probiotics have in other disease states?