Martin H. Floch

Recommendations for Probiotic Use—2011 Update

This study describes the consensus opinion of the participants of the third Yale Workshop on probiotic use. There were 10 experts participating. The recommendations update those of the first 2 meetings that were published in 2005 and 2008. The workshop presentations and papers in this supplement relate to the involvement of normal microbiota involved in intestinal microecology, how the microbes interact with the intestine to affect our immunologic responses, the stability and natural history of probiotic organisms, and the role of the intestinal microbatome with regard to affecting cardiac risk factors and obesity. Recommendations for the use of probiotics in necrotizing enterocolitis, childhood diarrhea, inflammatory bowel disease, irritable bowel syndrome, and Clostridium difficile diarrhea are reviewed. As in previous publications, the recommendations are given as A, B, or C ratings. The recent positive experiences with bacteriotherapy (fecal microbiome transplant) are also discussed in detail and a positive recommendation is made for use in severe resistant C. difficile diarrhea.

Diverticular Disease and Diverticulitis

Diverticular disease is one of the most prevalent medical conditions to affect Western populations. Symptomatic diverticular disease can range from mild, low-level symptomatology similar to that seen in irritable bowel syndrome to acute bouts of diverticulitis complicated by abscess or frank perforation. This review discusses the epidemiology, pathophysiology, clinical presentation, and management of the spectrum of diverticular disease, including mention of recent advances in the treatment of chronic diverticular disease with aminosalicyclates and probiotics.

Recommendations for probiotic use.

Probiotics are live microbial organisms that are administrated as supplements or in foods to benefit the host. It is the recommendation that they may be helpful in the prevention and treatment of acute diarrhea in adults and children, the prevention of antibiotic-associated diarrhea in adults and children, and the maintenance of remission and prevention of pouchitis. Although early results indicate that probiotics may also be useful in immunologic modulation to prevent atopy, treatment of radiation intestinal disease, vaginosis, ulcerative colitis, and the irritable bowel syndrome, the studies available are not sufficient to say they are definitely helpful. Even fewer data are available to recommend probiotics for the treatment of H pylori and Crohn disease and for the prevention of cardiovascular risk factors or other degenerative diseases. Clearly, larger and better-designed studies of probiotics are necessary, including comparative and dose-ranging trials.

Probiotics Used in Human Studies

Goal: To investigate the literature from 1980 to 2004 for the types of studies and organisms used as probiotics in human studies and diseases. Methods: PubMed search for probiotic organisms used in studies from 1980 to August 2004. The data from those papers were evaluated for organisms used, dose, vehicle, frequency, and investigators report of positive or negative results. Results: A total of 185 manuscripts were identified. Investigators reported results of both single and multiple organisms in the same manuscript. A single organism was used in 125 reports, and multiple organisms, ranging from 2 to 9, were used in 60 reports. Positive results were reported in 239 clinical situations and negative results reported in 49 in a total of 288 clinical conclusions drawn by the respective investigators. The studies are tabulated in this review. Conclusion: There is a large literature available in credible journals that report benefit of probiotic administration using a wide range of doses, organisms, and clinical situations. Most of the studies are simple reports of a clinical situation and require additional evaluation.

Use of diet and probiotic therapy in the irritable bowel syndrome: analysis of the literature.

Goal:The goal of this report is to review the use of dietary intake and probiotics in patients with irritable bowel syndrome (IBS) in published reports. Background:Dietary factors can be important in inducing symptoms that occur in patients with the IBS. Dietary intolerances, dietary allergies, specific food metabolites, and regular diet contents all may act as triggers and aggravate the symptoms of IBS; but when any of these mechanisms can be proven to cause the symptoms, then their elimination results in the resolution of that patients IBS. Methods:Our previous review was updated. In addition, a careful Medline search was made for the years from 1975 to 2004 to evaluate human research reports on diet and probiotics in the IBS. Forty-six manuscripts were reviewed on diet and six were available on probiotic use in IBS. The most common dietary factor evaluated in the literature was bran, and the most common probiotic used was Lactobacillus plantarum. Conclusions:Although investigations have shown that bran may be helpful in some patients, a complete review of the literature does not reveal conclusive evidence that diet therapy is effective in IBS. From the limited reports on probiotics, there appears to be a trend to decreasing symptoms. It is clear that much more prospective research is needed to study both dietary factors and probiotics in these areas.

Recommendations for Probiotic Use--2015 Update: Proceedings and Consensus Opinion

This paper describes the consensus opinion of the participants in the 4th Triennial Yale/Harvard Workshop on Probiotic Recommendations. The recommendations update those of the first 3 meetings that were published in 2006, 2008, and 2011. Recommendations for the use of probiotics in necrotizing enterocolitis, childhood diarrhea, inflammatory bowel disease, irritable bowel syndrome and Clostridium difficile diarrhea are reviewed. In addition, we have added recommendations for liver disease for the first time. As in previous publications, the recommendations are given as A, B, or C ratings.

Diet in the irritable bowel syndrome

Patients with irritable bowel syndrome (IBS) often request dietary recommendations. They must eat, and they want to know what to eat. Present national guidelines recommend dietary treatment with fiber for IBS patients with constipation. Diet recommendations are made based on symptoms. There may be different dietary recommendations for constipation, diarrhea, and pain or bloating. This article reviews the relationship of foods to IBS and. issues of food intolerances and hypersensitivities, and recommendations for diet therapy. The role of dietary fiber, both soluble and insoluble, is reviewed. Although there are few studies to substantiate exac; diets, broad dietary plans are recommended for the different symptoms of IBS. In addition, the recent literature on probiotics and prebiotics pertinent to IBS is reviewed.

Fecal bacteriotherapy, fecal transplant, and the microbiome.

In this issue, there are 3 papers published that involve the fecal microbiome. One is an important physiologic study and 2 are a further elaboration of treatment using fecal bacteriotherapy, now often referred to as fecal transplantation.In the paper from Australia, Grehan et al1 describe the result

Histochemical Localization of Gastric And Small Bowel Mucosal Enzymes of Man, Monkey, and Chimpanzee

Summary Specimens of gastric and distal duodenal mucosa from the chimpanzee, man, and monkey were compared for activity of nonspecific esterase, alkaline phosphatase, acid phosphatase, succinate dehydrogenase, reduced nicotinamide adenine dinucleotide and nicotinamide adenine dinucleotide phosphate dehydrogenases, and cytochrome oxidase. Except for an abnormal distribution of reduced nicotinamide adenine dinucleotide phosphate dehydrogenase in the chimpanzee small bowel, which may well have been the result of some chronic inflammatory response, all the enzymes studied in the three species of primates had essentially the same localization and intensity of reaction.

Diet and nutrition in ulcer disease.

In this era of H2-inhibitors, the available evidence does not support the need to place peptic ulcer disease patients on restrictive diets. The major goal of diet is to avoid extreme elevations of gastric acid secretion and the direct irritation of gastric mucosa. In view of this, only slight modifications in the patients usual diet are recommended. Table 1 depicts a sample menu for chronic peptic ulcer disease. Frequent milk ingestion as previously prescribed is not encouraged. This is owing to the transient buffering effect and significant gastric acid secretion effect of milk. The fat content of milk has no influence on these effects. Spices, in particular black pepper, red pepper, and chili powder, may produce dyspepsia. One study shows red chili powder to have no detrimental effect on duodenal ulcer healing. It has also been proposed that daily pepper ingestion may have a beneficial adaptive cytoprotective response. While still controversial and under evaluation, peptic ulcer patients should avoid any spice that causes discomfort, especially during exacerbation of peptic disease. Currently, studies indicate that it is prudent to avoid alcohol. This is especially true for the concentrated forms, such as 40% (80 proof) alcohol. Coffee should be avoided on the basis of its strong acid secretagogue property. Coffee can induce dyspepsia. Whether noncoffee caffeine-containing beverages (tea, soft drinks) induce peptic ulcer is unknown, but they are acid secretion stimulators. Decaffeinated coffee has an acid stimulating effect as well. It is reasonable to have peptic ulcer patients restrict decaffeinated coffee and all caffeine-containing beverages. There appears to be no evidence to restrict dietary fiber. Some fiber-containing foods may possess factors that are protective against ulcer disease. According to the Mayo Clinic Diet Manual, previously recommended small frequent feedings have not been shown to be more effective than three meals per day in the treatment of chronic peptic ulcer disease. This reference cites authorities advising against extra feedings because of increased acid secretion and unnecessary complication of eating patterns. However, some patients claim to be relieved of symptoms with more frequent feedings, especially during acute phases. Citric acid juices may induce reflux and cause discomfort in selective patients. Stomach distention with large quantities of food should be discouraged. Although there is now little role for dietary therapy, one should note that bland and ulcer diets probably are not detrimental to most persons if they are used for a short time and may have some psychological benefit.(ABSTRACT TRUNCATED AT 400 WORDS)