ESPEN Congress Vienna Networking with your microbiota Specific evidence-based indications. H. Lochs (Germany)
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1 ESPEN Congress Vienna 2009 Networking with your microbiota Specific evidence-based indications H. Lochs (Germany)
2 Probiotics Evidence based indications H. Lochs Medizinische Klinik mit Schwerpunkt Gastroenterologie, Hepatologie und Endokrinologie
3 Critical illness Trauma/Infection Acute Stress Response Iatrogenic Factors Immunological Response Neuroendocrine Response Metabolic Response
4 L. Johnsonii Probiotics Rationale L. Lactis Saccharomyces boulardii E. Coli Nissle Feces are a spatially organised biosystem Fecal Bacteria interact with each other Immune system Intestinal Barrier Changing the flora may have consequences on the organism Bifidobacteria
5 Spatial Organisation of Fecal Flora Swidsinski et al., Gastro 2008, Patient Diarrhea Ebac Fprau
6 Mucosal biofilm in CHF Highly colonised large intestinal mucosa
7 Possible Effects of probiotics Antimicrobial Effects Secretion of antibacterial substances Binding of bacteria Antiadhesion Increase of IgA secretion Increase of mucin secretion Improvement of intestinal Barrier IgA secretion Tight junctions Immune effects Influence on cytokine secretion Direct Cytokine secretion Enzyme replacement Lactase deficiency Metabolic effects Intestinal ph
8 Antibacterial activity of Probiotics Well Diffusion Test Timmermann et al., Clin. Nutr. 2007
9 Adhesion of E. coli - on HT29 - effect of lactobacteria Mack et. al. Am J. Physiol. 1999
10 Effect of Bacteria on tight junctions Otte et. al. AJP 2004 Control S. Dublin Pretreatment E. Coli Nissle
11 Bacterial DNA Effect on Cytokine Production Jijon, Gastro 2004
12 L. Johnsonii L. Lactis Saccharomyces boulardii E. Coli Nissle Probiotics Possible indications Diarrhea Infections Allergy Inflammatory Bowel disease Irritable bowel syndrome Surgery ICU Bifidobacteria
13 Diarrhea in Children Guandalini, J.Clin Gastro 2008 Low Evidence High Evidence
14 Probiotics in antibiotic associated diarrhea D Souza et. al., BMJ 2002
15 Prevention of Antiobiotic diarrhea Doron et al., J. Clin Gastro 2008 Lactobacillus GG and Saccharomyces bul. are safe and effective. Caution in Patients with disturbed intestinal barrier
16 Probiotics and Atopia 50 % Atopic Eczema with 2 a Placebo Kalliomaki et. al. Lancet 2001 Lactobacillus GG
17 Effect of L. rhamnosus and L. reuteri on symptoms and PI in 41 children with atopic dermatitis Rosenfeldt et. al. J. Ped. 2004
18 Probiotics- Infant Allergy and Food Hypersensitivity Osborne, Sinn, Cochrane 2009 Insufficient Evidence Atopic Eczema
19 Mucosa associated Flora in disease
20 Relapse Prevention in UC Effect of E. coli Nissle vs. Mesalazine Kruis et. al. Gut 2004 n = 325, 12 months
21 Probiotics - Prevention of Pouchitis Mimura et al. Gut 2004 n= 36
22 Bacterial DNA Effect on DSS Colitis Rachmilewitz et. al. Gastro 2002
23 Probitics IBS O Mahony et. al. Gastro 2005
24 Probiotics in IBS Quigley J.Clin. Gastro 2008
25 Probiotics Infections after LTX Patients with infections ( n ) Group1 Group 2 Group 3 p SBD Lactobacillus Placebo (n=32) ( n = 31 ) ( n=32 ) ,017 ICU days 15,7±12 11,7 ±7 13,5 ±12 n.s. Hospital days 39 ±5 35 ±2,4 36 ±2,7 n.s. Antibiotic therapy (days) 12 ±17 7 ±7 12 ±18 n.s. Rayes et. al. Transplantation 2002
26 Probiotics in Surgery Besselink et al. Dig. Surg 2005
27 Indication for Probiotics Ulceratice Colitis, Pouchitis +++ E. Coli Nissle, VSL3, L. rhamnosus Infectious Diarrhea, Antibiotic induced Diarrhea ++ E. Coli Nissle, L. acidophilus, L. Reuteri, Saccharomyces Necrotising Enterocolitis ++ B. infantis, Lactobacilli Atopic Dermatitis ++ L. rhamnosus, divers Pancreatitis +/- Lactobacilli IBS ++ VSL3, B. infantis, L. plantarum Perioperative +? Synbiotic 2000, Lactobacilli ICU? Lactobacilli, multiple Turboprobiotics? Lactase, IL10
28 Probiotics Evidence based Indications Rationale +++ IBD, Diarrhea ++ Pancreatitis +? IBS + Perioperative ++ ICU +? Genetically manipulated?
29 Probiotics Recommendations Floch et al. J. Clin Gastro 2008
30 P Probiotics in IBS Floch J. Clin. Gastro 2005
31 Spatial Organisation of Intestinal Flora Swidsinski et al. IBD, 2007, Mouse, Colon
32 Probiotics with Mimic Receptors Paton et al., Nat. Rev. Microbiol E. Coli, ganglioside Receptor mimic + cholera Toxin
33 Secretory IgA - Effect of Starvation and Steroid Stress Spitz et. al., Crit. Care Med 1996
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