Use of Synbiotics for Ulcerative Colitis Treatment.

Inflammatory bowel diseases, namely Crohn's disease and ulcerative colitis, are currently considered multifactorial pathologies in which various combined environmental factors act on genetic background, giving rise to chronic inflammation of the gastrointestinal tract. Ulcerative colitis is an inflammation of the colon caused by a dysregulated immune response to host intestinal microbiota in genetically susceptible subjects. Ulcerative colitis has a strong impact on patients' quality of life, as well as high costs for the health-care system. A great interest on the role of intestinal microbiota modulation in ulcerative colitis is emerging. Several studies have shown an improvement of inflammatory markers and symptoms in ulcerative colitis patients through treatments with probiotics and prebiotics separately. Despite the low number of studies on the treatment of ulcerative colitis by specific strains of probiotics plus selected prebiotics, i.e. synbiotics, the results are promising, even if discordant. The mechanism of action in synbiotics supplementation is still unclear and needs more investigation, although there is a large number of data indicating that the synergism between probiotics and prebiotics favours the survival and implantation of probiotics into the gastrointestinal tract with beneficial effects on human health by modulating the inflammatory response and gut microbiota composition. The aim of this minireview is to describe the main in vitro, animal and human studies performed up to now, that have used synbiotics to treat ulcerative colitis, and to highlight limitations and future perspectives.

Assessment of the Effect of Dietary Modifications and Bioenteric Intragastric Balloon Treatment on the Changes of Some Morphological and Biochemical Parameters in Obese Patients.

Obesity is the most common disease of affluence of the XXI century. According to WHO (World Health Organization), it is defined as a chronic metabolic disorder manifested by excessive accumulation of adipose tissue with high tendency for familial occurrence. According to WHO, obesity reaches epidemic proportions in many countries. High BMI (Body Mass Index) correlates with coexisting diseases. Traditional dietetic treatment often does not bring any results. A form of conservative (non-surgical) support for patients in fighting with obesity is the reduction of stomach volume by bioenteric intragastric balloon (BIB) treatment. The aim of the work was to develop a diet with anti-inflammatory properties, well-tolerated by the patients after BIB treatment. An American diet was modified by changing the composition of fatty acids, increasing anti-oxidative potential and adding synbiotics for patients treated with BIB. Chemical analysis of reconstructed food ratios of recommended diet was performed, analysing the content of micronutrients, composition of fatty acids, antioxidative capacity, reducing power and the content of polyphenols. Improvement in anthropometric measurement results and satisfying body weight loss were obtained, while preserving fat-free body mass. Improvement in the parameters of lipid metabolism was also observed, that is, decrease in total CH (cholesterol) and TG (triglycerides), and normalized concentration of HDL (high density lipoproteins) and LDL (low density lipoproteins) fractions. Reduced concentration of glucose in blood and lower blood pressure was also noted. Performed study confirms the effectiveness of complex treatment with BIB and properly adjusted individualized diet. Observations and own experience allow to deduce that patients who resign from systematic contact with a dietician cannot maintain reduced body weight. Abandoning previous habits is the only way to maintain the effect of weight loss. Most importantly, the change in patients' awareness and consequent behaviour in the future are crucial. Even though genes may contribute to obesity, environmental factors mainly determine the possibility of the disease to occur. Therefore, the change of patients' lifestyle after body weight reduction will decide on their fate.

Assessment of human 4-hydroxynonenal, 8-isoprostane concentrations and glutathione reductase activity after synbiotics administration.

PURPOSE: Probiotics and prebiotics have become an object of intense research, to identify methods of mitigating oxidative stress. Over the past few years, the number of in vitro and in vivo studies, related to antioxidant properties of probiotics/prebiotics has significantly increased. The aim of the present study was to assess whether probiotic in combination with prebiotic influences the level of human 4-hydroxynonenal, 8-isoprostane and glutathione reductase activity. MATERIAL/METHODS: Experiments were carried out on healthy volunteers (male and female). All oxidative stress markers were measured in blood plasma pre- and post-administration of synbiotic. RESULTS: The administration of synbiotic resulted in a significant decrease in 4-hydroxynonenal in the female-synbiotic group (p < 0.05), 8-isoprostanes in the female-synbiotic group and male-synbiotic group (p < 0.05) and non-significant increase in the activity of glutathione reductase (p > 0.05) vs. control. CONCLUSIONS: The present results show that supplementation of synbiotics contributed to the decrease in oxidative stress parameters in the female patients.

Effects of perioperative supplementation with pro-/synbiotics on clinical outcomes in surgical patients: A meta-analysis with trial sequential analysis of randomized controlled trials.

BACKGROUND & AIMS: The Potential benefits and possible risks of perioperative supplementation with probiotics/synbiotics in surgical patients are not fully understood. Recent evidence has rapidly evolved and conveys conflicting results. Thus, we undertook a meta-analysis of randomized controlled trials (RCTs) to valuate the effectiveness, safety, cost-effectiveness and quality of life of perioperative supplementation with pro-/synbiotics. METHODS: We systematically searched PubMed, Embase and the Cochrane Library through October 2015 to identify RCTs that assessed the effects of perioperative supplementation with pro-/synbiotics in surgical patients. The predefined primary efficacy outcome was surgical site infection (SSI). Random-effects model was applied to pool outcome data accounting for clinical heterogeneity. RESULTS: Our meta-analysis included data from 34 trials comprising 2634 participants, of whom 1300 received perioperative pro-/synbiotics intervention and 1334 received valid control treatment. Compared with the control group, patients in the pro-/synbiotics group had a lower risk of SSI (relative risk: 0.65; 95% confidence interval: 0.51, 0.84; P = 0.0007). Trial sequential analysis confirmed the evidence was sufficient and conclusive. Subgroup analyses indicated the findings were consistent in all subgroup analyses except for the probiotics, enteral feeding, pre-/postoperative and live transplantation subgroups. Pro-/synbiotics also reduced the incidence of other infectious complications (including any infection, pneumonia, urinary tract infection, wound infection and sepsis); shortened antibiotic therapy, intensive care unit stay and hospital stay; and promoted earlier first defecation and first bowel movement. Pro-/synbiotics further reduced the incidence of abdominal side effects, lowered hospital costs and improved the Gastro-Intestinal Quality of Life. CONCLUSIONS: For surgical patients, perioperative supplementation with pro-/synbiotics is effective in preventing or controlling SSI and other infectious complications. Perioperative pro-/synbiotics might also be associated with fewer side effects, lower hospital cost and better quality of life. Current evidence indicated that perioperative synbiotics supplementation is preferred and recommended as an adjunct in surgical patients.

Assessment of the synbiotic properites of human milk oligosaccharides and Bifidobacterium longum subsp. infantis in vitro and in humanised mice.

The mode of delivery plays a crucial role in infant gastrointestinal tract colonisation, which in the case of caesarean section is characterised by the presence of clostridia and low bifidobacterial counts. Gut colonisation can be modified by probiotics, prebiotics or synbiotics. Human milk oligosaccharides (HMOs) are infant prebiotics that show a bifidogenic effect. Moreover, genome sequencing of Bifidobacterium longum subsp. infantis within the infant microbiome revealed adaptations for milk utilisation. This study aimed to evaluate the synbiotic effect of B. longum subsp. infantis, HMOs and human milk (HM) both in vitro and in vivo (in a humanised mouse model) in the presence of faecal microbiota from infants born by caesarean section. The combination of B. longum and HMOs or HM reduced the clostridia and G-bacteria counts both in vitro and in vivo. The bifidobacterial population in vitro significantly increased and produce high concentrations of acetate and lactate. In vitro competition assays confirmed that the tested bifidobacterial strain is a potential probiotic for infants and, together with HMOs or HM, acts as a synbiotic. It is also able to inhibit potentially pathogenic bacteria. The synbiotic effects identified in vitro were not observed in vivo. However, there was a significant reduction in clostridia counts in both experimental animal groups (HMOs + B. longum and HM + B. longum), and a specific immune response via increased interleukin (IL)-10 and IL-6 production. Animal models do not perfectly mimic human conditions; however, they are essential for testing the safety of functional foods.