Evaluation of Safety and Beneficial Health Effects of the Human-Milk Strain Bifidobacterium breve DSM32583: An Infant Pilot Trial.

Human milk promotes the growth of bifidobacteria in the infant gut. Adding bifidobacterial species to infant formula may contribute to increasing their presence in the gut of formula-fed infants. Therefore, the safety and anti-infectious effects of Bifidobacterium breve DSM32583, a breast milk isolate, were assessed in a pilot trial involving 3-month-old infants. The infants were randomly assigned to either the probiotic (PG) or the control (CG) groups. All the infants consumed the same formula, although it was supplemented with the strain (1 × 107 cfu/g of formula) in the PG. Overall, 160 infants (80 per group) finished the intervention. Infants in CG gained more weight compared to PG (p < 0.05), but the weights for age Z-scores at 6 months were within the normal distribution for this age group. The rates of infections affecting the gastrointestinal and respiratory tracts and antibiotic therapy were significantly lower in the PG. The bifidobacterial population and the level of short-chain fatty acids were higher (p < 0.05) in the fecal samples of PG infants. No adverse events related to formula consumption were observed. In conclusion, the administration of an infant formula with B. breve DSM32583 was safe and exerted potential beneficial effects on gut health.

Effects of a Novel Infant Formula on the Fecal Microbiota in the First Six Months of Life: The INNOVA 2020 Study.

Exclusive breastfeeding is highly recommended for infants for at least the first six months of life. However, for some mothers, it may be difficult or even impossible to do so. This can lead to disturbances in the gut microbiota, which in turn may be related to a higher incidence of acute infectious diseases. Here, we aimed to evaluate whether a novel starting formula versus a standard formula provides a gut microbiota composition more similar to that of breastfed infants in the first 6 months of life. Two hundred and ten infants (70/group) were enrolled in the study and completed the intervention until 12 months of age. For the intervention period, infants were divided into three groups: Group 1 received formula 1 (INN) with a lower amount of protein, a proportion of casein to whey protein ratio of about 70/30 by increasing the content of α-lactalbumin, and with double the amount of docosahexaenoic acid/arachidonic acid than the standard formula; INN also contained a thermally inactivated postbiotic (Bifidobacterium animalis subsp. lactis). Group 2 received the standard formula (STD) and the third group was exclusively breastfed (BF) for exploratory analysis. During the study, visits were made at 21 days, 2, 4, and 6 months of age, with ±3 days for the visit at 21 days of age, ±1 week for the visit at 2 months, and ±2 weeks for the others. Here, we reveal how consuming the INN formula promotes a similar gut microbiota composition to those infants that were breastfed in terms of richness and diversity, genera, such as Bacteroides, Bifidobacterium, Clostridium, and Lactobacillus, and calprotectin and short-chain fatty acid levels at 21 days, 2 and 6 months. Furthermore, we observed that the major bacteria metabolic pathways were more alike between the INN formula and BF groups compared to the STD formula group. Therefore, we assume that consumption of the novel INN formula might improve gut microbiota composition, promoting a healthier intestinal microbiota more similar to that of an infant who receives exclusively human milk.

Current Progress and Future Perspectives on the Use of Bacillus clausii

Bacillus clausii is a probiotic that benefits human health. Its key characteristics include the ability to form spores; the resulting tolerance to heat, acid, and salt ensures safe passage through the human gastrointestinal tract with no loss of cells. Although B. clausii has been widely used for many decades, the beneficial properties of other probiotics, such as Lactobacillus spp. and Bifidobacterium spp., are better disseminated in the literature. In this review, we summarize the physiological, antimicrobial, and immunomodulatory properties of probiotic B. clausii strains. We also describe findings from studies that have investigated B. clausii probiotics from the perspective of quality and safety. We highlight innovative properties based on biochemical investigations of non-probiotic strains of B. clausii, revealing that B. clausii may have further health benefits in other therapeutic areas.

Status of transition care in inflammatory bowel disease in Spain. Different medical perspectives

Introduction: transition is important for a successful follow-up of adolescents with inflammatory bowel disease (IBD). The objectives of the study were to establish the situation of transition in Spain and to identify needs, requirements and barriers to transition from pediatric and adult gastroenterologist perspectives. Methods: a structured survey for self-completion using the REDCap platform was distributed via the Spanish Society for Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP) and the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU). The questionnaire contained closed and ranked questions concerning transition, perceived needs, organizational, clinician and patient related barriers to transition. Results: one hundred and forty surveys were answered, 53% in pediatrics (PG) and 47% from adult gastroenterologists (AG) among 90 hospitals; 66% of them were reference centers. There was a higher response from pediatricians (18.2%) versus adult gastroenterologists (8.3%) (p = 0.03). A structured transition program is adequate in 42.2% centers. A well-structured transition was perceived as very important by 79.5% of PG and 63% of AG (p = 0.03). A higher proportion of both groups identified inadequacies in the preparation of adolescents for transfer (43% and 38%, p = ns). The main deficit areas were the lack of knowledge about disease and treatment as well as the lack of self-advocacy and care coordination. Lack of resources, time and critical mass of patients were the highest ranked barriers by both groups. AG and PG (54% and 55%) highlighted suboptimal training in adolescent medicine. Conclusions: in Spain, nearly half of the centers have developed a structured transition program. Lack of training, time and insufficient resources are the main barriers for a successful transition

No disponible

Status of transition care in inflammatory bowel disease in Spain. Different medical perspectives.

INTRODUCTION: transition is important for a successful follow-up of adolescents with inflammatory bowel disease (IBD). The objectives of the study were to establish the situation of transition in Spain and to identify needs, requirements and barriers to transition from pediatric and adult gastroenterologist perspectives. METHODS: a structured survey for self-completion using the REDCap platform was distributed via the Spanish Society for Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP) and the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU). The questionnaire contained closed and ranked questions concerning transition, perceived needs, organizational, clinician and patient related barriers to transition. RESULTS: one hundred and forty surveys were answered, 53% in pediatrics (PG) and 47% from adult gastroenterologists (AG) among 90 hospitals; 66% of them were reference centers. There was a higher response from pediatricians (18.2%) versus adult gastroenterologists (8.3%) (p = 0.03). A structured transition program is adequate in 42.2% centers. A well-structured transition was perceived as very important by 79.5% of PG and 63% of AG (p = 0.03). A higher proportion of both groups identified inadequacies in the preparation of adolescents for transfer (43% and 38%, p = ns). The main deficit areas were the lack of knowledge about disease and treatment as well as the lack of self-advocacy and care coordination. Lack of resources, time and critical mass of patients were the highest ranked barriers by both groups. AG and PG (54% and 55%) highlighted suboptimal training in adolescent medicine. CONCLUSIONS: in Spain, nearly half of the centers have developed a structured transition program. Lack of training, time and insufficient resources are the main barriers for a successful transition.

[Diet and microbiota. Impact on health]. / Dieta y microbiota. Impacto en la salud.

months of life, reaching the state of mature microbiota when the child is around two years old. Even so, diet, lifestyle, antibiotic consumption or the aging process will determine changes in its composition and, as a consequence, the possibility of suffering chronic non-communicable diseases. Currently, there is sufficient scientific evidence to strengthen the importance of diet for the establishment, structure and functional activity of the gut microbiota, as well as many studies that demonstrate the role of diet in certain diseases through its effects on microbial communities of the gut. Modulation of the gut microbiota through dietary intervention is an emerging therapeutic and preventive strategy for many conditions. Probiotics and prebiotics may also be effective for restoration of beneficial bacteria and microbiota diversity capable to shift from disease to health promoting states.

La microbiota autóctona es esencial para los seres vivos, incluso desde antes del nacimiento. Diversos factores pueden intervenir en su adecuado desarrollo, sobre todo en los primeros meses de vida, hasta alcanzar el estado de microbiota madura al final del segundo año de vida. Aún así, la dieta, el estilo de vida, el consumo de antibióticos o el proceso de envejecimiento van a determinar cambios en su composición y, como consecuencia, la posibilidad de padecer enfermedades crónicas no transmisibles.En la actualidad, hay suficiente evidencia científica que refuerza la importancia de la dieta para el establecimiento, la estructura y la actividad funcional de la microbiota intestinal, así como estudios que demuestran el papel de la dieta en determinadas enfermedades a través de sus efectos sobre las comunidades microbianas del intestino.La modulación de la microbiota intestinal a través de la intervención dietética se ha convertido en una estrategia terapéutica y preventiva emergente para muchas enfermedades. Los probióticos y los prebióticos también serían efectivos para restablecer la diversidad de las bacterias beneficiosas y contribuir a una microbiota con capacidad de pasar de estados de enfermedad a situaciones más saludables.

Dieta y microbiota. Impacto en la salud / Diet and microbiota. Impact on health

La microbiota autóctona es esencial para los seres vivos, incluso desde antes del nacimiento. Diversos factores pueden intervenir en su adecuado desarrollo, sobre todo en los primeros meses de vida, hasta alcanzar el estado de microbiota madura al final del segundo año de vida. Aún así, la dieta, el estilo de vida, el consumo de antibióticos o el proceso de envejecimiento van a determinar cambios en su composición y, como consecuencia, la posibilidad de padecer enfermedades crónicas no transmisibles. En la actualidad, hay suficiente evidencia científica que refuerza la importancia de la dieta para el establecimiento, la estructura y la actividad funcional de la microbiota intestinal, así como estudios que demuestran el papel de la dieta en determinadas enfermedades a través de sus efectos sobre las comunidades microbianas del intestino. La modulación de la microbiota intestinal a través de la intervención dietética se ha convertido en una estrategia terapéutica y preventiva emergente para muchas enfermedades. Los probióticos y los prebióticos también serían efectivos para restablecer la diversidad de las bacterias beneficiosas y contribuir a una microbiota con capacidad de pasar de estados de enfermedad a situaciones más saludables

The autochthonous microbiota is essential for life even before birth. Diverse factors can influence the microbiota development, especially in the first months of life, reaching the state of mature microbiota when the child is around two years old. Even so, diet, lifestyle, antibiotic consumption or the aging process will determine changes in its composition and, as a consequence, the possibility of suffering chronic non-communicable diseases. Currently, there is sufficient scientific evidence to strengthen the importance of diet for the establishment, structure and functional activity of the gut microbiota, as well as many studies that demonstrate the role of diet in certain diseases through its effects on microbial communities of the gut. Modulation of the gut microbiota through dietary intervention is an emerging therapeutic and preventive strategy for many conditions. Probiotics and prebiotics may also be effective for restoration of beneficial bacteria and microbiota diversity capable to shift from disease to health promoting states

Dual-coated lactic acid bacteria: an emerging innovative technology in the field of probiotics.

Probiotics are living micro-organisms that do not naturally have shelf life, and normally are weakly protected against the digestive action of the GI tract. A new dual coating technology has been developed in an effort to maximize survival, that is, to be able to reach the intestine alive and in sufficient numbers to confer the beneficial health effects on the host. Dual-coating of lactic acid bacteria (LAB) is the result of fourth-generation coating technology for the protection of these bacteria at least 100-fold or greater than the uncoated LAB. This innovative technique involves a first pH-dependent protein layer that protects bacteria from gastric acid and bile salt, and a second polysaccharide matrix that protects bacteria from external factors, such as humidity, temperature and pressure, as well as the digestive action during the passage through the GI tract. Dual-coated probiotic formulation is applicable to different therapeutic areas, including irritable bowel syndrome, atopic dermatitis, acute diarrhea, chronic constipation, Helicobacter pylori eradication, and prevention of antibiotic-associated diarrhea. An updated review of the efficacy of doubly coated probiotic strains for improving bacterial survival in the intestinal tract and its consequent clinical benefits in humans is here presented.

[Microbiota in women; clinical applications of probiotics]. / LA MICROBIOTA EN LA MUJER; APLICACIONES CLÍNICAS DE LOS PROBIÓTICOS.

The main function of vaginal microbiota is to protect the mucosa against the colonization and growth of pathogenic microorganisms. This microbiota is modified by hormonal activity. Its maximum concentration and effectiveness occurs during the fertile period, where there is a predominance of lactobacilli. When it is reduced (microbiota dysbiosis) leads to bacterial vaginosis and candida vaginitis which are common diseases in women. Consequently, instillation of lactobacilli in the vagina has beneficial effects on the symptomatology and prognosis of these illnesses. Breast milk is one of the key factors in the development of gut microbiota of the infant. There is an enteric-breast circulation, which is higher at the end of pregnancy and during breastfeeding. This circulation could explain the modulation of the breast microbiota by using probiotics. It could have a positive impact not only for the health of the mother, who would reduce the incidence of mastitis, but also for their infant. The use of probiotics is a hopeful alternative in various gynecological pathologies. However, it's is necessary first some well-designed, randomized trials with standardized methods and with a significant number of patients in order to confirm its benefits and allow us its use in protocols.

La microbiota vaginal tiene como función principal la de proteger la mucosa frente a la colonización y proliferación de microorganismos patógenos. Dicha microbiota cambia con la actividad hormonal, siendo máxima su concentración y efectos durante el periodo fértil, durante el cual existe una predominancia de los lactobacilos. Su disminución (disbiosis) conduce a la aparición de vaginosis bacteriana y vaginitis candidiásica, dos patologías muy frecuentes. Por ello, la instilación de lactobacilos en la cavidad vaginal tiene efectos beneficiosos sobre la sintomatología y pronóstico de estas infecciones. La leche humana es uno de los factores clave en el desarrollo de la microbiota intestinal del lactante. La posible existencia de una circulación enteromamaria, que se intensifica al final del embarazo y durante la lactancia, abre la interesante posibilidad de modular la microbiota mamaria mediante la ingestión de probióticos, lo que puede tener un impacto favorable no solo para la salud de la madre, con la reducción de la incidencia de mastitis, sino también para la de su hijo. El empleo de probióticos representa una alternativa prometedora en diversas patologías ginecológicas, aunque son necesarios ensayos clínicos aleatorizados, bien diseñados, con metodologías estandarizadas y con un número suficiente de pacientes, que nos permitan confirmar las ventajas asociadas a su uso y perfeccionar los protocolos de utilización.

La microbiota en la mujer; aplicaciones clínicas de los probióticos / Microbiota in women; clinical applications of probiotics

La microbiota vaginal tiene como función principal la de proteger la mucosa frente a la colonización y proliferación de microorganismos patógenos. Dicha microbiota cambia con la actividad hormonal, siendo máxima su concentración y efectos durante el periodo fértil, durante el cual existe una predominancia de los lactobacilos. Su disminución (disbiosis) conduce a la aparición de vaginosis bacteriana y vaginitis candidiásica, dos patologías muy frecuentes. Por ello, la instilación de lactobacilos en la cavidad vaginal tiene efectos beneficiosos sobre la sintomatología y pronóstico de estas infecciones. La leche humana es uno de los factores clave en el desarrollo de la microbiota intestinal del lactante. La posible existencia de una circulación enteromamaria, que se intensifica al final del embarazo y durante la lactancia, abre la interesante posibilidad de modular la microbiota mamaria mediante la ingestión de probióticos, lo que puede tener un impacto favorable no solo para la salud de la madre, con la reducción de la incidencia de mastitis, sino también para la de su hijo. El empleo de probióticos representa una alternativa prometedora en diversas patologías ginecológicas, aunque son necesarios ensayos clínicos aleatorizados, bien diseñados, con metodologías estandarizadas y con un número suficiente de pacientes, que nos permitan confirmar las ventajas asociadas a su uso y perfeccionar los protocolos de utilización (AU)

The main function of vaginal microbiota is to protect the mucosa against the colonization and growth of pathogenic microorganisms. This microbiota is modified by hormonal activity. Its maximum concentration and effectiveness occurs during the fertile period, where there is a predominance of lactobacilli. When it is reduced (microbiota dysbiosis) leads to bacterial vaginosis and candida vaginitis which are common diseases in women. Consequently, instillation of lactobacilli in the vagina has beneficial effects on the symptomatology and prognosis of these illnesses. Breast milk is one of the key factors in the development of gut microbiota of the infant. There is an enteric-breast circulation, which is higher at the end of pregnancy and during breastfeeding. This circulation could explain the modulation of the breast microbiota by using probiotics. It could have a positive impact not only for the health of the mother, who would reduce the incidence of mastitis, but also for their infant. The use of probiotics is a hopeful alternative in various gynecological pathologies. However, it’s is necessary first some well-designed, randomized trials with standardized methods and with a significant number of patients in order to confirm its benefits and allow us its use in protocols (AU)

[Use of probiotics and prebiotics in primary care]. / Empleo de probióticos y prebióticos en atención primaria.

Probiotics are used in a great number of both paediatric and adult diseases, mainly in gastrointestinal disorders, like diarrhoea. Nevertheless, their beneficial effect on immune alterations, such as atopic dermatitis and, more recently, in women related diseases such as vulvovaginitis and mastitis have also been observed. However, the use of probiotics is not completely implemented into the routine clinical practice for primary care physicians. There is still a great controversy with scarce scientific evidence, due to the diversity in the designs thereof which justifies the variability in the efficacy results. This outcome leads to difficulties in developing definitive treatment guidelines although there are exceptions, for example, WGO. The aim of this workshop, held at the VI Congress of the Spanish Society of Probiotics and Prebiotics is the training of primary care physicians, both paediatricians and general practitioners in the clinical applications of these nutritional preparations in different diseases: acute diarrhoea; antibiotic associated diarrhoea, necrotizing enterocolitis, employment in infant milk formulas, infant colic, irritable bowel syndrome and inflammatory bowel disease, as well as vulvovaginitis and mastitis.

Los probióticos se utilizan en gran número de patologías tanto pediátricas como en el adulto, principalmente en problemas gastrointestinales como la diarrea aunque también se ha valorado su efecto beneficioso en alteraciones inmunológicas como la dermatitis atópica y, en los últimos años, en diferentes patologías de la mujer como las vulvovaginitis y las mastitis. Sin embargo, el empleo de probióticos no está del todo incorporado a la práctica clínica habitual por los médicos de Atención Primaria debido en parte a los resultados poco concluyentes de la mayoría de los estudios, y por otro lado a la gran diversidad en el diseño de los mismos, lo que justifica la variabilidad en los resultados de su eficacia. Esto trae consigo una importante dificultad para desarrollar guías definitivas de tratamiento, aunque hay excepciones como, por ejemplo, la de la WGO. El objetivo del presente taller, impartido en el VI Workshop de la Sociedad Española de Probióticos y Prebióticos es formar a los médicos de Atención Primaria, tanto pediatras como generalistas, en las aplicaciones clínicas de estos preparados nutricionales en diversas patologías: diarrea aguda y diarrea asociada a antibióticos, enterocolitis necrotizante, empleo en fórmulas lácteas infantiles, cólico del lactante, síndrome de intestino irritable, enfermedad inflamatoria intestinal, vulvovaginitis y mastitis.

[Probiotics for the treatment of infant colic: a clinical case]. / Probioticoterapia en el cólico del lactante: caso clínico.

Infant colic is a prevalent physiological event of healthy children under 3 months of age which can disrupt the child's home environment. Despite its benign natural history, sometimes requires a therapeutic approach. Numerous therapeutical lines have been proposed although its pathogenesis remains unknown and multifactorial. The gut microbiota plays an important role in the infant colic. Several studies have shown less bifidobacteria and lactobacilli in infant colic meanwhile Escherichia, Klebsiella, Serratia, Vibrio, Yersinia and Pseudomonas are more prominent in colon. The probiotic strain L. reuteri DSM 17938, when administered once daily to 108 cfu / day, seems to have the most scientific evidence up to date in the treatment of infant colic, without significant side effects.

El cólico del lactante es un evento fisiológico prevalente en niños sanos menores de 3 meses capaz de perturbar el entorno familiar. A pesar de su naturaleza benigna y autorresolutiva, en algunas ocasiones, requiere un abordaje terapéutico. Se han propuesto numerosas líneas terapéuticas aunque su etiopatogenia sigue siendo desconocida y multifactorial. La microbiota intestinal tiene un papel importante en el cólico. Varios estudios muestran que los lactantes con cólicos tienen menos bifidobacterias y lactobacilos y más Escherichia, Klebsiella, Serratia, Vibrio, Yersinia y Pseudomonas en el colon. La cepa probiótica L. reuteri DSM 17938 administrada una vez al día a 108 ufc/día es la que más evidencia científica tiene hasta el momento en el tratamiento del cólico del lactante, sin observarse efectos secundarios.

Empleo de probióticos y prebióticos en atención primaria / Use of probiotics and prebiotics in primary care

Los probióticos se utilizan en gran número de patologías tanto pediátricas como en el adulto, principalmente en problemas gastrointestinales como la diarrea aunque también se ha valorado su efecto beneficioso en alteraciones inmunológicas como la dermatitis atópica y, en los últimos años, en diferentes patologías de la mujer como las vulvovaginitis y las mastitis. Sin embargo, el empleo de probióticos no está del todo incorporado a la práctica clínica habitual por los médicos de Atención Primaria debido en parte a los resultados poco concluyentes de la mayoría de los estudios, y por otro lado a la gran diversidad en el diseño de los mismos, lo que justifica la variabilidad en los resultados de su eficacia. Esto trae consigo una importante dificultad para desarrollar guías definitivas de tratamiento, aunque hay excepciones como, por ejemplo, la de la WGO. El objetivo del presente taller, impartido en el VI Workshop de la Sociedad Española de Probióticos y Prebióticos es formar a los médicos de Atención Primaria, tanto pediatras como generalistas, en las aplicaciones clínicas de estos preparados nutricionales en diversas patologías: diarrea aguda y diarrea asociada a antibióticos, enterocolitis necrotizante, empleo en fórmulas lácteas infantiles, cólico del lactante, síndrome de intestino irritable, enfermedad inflamatoria intestinal, vulvovaginitis y mastitis (AU)

Probiotics are used in a great number of both paediatric and adult diseases, mainly in gastrointestinal disorders, like diarrhoea. Nevertheless, their beneficial effect on immune alterations, such as atopic dermatitis and, more recently, in women related diseases such as vulvovaginitis and mastitis have also been observed. However, the use of probiotics is not completely implemented into the routine clinical practice for primary care physicians. There is still a great controversy with scarce scientific evidence, due to the diversity in the designs thereof which justifies the variability in the efficacy results. This outcome leads to difficulties in developing definitive treatment guidelines although there are exceptions, for example, WGO. The aim of this workshop, held at the VI Congress of the Spanish Society of Probiotics and Prebiotics is the training of primary care physicians, both paediatricians and general practitioners in the clinical applications of these nutritional preparations in different diseases: acute diarrhoea; antibiotic associated diarrhoea, necrotizing enterocolitis, employment in infant milk formulas, infant colic, irritable bowel syndrome and inflammatory bowel disease, as well as vulvovaginitis and mastitis (AU)

Probioticoterapia en el cólico del lactante: caso clínico / Probiotics for the treatment of infant colic: a clinical case

El cólico del lactante es un evento fisiológico prevalente en niños sanos menores de 3 meses capaz de perturbar el entorno familiar. A pesar de su naturaleza benigna y autorresolutiva, en algunas ocasiones, requiere un abordaje terapéutico. Se han propuesto numerosas líneas terapéuticas aunque su etiopatogenia sigue siendo desconocida y multifactorial. La microbiota intestinal tiene un papel importante en el cólico. Varios estudios muestran que los lactantes con cólicos tienen menos bifidobacterias y lactobacilos y más Escherichia, Klebsiella, Serratia, Vibrio, Yersinia y Pseudomonas en el colon. La cepa probiótica L. reuteri DSM 17938 administrada una vez al día a 108 ufc/día es la que más evidencia científica tiene hasta el momento en el tratamiento del cólico del lactante, sin observarse efectos secundarios (AU)

Infant colic is a prevalent physiological event of healthy children under 3 months of age which can disrupt the child’s home environment. Despite its benign natural history, sometimes requires a therapeutic approach. Numerous therapeutical lines have been proposed although its pathogenesis remains unknown and multifactorial. The gut microbiota plays an important role in the infant colic. Several studies have shown less bifidobacteria and lactobacilli in infant colic meanwhile Escherichia, Klebsiella, Serratia, Vibrio, Yersinia and Pseudomonas are more prominent in colon. The probiotic strain L. reuteri DSM 17938, when administered once daily to 108 cfu / day, seems to have the most scientific evidence up to date in the treatment of infant colic, without significant side effects (AU)

[Clinical applications of the use of probiotics in pediatrics]. / Aplicaciones clínicas del empleo de probióticos en pediatría.

INTRODUCTION: The use of probiotics supposes a novel advance in the field of Pediatrics since they can be useful in the prevention and treatment of many gastrointestinal pathologies, constituting one more element in our therapeutic arsenal. OBJECTIVE: This article presents an updated review of the scientific literature on the use of probiotics in paediatrics, mainly in gastrointestinal problems with alteration in the intestinal microbiota describing the main applications of the use of probiotics and prebiotics in childhood and reviewing the future lines of research. RESULTS AND CONCLUSIONS: Although there enough scientific evidence in various pathologies, the use of probiotics is not entirely incorporated into the clinical practice of pediatricians. It is used in the context of the gastrointestinal diseases (acute infectious diarrhea, diarrhea associated with antibiotics, bacterial overcast) and, more recently, in chronic inflammatory processes such as inflammatory bowel disease or functional disorders as colic infant or constipation. Also have been assessed their beneficial effect in extraintestinal alterations, such as the allergies (atopic dermatitis) or the effects on respiratory or urogenital mucosae and, in recent years, in the prevention of pathology of the preterm newborn and in the H. pylori infection. In addition there are several lines of research open in nutritional supplementation with probiotics. and prebiotics. Each strain probiotics should be studied individually and extensively to determine its efficacy and safety in all situations in which their employment may be advisable.

Introducción: El empleo de probióticos supone un novedoso avance en el campo de la Pediatría puesto que pueden ser útiles en la prevención y tratamiento de múltiples patologías gastrointestinales, constituyendo un elemento más en nuestro arsenal terapéutico. Objetivo: En este artículo se presenta una revisión actualizada de la literatura científica sobre el uso de los probióticos en Pediatría, principalmente en problemas gastrointestinales con alteración en la microbiota intestinal describiéndose las principales aplicaciones del empleo de los probióticos y prebióticos en la infancia y repasando las líneas de investigación futuras. Resultados y conclusiones: A pesar de existir suficiente evidencia científica en varias patologías, la utilización de probióticos no está del todo incorporado a la práctica clínica habitual de los pediatras. Se emplea en el contexto de las enfermedades gastrointestinales (diarrea aguda infecciosa, la diarrea asociada a antibióticos, sobredesarrollo bacteriano) y, más recientemente, en procesos inflamatorios crónicos como la enfermedad inflamatoria intestinal o en trastornos funcionales como el cólico del lactante o el estreñimiento. También se ha valorado su efecto beneficioso en alteraciones extraintestinales, tales como la alergia (dermatitis atópica) o los efectos sobre las mucosas respiratorias o urogenitales y, en los últimos años, en la prevención de patología del recién nacido pretérmino y en la infección por H. pylori. Además existen varias líneas de investigación abiertas en la suplementación alimentaria con probióticos y prebióticos. Cada cepa prebiótica debe ser estudiada individualmente y extensamente para determinar su eficacia y seguridad en todas aquellas situaciones en que su empleo puede ser aconsejable.

Aplicaciones clínicas del empleo de probióticos en pediatría / Clinical applications of the use of probiotics in pediatrics

Introducción: El empleo de probióticos supone un novedoso avance en el campo de la Pediatría puesto que pueden ser útiles en la prevención y tratamiento de múltiples patologías gastrointestinales, constituyendo un elemento más en nuestro arsenal terapéutico. Objetivo: En este artículo se presenta una revisión actualizada de la literatura científica sobre el uso de los probióticos en Pediatría, principalmente en problemas gastrointestinales con alteración en la microbiota intestinal describiéndose las principales aplicaciones del empleo de los probióticos y prebióticos en la infancia y repasando las líneas de investigación futuras. Resultados y conclusiones: A pesar de existir suficiente evidencia científica en varias patologías, la utilización de probióticos no está del todo incorporado a la práctica clínica habitual de los pediatras. Se emplea en el contexto de las enfermedades gastrointestinales (diarrea aguda infecciosa, la diarrea asociada a antibióticos, sobredesarrollo bacteriano) y, más recientemente, en procesos inflamatorios crónicos como la enfermedad inflamatoria intestinal o en trastornos funcionales como el cólico del lactante o el estreñimiento. También se ha valorado su efecto beneficioso en alteraciones extraintestinales, tales como la alergia (dermatitis atópica) o los efectos sobre las mucosas respiratorias o urogenitales y, en los últimos años, en la prevención de patología del recién nacido pretérmino y en la infección por H. pylori. Además existen varias líneas de investigación abiertas en la suplementación alimentaria con probióticos y prebióticos. Cada cepa prebiótica debe ser estudiada individualmente y extensamente para determinar su eficacia y seguridad en todas aquellas situaciones en que su empleo puede ser aconsejable (AU)

INTRODUCTION: The use of probiotics supposes a novel advance in the field of Pediatrics since they can be useful in the prevention and treatment of many gastrointestinal pathologies, constituting one more element in our therapeutic arsenal. OBJECTIVE: This article presents an updated review of the scientific literature on the use of probiotics in paediatrics, mainly in gastrointestinal problems with alteration in the intestinal microbiota describing the main applications of the use of probiotics and prebiotics in childhood and reviewing the future lines of research. RESULTS AND CONCLUSIONS: Although there enough scientific evidence in various pathologies, the use of probiotics is not entirely incorporated into the clinical practice of pediatricians. It is used in the context of the gastrointestinal diseases (acute infectious diarrhea, diarrhea associated with antibiotics, bacterial overcast) and, more recently, in chronic inflammatory processes such as inflammatory bowel disease or functional disorders as colic infant or constipation. Also have been assessed their beneficial effect in extraintestinal alterations, such as the allergies (atopic dermatitis) or the effects on respiratory or urogenital mucosae and, in recent years, in the prevention of pathology of the preterm newborn and in the H. pylori infection. In addition there are several lines of research open in nutritional supplementation with probiotics. and prebiotics. Each strain probiotics should be studied individually and extensively to determine its efficacy and safety in all situations in which their employment may be advisable (AU)

Breath test using a single 50-mg dose of 13C-urea to detect Helicobacter pylori infection in children.

BACKGROUND: The 13C-urea breath test is an accurate, noninvasive method for the diagnosis of in adults. A dose of 75 to 100 mg of urea is generally used, especially in adults, but the optimal dose in children is still unknown. Our aim was to determine whether urea breath test performed with a single 50-mg dose of 13C-urea was sufficient and accurate for diagnosing infection in children. METHODS: Consecutive children 4 to 14 years of age undergoing upper intestinal endoscopy to evaluate symptoms of recurrent abdominal pain were prospectively included. Exclusion criteria included use of antibiotics or proton pump inhibitors during the last month, gastric surgery, and previous eradication therapy. Reference criteria for diagnosis of infection were based on histology, culture, and serology. Urea breath test (TAU-KIT; Isomed, S.L., Madrid, Spain) was performed as follows: citric acid (Citral pylori) dissolved in 100 mL of water was initially given. Ten minutes later, a baseline exhaled breath sample was collected, and thereafter 50 mg of 13C-urea dissolved in 50 mL of water was given. A second breath sample was obtained 30 minutes later. Breath samples were analyzed by isotope ratio mass spectrometry. The endoscopist, the pathologist, the microbiologist, and the person responsible for reading the serology and the urea breath test were all unaware of status by the other diagnostic methods. RESULTS: One hundred children were included (40% males; mean age, 9.2 +/- 2 years; mean weight, 33.9 +/- 12 kg). Based on the reference criteria, 45% were infected, 37% were not infected, and 18% were indeterminate. Sensitivity, specificity, positive predictive value, and negative predictive value were, respectively, 91% (95% confidence interval [CI], 79%-96%), 97% (95% CI, 86%-99%), 98% (95% CI, 87%-91%), and 90% (95% CI, 76%-96%). Positive and negative likelihood ratios were of 33 and 0.09. Any cutoff point between 2 and 14 delta units had the same high diagnostic accuracy. The area under the receiver operating characteristic curve was 0.94. No adverse effects were reported. CONCLUSION: Urea breath test using 50 mg of urea is sufficient and accurate for the diagnosis of infection in children. Use of a small test dose significantly lowers the cost of the test.