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1.
Medicine (Baltimore) ; 99(45): e23045, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157958

RESUMO

BACKGROUND: Probiotics, prebiotics and synbiotics have been widely used in the treatment of respiratory diseases, but their clinical efficacy for treating chronic bronchitis (CB) or chronic obstructive pulmonary disease (COPD) has not been well studied. METHODS: The following electronic databases will be searched for eligible randomized controlled trials: the Cochrane Library, EMBASE, MEDLINE, PubMed, Scopus, the Web of Science, the China National Knowledge Infrastructure, the Wanfang database, and the China Science and Technology Journal database (VIP Information Network). We will search these electronic databases weekly and extract relevant data from their inception dates until September 30, 2020. Risk of publication bias will be evaluated by the Cochrane Handbook for Systematic Reviews of Interventions. Data synthesis will be conducted using Review Manager (RevMan) version 5.3 software. Sensitivity and quality of evidence analyses will be conducted. RESULTS: This systematic review and meta-analysis will provide a high-quality synthesis from existing evidence for estimating the efficacy and safety of probiotics, prebiotics and synbiotics in the treatment of CB or COPD. CONCLUSION: This systematic review and meta-analysis will provide reliable and accurate evidence to guide the use of probiotics, prebiotics and synbiotics in the treatment of CB or COPD. REGISTRATION OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/SP35M.


Assuntos
Bronquite Crônica/terapia , Prebióticos/efeitos adversos , Probióticos/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/terapia , Simbióticos/efeitos adversos , Feminino , Humanos , Masculino , Probióticos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Resultado do Tratamento
2.
Rev Med Suisse ; 16(710): 1916-1919, 2020 Oct 14.
Artigo em Francês | MEDLINE | ID: mdl-33058577

RESUMO

Probiotics are a big food and pharmaceutical industry today. The most widely used probiotics are Lactobacillus spp, Bifidobacterium spp, strains of Enterococcus spp, Streptococcus spp and yeasts such as Saccharomyces pp. Among the best-known indications are Clostridioides difficile colitis and diarrhea due to antibiotics, but probiotics are also proposed as adjuvants for atopic syndromes, autoimmune diseases, prevention and treatment of obesity, diabetes and cystic fibrosis, where dysbiosis play an important role. However, their use remains debated due to a lack of powerful data proving their effectiveness and their often-overlooked side effects.


Assuntos
Probióticos/efeitos adversos , Probióticos/uso terapêutico , Antibacterianos/efeitos adversos , Diarreia/microbiologia , Diarreia/terapia , Disbiose/microbiologia , Disbiose/terapia , Humanos
3.
Medicina (Kaunas) ; 56(9)2020 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-32867260

RESUMO

The positive impact of probiotic strains on human health has become more evident than ever before. Often delivered through food, dietary products, supplements, and drugs, different legislations for safety and efficacy issues have been prepared. Furthermore, regulatory agencies have addressed various approaches toward these products, whether they authorize claims mentioning a disease's diagnosis, prevention, or treatment. Due to the diversity of bacteria and yeast strains, strict approaches have been designed to assess for side effects and post-market surveillance. One of the most essential delivery systems of probiotics is within food, due to the great beneficial health effects of this system compared to pharmaceutical products and also due to the increasing importance of food and nutrition. Modern lifestyle or various diseases lead to an imbalance of the intestinal flora. Nonetheless, as the amount of probiotic use needs accurate calculations, different factors should also be taken into consideration. One of the novelties of this review is the presentation of the beneficial effects of the administration of probiotics as a potential adjuvant therapy in COVID-19. Thus, this paper provides an integrative overview of different aspects of probiotics, from human health care applications to safety, quality, and control.


Assuntos
Infecções por Coronavirus/prevenção & controle , Suplementos Nutricionais/normas , Gastroenteropatias/terapia , Hepatopatias/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Probióticos/uso terapêutico , Betacoronavirus , Doença Celíaca/terapia , Infecções por Clostridium/terapia , Constipação Intestinal/terapia , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/terapia , Transtorno Depressivo/terapia , Doenças Diverticulares/terapia , Disenteria/terapia , Enterocolite Necrosante/terapia , Alimentos e Bebidas Fermentados , Hipersensibilidade Alimentar/terapia , Infecções por Helicobacter/terapia , Encefalopatia Hepática/terapia , Humanos , Doenças Inflamatórias Intestinais/terapia , Hepatopatia Gordurosa não Alcoólica/terapia , Pneumonia Viral/terapia , Probióticos/efeitos adversos , Probióticos/normas , Controle de Qualidade
4.
PLoS One ; 15(7): e0235873, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687505

RESUMO

This study evaluates whole-genome sequence of Lactobacillus reuteri PNW1 and identifies its safety genes that may qualify it as a putative probiotic. It further extracted the bacteriocin produced by the strain and tested its effectiveness against pathogenic STEC E. coli O177. The genomic DNA was sequenced on illuminal Miseq instrument and the sequenced data was assessed for quality reads before assembled with SPAdes. The draft assembly was annotated with Prokaryotic Genome Annotation Pipeline (PGAP) and Rapid Annotations using Subsystems Technology (RAST). Further downstream analyses were carried out using appropriate bioinformatic tools. Production of biogenic amines was biochemically confirmed through HPLC analysis. The assembled genome was 2,430,215 bp long in 420 contigs with 39% G+C content. Among all known genes, putatively responsible for the production of toxic biochemicals, only arginine deiminase (EC3.5.3.6) was spotted. Coding sequences (CDS) putative for D-lactate dehydrogenase (EC1.1.1.28), L-lactate dehydrogenase (EC1.1.1.27) and bacteriocin helveticin J were found within the genome together with plethora of other probiotic important genes. The strain harbours only resistant genes putative for Lincosamide (lnuC) and Tetracycline resistant genes (tetW). There was no hit found for virulence factors and probability of the strain being a human pathogen was zero. Two intact prophage regions were detected within the genome of L. reuteri PNW1 and nine CDS were identified for insertion sequence by OASIS which are belong to seven different families. Five putative CDS were identified for the CRISPR, each associated with Cas genes. Maximum zone of inhibition exhibited by the bacteriocin produced L. reuteri PNW1 is 20.0±1.00 mm (crude) and 23.3±1.15 mm (at 0.25 mg/ml) after being partially purified. With the strain predicted as non-human pathogen, coupled with many other identified desired features, L. reuteri PNW1 stands a chance of making good and safe candidates for probiotic, though further in-vivo investigations are still necessary.


Assuntos
Genoma Bacteriano , Lactobacillus reuteri/genética , Probióticos/efeitos adversos , Proteínas de Bactérias/genética , Bacteriocinas/genética , Bacteriocinas/metabolismo , Bacteriocinas/farmacologia , Escherichia coli/efeitos dos fármacos , Hidrolases/genética , L-Lactato Desidrogenase/genética , Lactobacillus reuteri/patogenicidade , Anotação de Sequência Molecular , Fatores de Virulência/genética
5.
Cochrane Database Syst Rev ; 7: CD006634, 2020 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-32678465

RESUMO

BACKGROUND: Crohn's disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract, in which the pathogenesis is believed to be partly influenced by the gut microbiome. Probiotics can be used to manipulate the microbiome and have therefore been considered as a potential therapy for CD. There is some evidence that probiotics benefit other gastrointestinal conditions, such as irritable bowel syndrome and ulcerative colitis, but their efficacy in CD is unclear. This is the first update of a Cochrane Review previously published in 2008. OBJECTIVES: To assess the efficacy and safety of probiotics for the induction of remission in CD. SEARCH METHODS: The following electronic databases were searched: MEDLINE (from inception to 6 July 2020), Embase (from inception to 6 July 2020), the Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane IBD Review Group Specialised Trials Register, World Health Organization (WHO) International Clinical Trials Registry, and ClinicalTrials.gov. SELECTION CRITERIA: Randomised controlled trials (RCTs) that compared probiotics with placebo or any other non-probiotic intervention for the induction of remission in CD were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed the methodological quality of included studies. The primary outcome was clinical remission. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for dichotomous outcomes. MAIN RESULTS: There were two studies that met criteria for inclusion. One study from Germany had 11 adult participants with mild-to-moderate CD, who were treated with a one-week course of corticosteroids and antibiotics (ciprofloxacin 500 mg twice daily and metronidazole 250 mg three times a day), followed by randomised assignment to Lactobacillus rhamnosus strain GG (two billion colony-forming units per day) or corn starch placebo. The other study from the United Kingdom (UK) had 35 adult participants with active CD (CDAI score of 150 to 450) randomised to receive a synbiotic treatment (comprised of freeze-dried Bifidobacterium longum and a commercial product) or placebo. The overall risk of bias was low in one study, whereas the other study had unclear risk of bias in relation to random sequence generation, allocation concealment, and blinding. There was no evidence of a difference between the use of probiotics and placebo for the induction of remission in CD (RR 1.06; 95% CI 0.65 to 1.71; 2 studies, 46 participants) after six months. There was no difference in adverse events between probiotics and placebo (RR 2.55; 95% CI 0.11 to 58.60; 2 studies, 46 participants). The evidence for both outcomes was of very low certainty due to risk of bias and imprecision. AUTHORS' CONCLUSIONS: The available evidence is very uncertain about the efficacy or safety of probiotics, when compared with placebo, for induction of remission in Crohn's disease. There is a lack of well-designed RCTs in this area and further research is needed.


Assuntos
Doença de Crohn/terapia , Probióticos/uso terapêutico , Adulto , Antibacterianos/uso terapêutico , Bifidobacterium longum , Ciprofloxacino/uso terapêutico , Doença de Crohn/microbiologia , Microbioma Gastrointestinal , Humanos , Lactobacillus rhamnosus , Metronidazol/uso terapêutico , Placebos/efeitos adversos , Probióticos/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Indução de Remissão
7.
Lett Appl Microbiol ; 71(4): 400-404, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32687604

RESUMO

The objective was to carry out cytotoxicity assays in Vero cells and cytokines analyses in Balb/c mice as safety assessments to evaluate the probiotic mixture (M) Saccharomyces cerevisiae RC016 (Sc) and Lactobacillus rhamnosus RC007 (Lr) for use as feed additive. Vero cells (104 cells per well) were exposed to Sc (2·08 × 107 , 2·08 × 106 ; 2·08 × 105 cells per ml), Lr (8·33 × 107 ; 8·33 × 106 ; 8·33 × 105 cells per ml) and their M (1 : 1). Sc concentrations did not affect the Vero cells viability; in contrast, they were lower when exposed to Lr (P Ë‚ 0·0001). Vero cells showed increasing viability with M decreasing concentrations (91% viability with M2). Control BALB/c mice received only phosphate buffer saline and the others received the M. The IL-10, IL-6 and TNFα concentrations from intestinal fluid were analysed and no significant differences were observed among treatments. The same occurred with the ratio between IL-10/TNF-α. Beneficial effects of probiotics are associated with the regulation of the excessive inflammatory response; it is desirable they can modulate the cytokines production only under pathological conditions. Here, M administration to healthy mice did not induce negative side effects and expands the knowledge about beneficial effects of using probiotic microorganisms in mixture for feed additives development.


Assuntos
Aditivos Alimentares/análise , Lactobacillus rhamnosus/metabolismo , Probióticos/farmacologia , Saccharomyces cerevisiae/metabolismo , Ração Animal/análise , Animais , Sobrevivência Celular/efeitos dos fármacos , Chlorocebus aethiops , Citocinas/genética , Citocinas/imunologia , Aditivos Alimentares/efeitos adversos , Interleucina-10/imunologia , Camundongos , Camundongos Endogâmicos BALB C , Probióticos/efeitos adversos , Probióticos/metabolismo , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/imunologia , Células Vero
8.
Cochrane Database Syst Rev ; 6: CD012970, 2020 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-32575163

RESUMO

BACKGROUND: Gestational diabetes mellitus (GDM) is carbohydrate intolerance first recognised during pregnancy and associated with complications for mothers and babies. Probiotics are naturally occurring micro-organisms, which when ingested in adequate amounts, may confer health benefits. Evidence of the role of probiotics as treatment for GDM is limited. OBJECTIVES: To evaluate the safety and effectiveness of probiotics in treating women with GDM on maternal and infant outcomes. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth's Trials Register ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP) (24 July 2019), and reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing the use of probiotics versus placebo/standard care for the treatment of GDM. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data, checked data accuracy, and assessed risk of bias of included trials. The certainty of evidence for selected maternal and infant/child outcomes was assessed using GRADE. MAIN RESULTS: Nine RCTs (695 pregnant women with GDM) comparing probiotics versus placebo were identified. The overall risk of bias in the nine RCTs was low to unclear and the evidence was downgraded for imprecision due to the small numbers of women participating in the trials. The trials were carried out in hospitals and universities in Iran (seven trials), Thailand (one trial) and Ireland (one trial). All trials compared probiotics with placebo. Maternal outcomes We are uncertain if probiotics have any effect compared with placebo on hypertensive disorders of pregnancy, (risk ratio (RR) 1.50, 95% confidence interval (CI) 0.64 to 3.53; participants = 256; studies = 3; low-certainty evidence) and mode of birth as caesareans (average RR 0.64, 95% CI 0.30 to 1.35; participants = 267; studies = 3; low-certainty evidence) because the certainty of evidence is low and the 95% CIs span possible benefit and possible harm. No trials reported primary outcomes of: mode of birth as vaginal/assisted and subsequent development of type 2 diabetes. We are uncertain if probiotics have any effect compared with placebo on induction of labour (RR 1.33, 95% CI 0.74 to 2.37; participants = 127; studies = 1; very low-certainty evidence). For other secondary maternal outcomes, we are uncertain if there are differences between probiotics and placebo for: postpartum haemorrhage; weight gain during pregnancy intervention and total gestational weight gain; fasting plasma glucose and need for extra pharmacotherapy (insulin). Probiotics may be associated with a slight reduction in triglycerides and total cholesterol. In probiotics compared with placebo, there was evidence of reduction in markers for insulin resistance (HOMA-IR) and HOMA-B; and insulin secretion. There was also an increase in quantitative insulin sensitivity check index (QUICKI). Probiotics were associated with minor benefits in relevant bio-markers with evidence of a reduction in inflammatory markers high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and marker of oxidative stress malondialdehyde; and an increase in antioxidant total glutathione, but we are uncertain if there is any difference in total antioxidant capacity. No trials reported secondary outcomes: perineal trauma, postnatal weight retention or return to pre-pregnancy weight and postnatal depression. Infant/child/adult outcomes We are uncertain if probiotics have any effect, compared with placebo, on the risk of large-for-gestational-age babies (RR 0.73, 95% CI 0.35 to 1.52; participants = 174; studies = 2; low-certainty evidence) or infant hypoglycaemia (RR 0.85, 95% CI 0.39 to 1.84; participants = 177; studies = 3; low-certainty evidence) because the certainty of evidence is low and the 95% CIs span possible benefit and possible harm. No trials reported primary outcomes of: perinatal (fetal/neonatal) mortality; or neurosensory disability. For other secondary outcomes, we are uncertain if there is any difference between probiotics and placebo in gestational age at birth, preterm birth, macrosomia, birthweight, head circumference, length, infant hypoglycaemia, and neonatal intensive care unit (NICU) admissions. There was evidence of a reduction in infant hyperbilirubinaemia with probiotics compared with placebo. No trials reported secondary outcomes: infant adiposity, and later childhood adiposity. There were no adverse events reported by any of the trials. AUTHORS' CONCLUSIONS: Low-certainty evidence means we are not certain if there is any difference between probiotic and placebo groups in maternal hypertensive disorders of pregnancy, caesareans; and large-for-gestational-age babies. There were no adverse events reported by the trials. Due to the variability of probiotics used and small sample sizes of trials, evidence from this review has limited ability to inform practice. Well-designed adequately-powered trials are needed to identify whether probiotics may improve maternal blood glucose levels and/or infant/child/adult outcomes; and whether they can be used to treat GDM.


Assuntos
Diabetes Gestacional/terapia , Probióticos/uso terapêutico , Adulto , Criança , Intervalos de Confiança , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Recém-Nascido , Criança Pós-Termo , Trabalho de Parto Induzido/estatística & dados numéricos , Razão de Chances , Placebos/uso terapêutico , Gravidez , Probióticos/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Medicine (Baltimore) ; 99(23): e20631, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32502043

RESUMO

This retrospective study aimed to explore the benefits and safety of probiotics (live combined Bacillus subtilis and Enterococcus faecium granules with multivitamines) for the treatment of children with antibiotic-associated diarrhea (AAD).A total of 72 children with AAD were analyzed in this study. Of these, 36 children received routine treatment plus probiotics, and were assigned to a treatment group. The other 36 children underwent routine treatment alone, and were assigned to a control group. Patients in both groups were treated for a total of 7 days. The efficacy and safety were evaluated by duration of diarrhea (days), number of dressings needed daily, abdominal pain intensity, stool consistency (as assessed by Bristol Stool Scale (BSS)), and any adverse events.After treatment, probiotics showed encouraging benefits in decreasing duration of diarrhea (days) (P < .01), number of dressings needed every day (P < .01), abdominal pain intensity (P < .01), and stool consistency (BSS (3-5), P < .01; BSS (6-7), P < .01). In addition, no adverse events were documented in this study.The findings of this study demonstrated that probiotics may provide promising benefit for children with AAD. Further studies are still needed to warrant theses findings.


Assuntos
Diarreia/induzido quimicamente , Probióticos/efeitos adversos , Bacillus subtilis/metabolismo , Estudos de Casos e Controles , Criança , Pré-Escolar , Enterococcus faecium/metabolismo , Feminino , Humanos , Masculino , Probióticos/farmacologia , Estudos Retrospectivos
10.
Medicine (Baltimore) ; 99(18): e20095, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358397

RESUMO

BACKGROUND: Several studies have suggested that intestinal flora may play an important role in allergic diseases. The purpose of this study was to investigate the effect of probiotics of Bifidobacterium triplex on the symptoms of allergic rhinitis (AR). The effects of this probiotic on the immune system have been reported in some studies, but most previous studies have been in animals. METHODS/DESIGN: 60 infants and young children with AR were randomly divided into 2 groups: probiotics/placebo group. The main outcome was the use of a comprehensive symptom drug score to assess allergy symptoms. In addition, health-related quality of life was investigated (rhinitis quality of life questionnaire). Secondary outcomes included a visual analog scale of allergy burden and a second quality of life questionnaire. This report describes the study design of a randomized controlled trial. DISCUSSION: The study design described a double-center, randomized, location at the Minda Hospital of Hubei Minzu University and West China Hospital of Sichuan University, which will be focused on the study about probiotics treatment and its effect on AR symptoms. TRIAL REGISTRATION: It has been registered at http://www.chictr.org.cn/listbycreater.aspx (Identifier: ChiCTR2000031175), Registered March 22, 2020.


Assuntos
Probióticos/uso terapêutico , Rinite Alérgica/terapia , Bifidobacterium , Criança , Pré-Escolar , China , Método Duplo-Cego , Humanos , Lactente , Probióticos/administração & dosagem , Probióticos/efeitos adversos , Qualidade de Vida , Índice de Gravidade de Doença
11.
J Pediatr ; 222: 59-64.e1, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32418818

RESUMO

OBJECTIVE: To determine the prevalence of probiotic administration in infants born preterm over time, as well as the association between probiotic administration and select adverse outcomes. STUDY DESIGN: We performed a multicenter cohort study of infants 23-29 weeks of gestational age admitted to 289 neonatal intensive care units from 1997 to 2016. We evaluated the type of probiotics given and prevalence of exposure to probiotics over time and by site. We matched infants exposed to probiotics by several factors to unexposed infants receiving enteral feeds on the same postnatal day. We performed conditional logistic regression to evaluate the association between probiotics exposure and adverse outcomes, including necrotizing enterocolitis (NEC), bloodstream infections, meningitis, and death. RESULTS: Of 78 076 infants, 3626 (4.6%) received probiotics. Probiotic use increased over the study period and varied among neonatal intensive care units. We matched 2178 infants exposed to probiotics to 33 807 without exposure. Probiotic administration was associated with a decrease in NEC (OR 0.62, 95% CI 0.48-0.80) and death (OR 0.52, 95% CI 0.39-0.70), an increase in Candida infection (OR 2.23, 95% CI 1.29-3.85), but no increase in bloodstream infection (OR 0.86, 95% CI 0.70-1.05) or meningitis (OR 1.18, 95% CI 0.40-3.46). CONCLUSIONS: Probiotic use increased over time and was associated with decreased odds of NEC and death. Prospective, randomized-controlled studies of specific probiotic products are needed to further investigate the safety and efficacy of probiotics in preterm infants.


Assuntos
Doenças do Prematuro/prevenção & controle , Probióticos/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Unidades de Terapia Intensiva Neonatal , Masculino , Probióticos/efeitos adversos , Resultado do Tratamento
12.
Int J Surg ; 79: 111-119, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32387213

RESUMO

BACKGROUND: & Objectives: Constipation-predominant irritable bowel syndrome (IBS-C) is functional bowel disorders that may involve disturbance of the gastrointestinal microbiota. We performed a systematic review and meta-analysis of the efficacy and safety of probiotics in patients with IBS-C. METHODS: We searched the Cochrane Library, PubMed, EMBASE and Web of Science databases up to 1 May 2019. Randomized controlled trials (RCTs) involving adults with IBS-C that compared probiotics to placebo or no therapy were eligible for the analysis. Dichotomous symptom data were pooled to calculate the relative risk (RR) with a 95% confidence interval (CI) of remaining symptoms after therapy. Continuous data were pooled using a standardized or weighted mean difference (MD) with the 95% CI. Two reviewers assessed trial quality and extracted data independently. The analysis was performed using Review Manager version 5.2. RESULTS: Seventeen RCTs involving 1469 patients were included in the analysis. Overall, probiotics significantly increased stool frequency by 1.29 bowel movements (BM)/wk (95% CI: 0.69 to 1.89 BM/wk; P < 0.0001), and improved stool consistency (SMD: 0.55; 95% CI: 0.27 to 0.82; P = 0.0001). Compared with placebo, patients using probiotics experienced a shorter gut transit time by 12.36 h (95% CI: -20.74 to -3.98 h; P = 0.004). No serious adverse events were reported. CONCLUSIONS: Generally, probiotics may be safe and may improve whole gut transit time, stool frequency, and stool consistency. However, adequately powered RCTs are required to better determine the species or strains, doses, and duration of use of probiotics that are most efficacious. Further research and evidence is required before probiotics is adopted as one of treatments of IBS-C.


Assuntos
Constipação Intestinal/tratamento farmacológico , Síndrome do Intestino Irritável/tratamento farmacológico , Probióticos/uso terapêutico , Humanos , Probióticos/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Cochrane Database Syst Rev ; 3: CD007443, 2020 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-32128794

RESUMO

BACKGROUND: Ulcerative colitis is an inflammatory condition affecting the colon, with an annual incidence of approximately 10 to 20 per 100,000 people. The majority of people with ulcerative colitis can be put into remission, leaving a group who do not respond to first- or second-line therapies. There is a significant proportion of people who experience adverse effects with current therapies. Consequently, new alternatives for the treatment of ulcerative colitis are constantly being sought. Probiotics are live microbial feed supplements that may beneficially affect the host by improving intestinal microbial balance, enhancing gut barrier function and improving local immune response. OBJECTIVES: The primary objective was to determine the efficacy of probiotics compared to placebo, no treatment, or any other intervention for the maintenance of remission in people with ulcerative colitis. The secondary objective was to assess the occurrence of adverse events associated with the use of probiotics. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and two other databases on 31 October 2019. We contacted authors of relevant studies and manufacturers of probiotics regarding ongoing or unpublished trials that may be relevant to the review, and we searched ClinicalTrials.gov. We also searched references of trials for any additional trials. SELECTION CRITERIA: Randomised controlled trials (RCTs) that compared probiotics against placebo or any other intervention, in both adults and children, for the maintenance of remission in ulcerative colitis were eligible for inclusion. Maintenance therapy had to be for a minimum of three months when remission has been established by any clinical, endoscopic,histological or radiological relapse as defined by study authors. DATA COLLECTION AND ANALYSIS: Two review authors independently conducted data extraction and 'Risk of bias' assessment of included studies. We analysed data using Review Manager 5. We expressed dichotomous and continuous outcomes as risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE methodology. MAIN RESULTS: In this review, we included 12 studies (1473 randomised participants) that met the inclusion criteria. Participants were mostly adults. The studies compared probiotics to placebo, probiotics to 5-aminosalicylic acid (5-ASA) and a combination of probiotics and 5-ASA to 5-ASA. The studies ranged in length from 12 to 52 weeks. The average age of participants was between 32 and 51, with a range between 18 and 88 years. Seven studies investigated a single bacterial strain, and five studies considered mixed preparations of multiple strains. The risk of bias was high in all except three studies due to selective reporting, incomplete outcome data and lack of blinding. This resulted in low- to very low-certainty of evidence. It is uncertain if there is any difference in occurrence of clinical relapse when probiotics are compared with placebo (RR 0.87, 95% CI 0.63 to 1.18; 4 studies, 361 participants; very low-certainty evidence (downgraded for risk of bias, imbalance in baseline characteristics and imprecision)). It is also uncertain whether probiotics lead to a difference in the number of people who maintain clinical remission compared with placebo (RR 1.16, 95% CI 0.98 to 1.37; 2 studies, 141 participants; very low-certainty evidence (downgraded for risk of bias, imbalance in baseline characteristics and imprecision)). When probiotics are compared with 5-ASA, there may be little or no difference in clinical relapse (RR 1.01, 95% CI 0.84 to 1.22; 2 studies, 452 participants; low-certainty evidence) and maintenance of clinical remission (RR 1.06, 95% CI 0.90 to 1.25; 1 study, 125 participants; low-certainty evidence). It is uncertain if there is any difference in clinical relapse when probiotics, combined with 5-ASA are compared with 5-ASA alone (RR 1.11, 95% CI 0.66 to 1.87; 2 studies, 242 participants; very low-certainty evidence (downgraded due to risk of bias and imprecision)). There may be little or no difference in maintenance of remission when probiotics, combined with 5-ASA, are compared with 5-ASA alone (RR 1.05, 95% CI 0.89 to 1.24; 1 study, 122 participants; low-certainty evidence). Where reported, most of the studies which compared probiotics with placebo recorded no serious adverse events or withdrawals due to adverse events. For the comparison of probiotics and 5-ASA, one trial reported 11/110 withdrawals due to adverse events with probiotics and 11/112 with 5-ASA (RR 1.02, 95% CI 0.46 to 2.25; 222 participants; very low-certainty evidence). Discontinuation of therapy was due to gastrointestinal symptoms. One study (24 participants) comparing probiotics combined with 5-ASA with 5-ASA alone, reported no withdrawals due to adverse events; and two studies reported two withdrawals in the probiotic arm, due to avascular necrosis of bilateral femoral head and pulmonary thromboembolism (RR 5.29, 95% CI 0.26 to 107.63; 127 participants; very low-certainty evidence). Health-related quality of life and need for additional therapy were reported infrequently. AUTHORS' CONCLUSIONS: The effectiveness of probiotics for the maintenance of remission in ulcerative colitis remains unclear. This is due to low- to very low-certainty evidence from poorly conducted studies, which contribute limited amounts of data from a small number of participants. Future trials comparing probiotics with 5-ASA rather than placebo will better reflect conventional care given to people with ulcerative colitis. Appropriately powered studies with a minimum length of 12 months are needed.


Assuntos
Colite Ulcerativa/terapia , Probióticos/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/uso terapêutico , Humanos , Mesalamina/uso terapêutico , Pessoa de Meia-Idade , Probióticos/efeitos adversos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Indução de Remissão , Adulto Jovem
15.
Cochrane Database Syst Rev ; 3: CD005573, 2020 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-32128795

RESUMO

BACKGROUND: Ulcerative colitis is an inflammatory condition affecting the colon, with an annual incidence of approximately 10 to 20 per 100,000 people. The majority of people with ulcerative colitis can be put into remission, leaving a group who do not respond to first- or second-line therapies. There is a significant proportion of people who experience adverse effects with current therapies. Consequently, new alternatives for the treatment of ulcerative colitis are constantly being sought. Probiotics are live microbial feed supplements that may beneficially affect the host by improving intestinal microbial balance, enhancing gut barrier function and improving local immune response. OBJECTIVES: To assess the efficacy of probiotics compared with placebo or standard medical treatment (5-aminosalicylates, sulphasalazine or corticosteroids) for the induction of remission in people with active ulcerative colitis. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and two other databases on 31 October 2019. We contacted authors of relevant studies and manufacturers of probiotics regarding ongoing or unpublished trials that may be relevant to the review, and we searched ClinicalTrials.gov. We also searched references of trials for any additional trials. SELECTION CRITERIA: Randomised controlled trials (RCTs) investigating the effectiveness of probiotics compared to standard treatments or placebo in the induction of remission of active ulcerative colitis. We considered both adults and children, with studies reporting outcomes of clinical, endoscopic, histologic or surgical remission as defined by study authors DATA COLLECTION AND ANALYSIS: Two review authors independently conducted data extraction and 'Risk of bias' assessment of included studies. We analysed data using Review Manager 5. We expressed dichotomous and continuous outcomes as risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE methodology. MAIN RESULTS: In this review, we included 14 studies (865 randomised participants) that met the inclusion criteria. Twelve of the studies looked at adult participants and two studies looked at paediatric participants with mild to moderate ulcerative colitis, the average age was between 12.5 and 47.7 years. The studies compared probiotics to placebo, probiotics to 5-ASA and a combination of probiotics plus 5-ASA compared to 5-ASA alone. Seven studies used a single probiotic strain and seven used a mixture of strains. The studies ranged from two weeks to 52 weeks. The risk of bias was high for all except two studies due to allocation concealment, blinding of participants, incomplete reports of outcome data and selective reporting. This led to GRADE ratings of the evidence ranging from moderate to very low. Probiotics versus placebo Probiotics may induce clinical remission when compared to placebo (RR 1.73, 95% CI 1.19 to 2.54; 9 studies, 594 participants; low-certainty evidence; downgraded due to imprecision and risk of bias, number needed to treat for an additional beneficial outcome (NNTB) 5). Probiotics may lead to an improvement in clinical disease scores (RR 2.29, 95% CI 1.13 to 4.63; 2 studies, 54 participants; downgraded due to risk of bias and imprecision). There may be little or no difference in minor adverse events, but the evidence is of very low certainty (RR 1.04, 95% CI 0.42 to 2.59; 7 studies, 520 participants). Reported adverse events included abdominal bloating and discomfort. Probiotics did not lead to any serious adverse events in any of the seven studies that reported on it, however five adverse events were reported in the placebo arm of one study (RR 0.09, CI 0.01 to 1.66; 1 study, 526 participants; very low-certainty evidence; downgraded due to high risk of bias and imprecision). Probiotics may make little or no difference to withdrawals due to adverse events (RR 0.85, 95% CI 0.42 to 1.72; 4 studies, 401 participants; low-certainty evidence). Probiotics versus 5-ASA There may be little or no difference in the induction of remission with probiotics when compared to 5-ASA (RR 0.92, 95% CI 0.73 to 1.16; 1 study, 116 participants; low-certainty evidence; downgraded due to risk of bias and imprecision). There may be little or no difference in minor adverse events, but the evidence is of very low certainty (RR 1.33, 95% CI 0.53 to 3.33; 1 study, 116 participants). Reported adverse events included abdominal pain, nausea, headache and mouth ulcers. There were no serious adverse events with probiotics, however perforated sigmoid diverticulum and respiratory failure in a patient with severe emphysema were reported in the 5-ASA arm (RR 0.21, 95% CI 0.01 to 4.22; 1 study, 116 participants; very low-certainty evidence). Probiotics combined with 5-ASA versus 5-ASA alone Low-certainty evidence from a single study shows that when combined with 5-ASA, probiotics may slightly improve the induction of remission (based on the Sunderland disease activity index) compared to 5-ASA alone (RR 1.22 CI 1.01 to 1.47; 1 study, 84 participants; low-certainty evidence; downgraded due to unclear risk of bias and imprecision). No information about adverse events was reported. Time to remission, histological and biochemical outcomes were sparsely reported in the studies. None of the other secondary outcomes (progression to surgery, need for additional therapy, quality of life scores, or steroid withdrawal) were reported in any of the studies. AUTHORS' CONCLUSIONS: Low-certainty evidence suggests that probiotics may induce clinical remission in active ulcerative colitis when compared to placebo. There may be little or no difference in clinical remission with probiotics alone compared to 5-ASA. There is limited evidence from a single study which failed to provide a definition of remission, that probiotics may slightly improve the induction of remission when used in combination with 5-ASA. There was no evidence to assess whether probiotics are effective in people with severe and more extensive disease, or if specific preparations are superior to others. Further targeted and appropriately designed RCTs are needed to address the gaps in the evidence base. In particular, appropriate powering of studies and the use of standardised participant groups and outcome measures in line with the wider field are needed, as well as reporting to minimise risk of bias.


Assuntos
Colite Ulcerativa/terapia , Probióticos/uso terapêutico , Adolescente , Adulto , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/uso terapêutico , Viés , Criança , Terapia Combinada/métodos , Humanos , Mesalamina/efeitos adversos , Mesalamina/uso terapêutico , Pessoa de Meia-Idade , Números Necessários para Tratar , Probióticos/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Indução de Remissão/métodos , Tamanho da Amostra , Sulfassalazina/uso terapêutico
16.
J Appl Microbiol ; 129(1): 116-136, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32141152

RESUMO

Probiotics administration in aquafeed is known to increase feed consumption and absorption due to their capacity to release a wide range of digestive enzymes and nutrients which can participate in digestion process and feed utilization, along with the absorption of diet components led to an increase in host's health and well-being. Furthermore, probiotics improve gut maturation, prevention of intestinal disorders, predigestion of antinutrient factors found in the feed ingredients, gut microbiota, disease resistance against pathogens and metabolism. The beneficial immune effects of probiotics are well established in finfish. However, in comparison, similar studies are less abundant in the shellfish. In this review, the discussions will mainly focus on studies reported the last 2 years. In recent studies, native probiotic bacteria were isolated and fed back to their hosts. Although beneficial effects were demonstrated, some studies showed adverse effects when treated with a high concentration. This adverse effect may be due to the imbalance of the gut microbiota caused by the replenished commensal probiotics. Probiotics revealed greatest effect on the shrimp digestive system particularly in the larval and early post-larval stages, and stimulate the production of endogenous enzymes in shrimp and contribute with improved the enzyme activities in the gut, as well as disease resistance.


Assuntos
Aquicultura , Bacillus/fisiologia , Suplementos Nutricionais , Lactobacillales/fisiologia , Probióticos/administração & dosagem , Fenômenos Fisiológicos da Nutrição Animal , Animais , Peixes/imunologia , Peixes/microbiologia , Microbioma Gastrointestinal , Probióticos/efeitos adversos , Frutos do Mar/microbiologia
17.
Medicine (Baltimore) ; 99(13): e19708, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32221098

RESUMO

BACKGROUND: The prevalence of prediabetes and diabetes is increasing rapidly, and 5% to 10% of prediabetic patients will develop diabetes every year. Diabetes causes major health problems as well as a large economic burden. Human studies have demonstrated the beneficial effects of probiotics, prebiotics, and synbiotics supplementation in prediabetes. However, there are no systematic reviews that explore the therapeutic efficacy of probiotics, prebiotics, and synbiotics supplementation in patients with prediabetes. Therefore, we aim to synthesize the existing evidence evaluating the effectiveness and safety of probiotics, prebiotics, and synbiotics supplementation in prediabetic patients. METHODS: We will search PubMed, EMBASE, Cochrane Library, Web of Science, the Clinical Trials.gov website, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Data Knowledge Service Platform from inception to August 2020. Additionally, the search will be conducted in multiple languages. Search terms are keywords and medical subject headings related to prediabetes, probiotics, prebiotics, and synbiotics. The primary outcomes are differences in glycated hemoglobin and fasting blood glucose. The secondary outcomes are differences in fasting insulin, homeostasis model assessment of insulin resistance, quantitative insulin sensitivity check index, and adverse events. The meta-analysis will be performed using the Revman5.3.0 software provided by the Cochrane Collaboration. RESULTS: Our study will systematically evaluate the effectiveness and safety of probiotics, prebiotics, and synbiotics supplementation in prediabetes. CONCLUSION: The findings of this study will provide the best available evidence for probiotics, prebiotics, and synbiotics in the treatment of prediabetes, and provide a strong basis for clinical treatment.


Assuntos
Suplementos Nutricionais , Estado Pré-Diabético/tratamento farmacológico , Probióticos/uso terapêutico , Glicemia/efeitos dos fármacos , Hemoglobina A Glicada/efeitos dos fármacos , Humanos , Resistência à Insulina/fisiologia , Prebióticos/administração & dosagem , Prebióticos/efeitos adversos , Probióticos/administração & dosagem , Probióticos/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Simbióticos/administração & dosagem , Simbióticos/efeitos adversos
18.
Benef Microbes ; 11(1): 5-17, 2020 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-32066254

RESUMO

Vaginal lactobacilli (LAB) in probiotic formulas constitute a promising alternative for microbiome reconstitution and for the prevention and treatment of urogenital infections. A double-blind, randomised clinical trial was conducted to assess the safety of LAB-gelatine capsules vaginally administered to healthy sexually active women. Participants were randomised into three groups: intervention A: Lactobacillus reuteri CRL1324, Lactobacillus gasseri CRL1263 and CRL1307; intervention B: Lactobacillus rhamnosus CRL1332, L. gasseri CRL1256 and CRL1320; and intervention C: placebo. In a survey and clinical evaluation, participants received a blister with 7 capsules to be administered 1 per day. A second sampling and a new survey were conducted 3-10 days after completing application. Colposcopy was performed to assess adverse effects on vaginal-cervical mucosa. Vaginal swabs were taken for Gram staining to determine the Nugent score, and obtainment of viable-cell cultures to quantify cultivable lactic acid bacteria and pathogens. The main outcomes evaluated were overall satisfaction and secondary effects, including discomfort, urogenital infection, inflammatory response or other symptoms. No significant differences were found in Nugent score or in leukocyte numbers in vaginal samples either before or after the three interventions. However, a tendency to decrease in both the Nugent score and in leukocyte numbers was observed after interventions A and B, though not after C. A significant increase in cultivable lactobacilli was determined after LAB interventions. No severe adverse events were detected. LAB-containing capsules were well tolerated by subjects, so they could be proposed as an adequate alternative to restore vaginal lactobacilli in sexually active women.


Assuntos
Microbiota/efeitos dos fármacos , Probióticos , Vagina/microbiologia , Administração Intravaginal , Adulto , Cápsulas , Colposcopia , Método Duplo-Cego , Feminino , Humanos , Lactobacillus gasseri , Lactobacillus reuteri , Lactobacillus rhamnosus , Pessoa de Meia-Idade , Probióticos/administração & dosagem , Probióticos/efeitos adversos , Probióticos/uso terapêutico , Vaginose Bacteriana/tratamento farmacológico
19.
Trials ; 21(1): 161, 2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32046750

RESUMO

BACKGROUND: Impulsivity and compulsivity are related to emotional and social maladjustment and often underlie psychiatric disorders. Recently, alterations in microbiota composition have been shown to have implications for brain development and social behavior via the microbiota-gut-brain axis. However, the exact mechanisms are not fully identified. Recent evidence suggests the modulatory effect of synbiotics on gut microbiota and the contribution of these agents in ameliorating symptoms of many psychiatric diseases. To date, no randomized controlled trial has been performed to establish the feasibility and efficacy of this intervention targeting the reduction of impulsivity and compulsivity. We hypothesize that supplementation with synbiotics may be an effective treatment in adults with high levels of impulsivity and/or compulsivity. METHODS/DESIGN: This is a prospective, multicenter, double-blind, randomized controlled trial with two arms: treatment with a synbiotic formula versus placebo treatment. The primary outcome is the response rate at the end of the placebo-controlled phase (response defined as a Clinical Global Impression-Improvement Scale score of 1 or 2 = very much improved or much improved, plus a reduction in the Affective Reactivity Index total score of at least 30% compared with baseline). A total of 180 participants with highly impulsive behavior and a diagnosis of attention deficit/hyperactivity disorder (ADHD) and/or borderline personality disorder, aged 18-65 years old, will be screened at three study centers. Secondary outcome measures, including changes in general psychopathology, ADHD symptoms, neurocognitive function, somatic parameters, physical activity, nutritional intake, and health-related quality of life, will be explored at assessments before, during, and at the end of the intervention. The effect of the intervention on genetics, microbiota, and several blood biomarkers will also be assessed. Gastrointestinal symptoms and somatic complaints will additionally be explored at 1-week follow-up. DISCUSSION: This is the first randomized controlled trial to determine the effects of supplementation with synbiotics on reducing impulsive and compulsive behavior. This clinical trial can contribute to explaining the mechanisms involved in the crosstalk between the intestinal microbiome and the brain. If effects can be established by reducing impulsive and compulsive behavior, new cost-effective treatments might become available to these patients. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03495375. Registered on 26 February 2018.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/dietoterapia , Microbioma Gastrointestinal/fisiologia , Comportamento Impulsivo/fisiologia , Probióticos/administração & dosagem , Adolescente , Adulto , Idoso , Transtorno do Deficit de Atenção com Hiperatividade/microbiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Placebos/administração & dosagem , Placebos/efeitos adversos , Probióticos/efeitos adversos , Estudos Prospectivos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Adulto Jovem
20.
Postgrad Med ; 132(5): 441-451, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32059116

RESUMO

BACKGROUND: While the literature indicates that probiotics are effective for the treatment or prevention of several conditions, data in children specifically focusing on individual probiotic strains are still limited. PURPOSE: To conduct a narrative review that summarizes data on the efficacy and safety of two common probiotic strains - Lactobacillus rhamnosus GG (LGG) and Bifidobacterium animalis subspecies lactis BB-12 (BB-12) - when administered to children. METHODS: Our search of the PubMed database identified 13 meta-analyses, three systematic reviews, and 15 randomized, controlled trials that assessed BB-12 and LGG, either alone or in combination, when administered to infants to improve growth or to children of any age to prevent or treat acute gastroenteritis (AGE), antibiotic- or healthcare-associated diarrhea (AAD and HAD, respectively), respiratory infections, otitis media, and functional gastrointestinal (GI) disorders including irritable bowel syndrome (IBS). RESULTS: Our review found evidence that LGG can prevent AAD and improve the symptoms of AGE, particularly among children in Europe. However, we found only moderate evidence regarding the benefits of LGG for treating respiratory infections and IBS in children and minimal evidence to support the use of BB-12. While no serious safety concerns were identified, LGG was associated with two non-serious safety concerns of wheezing and viral skin infections. CONCLUSIONS: We propose that LGG can be safely administered to toddlers and older children to manage the symptoms of AGE and prevent AAD. These findings should be considered for incorporation into clinical practice guidelines and should help to focus the efforts of the probiotic industry.


Assuntos
Bifidobacterium animalis , Lactobacillus rhamnosus , Probióticos/uso terapêutico , Criança , Saúde da Criança , Pré-Escolar , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/prevenção & controle , Quimioterapia Combinada , Gastroenteropatias/tratamento farmacológico , Gastroenteropatias/prevenção & controle , Humanos , Lactente , Saúde do Lactente , Metanálise como Assunto , Probióticos/administração & dosagem , Probióticos/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/prevenção & controle , Revisões Sistemáticas como Assunto
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