Probiotics and Diarrhea Management

A brief presentation explaining about probiotics, their roles and also how diarrhea can be managed

1. PROBIOTICS  Presented by : AND DIARRHEA MANAGEMENT MUHAMMAD USMAN SARWAR

2. CONTENTS Definition Characteristics Probiotic strains Role of Probiotics Foods containing probiotics Clinical implications of probiotics DIARRHEA MANAGEMENT

3. INTRODUCTION DEFINITION Probiotics are defined as live microbes which when administered in adequate amounts confer a beneficial health effect on the host--- WHO 2002 Ellie Metchnikoff , the first scientist who proposed the therapeutic use of lactic acid bacteria . Probiotics term coined in 1965 by Lilly And Stillwell

4. Characteristics of Probiotics Be nonpathogenic and nontoxic to the host  Resistant to gastric acid and bile acid Capable of surviving, colonizing and proliferating in the gut Produce antibacterial substances ( bacteriocins ) It should persist for short periods in the gastro-intestinal tract Able to inhabit in the S & L intestine Human in origin, genetically stable and capable of remaining viable for long periods in field condition   Good adhesion/ colonization to human intestinal tract.

5. Probiotic strains Lactobacillus species L . acidophilus L . plantarum L . casei rhamnosus L . brevis L . bulgaricus Bifidobacterium species B . adolescentis B . bifidum B. infantis B . breve Bacilus clausii Others Streptococcus thermophilus Enteterococcus faecium Lactococcus lactis Yeast – Saccharomyces boulardii

6. ROLE OF PROBIOTICS Probiotics have shown to provide a diverse variety of health benefits to human, animal, and plants . It is important that the health benefits of probiotics must be documented with the specific strain and specific dosage. HUMANS Probiotics Can Help Reduce Symptoms of Certain Digestive Disorders Probiotic bacteria, such as Lactobacillus and Bifidobacterium , can synthesize and supply vitamins to human body . Probiotics Lactobacillus rhamnosus may Reduce the Severity of Certain Allergies and Eczema Probiotic Lactobacillus plantarum may significantly reduces both cholesterol and blood pressure which Can Help Keep Your Heart Healthy Probiotic Lactobacillus amylovorus   may Help You Lose Weight and Belly Fat.

7. ANIMALS Probiotics can beneficially improve the intestinal microbial balance in host animal. Commercial probiotics for animal use are claimed to improve animal performance by increasing daily gain and feed efficiency in feedlot cattle, enhance milk production in dairy cows and enhanced growth. Probiotics improve health and performance of young calves and in improving growth performance of chickens Probiotics provide the animal with additional source of nutrients and digestive enzymes PLANTS Plant probiotics is strong growing market for the use in agricultural biotechnology It has shown worldwide with an annual growth rate of approximately 10%. The plant probiotics products can be used as bio fertilizers , plant strengtheners , phytostimulators , and bio pesticides  

8. Dairy drink Soya milk , Tofu Milk products – sour cream, butter milk, yogurt Foods containing probiotics

9. Clinical implications 1) Di arrhea: Treatment & prevention of acute diarrhea: L . reuteri , L. rhamnosus , L . casei Saccharomyces boulardii Antibiotic associated diarrhea Saccharomyces boulardii , L. rhamnosus L. casei effective in hospitalized adult patients Inflammatory bowel disease: ulcerative colitis Irritable bowel syndrome reduction in abdominal bloating and flatulence L. reuteri is widely used Colon cancer Lactose malabsorption Streptococcus thermophillus and L. delbrueckii prodution of β- D galactosidase enzymes that breakdown lactose Eradication of H. pylori Bifidobacteria and B. subtilis may inhibit the growth or attachment of H. pylori Allergy decreases serum IgE levels reduction of Th2 cytokine response Lowering cholesterol

10. RESEARCH STUDY Probiotics for treatment of acute diarrhea in children: randomized clinical trial of different preparations Objective   To compare the efficacy of five probiotic preparations recommended to patients in the treatment of acute diarrhea in children. Design   Randomized controlled clinical trial in collaboration with family pediatricians over 12 months . Author Year Country Participants Main Outcome Measures Results Conclusions Roberto Berni Published 16 August 2007 University of Naples, Italy Children aged 3-36 months visiting a family pediatrician for acute diarrhea. 571 children were allocated to intervention. M ain outcomes to measure were duration of diarrhea and daily number and consistency of stools. Safety and tolerance were also recorded. Duration of diarrhea was significantly shorter in children who received L rhamnosus  strain GG (78.5 hours) and the mix of four bacterial strains (70.0 hours) than in children who received oral rehydration solution alone (115.0 hours). One day after the first probiotic administration, the daily number of stools was significantly lower in children who received L rhamnosus  strain GG than those who received the probiotic mix than in the other groups. The remaining preparations did not affect primary outcomes. Not all commercially available probiotic preparations are effective in children with acute diarrhea. Pediatricians should choose bacterial preparations based on effectiveness data.

11. MANAGEMENT OF DIARRHEA

12. `1 ‘ D iarrhea is defined as the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual). Frequent passing of formed stools is not  diarrhea, nor is the passing of loose, “pasty” stools by breastfed babies’’ It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide ’’. Three clinical types of diarrhea : acute watery diarrhea – lasts several hours or days, and includes cholera; acute bloody diarrhea – also called dysentery; and persistent diarrhea – lasts 14 days or longer . D iarrhea Definition WHO

13. CLASSIFICATION & MANAGEMENT

14. SIGNS CLASSIFY AS TREATMENT OPTION No dehydration signs No dehydration Give fluid, zinc supplements/ORS & food ( BRAT ) to treat diarrhea at home No hospitalization need. 5-days follow up, if no improvement Two of following signs: Restless Some dehydration Give fluid, zinc supplements/ORS & food ( BRAT ) to treat diarrhea at home. Drinks eagerly, Sunken eyes Refer urgently to Hospital Skin pinch goes back slowly. Give ORS and continue breastfed on the way to hospital. Two of following signs: Lethargic or unconscious Severe dehydration Child is rehydrated quickly by using I/V infusion. I/V infusions recommended : R/L solution N/S when R/L is not available Sunken, not able to drink Reassess the infant every 15-30 min, until a strong radial pulse is present. Also give ORS (about 5 ml/kg/hour) as soon as the infant can drink, Reassess the infant after 6 hours. Skin pinch goes back very slowly. Before the mother leaves the hosp , 2 sachet of ORS be given. Probiotics -Treatment and prevention of acute diarrhea Lactobacillus rhamnosus GG and Bifidobacterium lactis

15. THANK YOU Any Questions ?