Probiotics in Gastroenterology

Abstract

Probiotics are defined as live microorganisms of human origin. Their use may favorably influence human health and ameliorate or prevent certain diseases. Prebiotics are non-digestible foodstuffs (fiber, oligofructans - “colonic foods”), which enter the colon and are metabolized by the probiotics. Probiotics should fulfill the following criteria: Phenotypic and genotypic classification, no pathogenic properties, human origin, application in the living state, resistance to gastric acid and bile, ability to adhere to colonocytes, ability to colonize the gut, clinically proved favorable health-effect, and safety. Experimental and clinical studies supplied evidence of the possible use of probiotics in the following diseases: Traveler’s diarrhea, antibiotic-associated diarrhea, relapsing Clostridium difficile colitis, infantile diarrhea, rotavirus enteritis, inflammatory bowel disease, irritable bowel syndrome, colon cancer, peritonitis, acute pancreatitis, and diarrhea associated with HIV infection. Probiotics displayed the following effects in these studies: Involvement in production of essential nutrients of the colonic mucosa, beneficial effect on intestinal immunity, recovery of the disturbed gut mucosal barrier and prevention of microbial translocation, elimination of toxins and eradication of microbial pathogens, production of steroids from cholesterol and reduction of its pool in circulation, participation in regulation of intestinal functions, reduced incidence of chemically induced colon tumors in rodents. Probiotics open new therapeutic modalities in a number of diseases and it may be expected that their importance will increase with growing knowledge and experience.

Probiotika in der Gastroenterologie

Probiotika sind als lebende Mikrorganismen humaner Herkunft definiert. Ihre Anwendung kann die menschliche Gesundheit günstig beeinflussen und bestimmte Krankheitszustände verbessern oder verhindern. Präbiotika sind unverdauliche Nahrungsbestandteile (Fasern, Oligofruktane - “Kolonnahrung”), die in das Kolon gelangen und dort von Probiotika verstoffwechselt werden. Probiotika sollen die folgenden Kriterien erfüllen: phänotypische und genotypische Charakterisierung, Apathogenität, humane Herkunft, Anwendung in lebender Form, Magensaft- und Gallenresistenz, Fähigkeit zur Kolonozytenadhäsion und zur Darmbesiedlung, in klinischen Prüfungen nachgewiesener günstiger Effekt auf die Gesundheit und Sicherheit. Experimentelle und klinische Studien lieferten Beweise für den möglichen Einsatz von Probiotika bei folgenden Erkrankungen: Reisediarrhö, antibiotikaassoziierte Diarrhö, rezidivierende Clostridium-difficile-Kolitis, akute Diarrhözustände bei Kindern, rotavirusassoziierte Enteritis, chronisch-entzündliche Darmerkrankungen, Reizdarmsyndrom, Kolonkarzinom, Peritonitis, akute Pankreatitis und HIV-assoziierte Diarrhö. Folgende Effekte der Probiotika zeigten sich in diesen Studien: Beteiligung bei der Produktion essenzieller Nährstoffe für die Kolonschleimhaut, vorteilhafter Effekt auf das intestinale Immunsystem, Wiederherstellung der gestörten Darmmukosabarriere, Verhinderung mikrobieller Translokation, Eliminierung von Toxinen und Eradikation mikrobieller Pathogene, Produktion von Steroiden aus Cholesterol und Reduktion des zirkulierenden Cholesterolpools, Beteiligung bei der Regulation intestinaler Funktionen und verminderte Inzidenz chemisch-induzierter Kolontumoren bei Nagetieren. Probiotika eröffnen neue therapeutische Wege bei zahlreichen Erkrankungen, und es ist zu erwarten, dass ihre Bedeutung mit zunehmender Kenntnis und Erfahrung steigen wird.

Key words

Probiotics - Prebiotics - Microbial Interference Therapy - Colonic Foods - Therapy of Digestive Diseases

Schlüsselwörter

Probiotika - Präbiotika - mikrobiellen Interferenztherapie - Kolonnahrung - Therapie der Verdauungskranheiten

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