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Probiotics to enhance anti-infective defences in the gastrointestinal tract

https://doi.org/10.1016/S1521-6918(03)00074-XGet rights and content

Abstract

Several clinical studies have demonstrated the therapeutic and/or prophylactic efficacy of specific probiotics against acute viral gastroenteritis and antibiotic-associated diarrhoea (including Clostridium difficile infection). Emerging evidence also suggests beneficial effects against Helicobacter pylori infection. The evidence of efficacy against traveller's diarrhoea remains, however, inconclusive. The precise mechanisms by which probiotics potentiate host gastrointestinal defences and mediate protection are not fully known. There is evidence to suggest, however, that probiotics might contribute to host defence by reinforcing non-immunological defences and stimulating both specific and non-specific host immune responses. Little is known about the relative importance of the probiotic-stimulated mechanisms in host protection. This review summarises the evidence for the anti-infective effects of probiotics and discusses the effect of orally delivered probiotics on non-immunological and immunological defence mechanisms in the host, especially in the gastrointestinal tract.

Section snippets

Anti-infective effects of probiotics

Several well-controlled studies have shown that the intake of specific strains of LAB (probiotics) can reduce the duration and severity of diarrhoea in infants and children hospitalized for acute rotavirus diarrhoea (Table 1).1., 2., 3., 4. A reduction in the duration of diarrhoea of 0.7 days (95% confidence interval: 0.3–1.2 days) and a reduction in diarrhoea frequency of 1.6 stools on day 2 of treatment in subjects receiving lactobacilli (95% confidence interval: 0.7–2.6 fewer stools)

Effects of probiotics on anti-infective defences

The GIT represents the largest surface area of the body that is permanently exposed to the external environment through the oral cavity. In addition to allowing the digestion and absorption of nutrients, the gastrointestinal mucosa provides a protective barrier against the constant barrage of antigens derived from food, resident microflora and the external environment. Protection against such agents is mediated by a host of non-immunological (physiological barriers) and immunological defences.

Summary

Infection with enteric pathogens continue to be a major health problem worldwide, especially in children, undernourished, hospitalized and immunocompromised individuals, travellers and the elderly. A lack of effective mucosal vaccines and the widespread emergence of antibiotic-resistant micro-organisms have stimulated the quest for alternative methods of infection control. Several recent clinical studies have provided unequivocal evidence that the intake of specific probiotics could be

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