Prevention of Travellers Diarrhoea by Lactobacillus GG

Pj, Oksanen; Salminen, Seppo; Saxelin, Maija; Hämäläinen, Päivi; Ihantola-Vormisto, A; Muurasniemi-Isoviita, L; Nikkari, Simo; Oksanen, Tuula; Pörsti, Ilkka; Salminen, Eeva

doi:10.3109/07853899009147242

Cited by 333 publications

(146 citation statements)

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“…The use of probiotics in the treatment of gastrointestinal (GI) tract disorders increased during the 1990s. Among the disorders that have been shown to benefit from probiotic treatment in placebo-controlled double-blinded studies are antibiotic-associated diarrhea, 7 traveller's diarrhea, 8 rotavirus induced diarrhea, 9 and…”

Section: Introductionmentioning

confidence: 99%

Probiotic Therapy of the Irritable Bowel Syndrome: Why Is the Evidence Still Poor and What Can Be Done About It?

Mazurak

Broelz²,

Storr

et al. 2015

J Neurogastroenterol Motil

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Background/AimsDespite numerous randomized clinical trials and meta-analyses, there is no increased evidence for the efficacy of probiotics in the treatment of irritable bowel syndrome (IBS). We review this evidence, identify and analyse the reasons for this lack of evidence and propose methodological improvements for future studies. MethodsBased on a literature search, we identified 56 papers that matched the purpose of our analyses. Twenty-seven studies used multi-species bacterial preparations and 29 used single-strain probiotics. They were analysed regarding patients included, treatment duration, probiotic dosage, and outcome measures. ResultsTrials in both groups suffered from heterogeneity with respect to probiotic concentration, duration of treatment, and other methodological issues (crossover design and underpowered studies). This heterogeneity did not allow the application of a meta-analytic approach and a systematic review was therefore performed instead. Multi-strain preparations combined 2 to 8 different bacterial subspecies, mostly lactobacilli or bifidobacteria, and used variable lengths of treatments. Overall, more than 50% of trials presented negative outcomes. The majority of the single-strain probiotic trials employing lactobacilli or Saccharomyces were negative, whereas trials employing bifidobacteria showed positive results. ConclusionsThe heterogeneity of the studies of probiotics in IBS questions the value of meta-analyses. The use of different bacterial strains and different mixtures of these strains, as well as different dosages, are the main contributors to this heterogeneity. Current data provides limited evidence for the efficacy of a small number of single-strain probiotics in IBS (mostly bifidobacteria) and

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Section: Introductionmentioning

confidence: 99%

Probiotic Therapy of the Irritable Bowel Syndrome: Why Is the Evidence Still Poor and What Can Be Done About It?

Mazurak

Broelz²,

Storr

et al. 2015

J Neurogastroenterol Motil

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“…[1][2][3][4] Overall, an estimated 15-20 million people contract travelers' diarrhea each year. 5 The U.S. military units temporarily deploying to overseas locations represent very large, identifiable groups of travelers whose infectious disease experiences have been documented in numerous investigations.…”

Section: Introductionmentioning

confidence: 99%

Pre-exposure anti-Campylobacter jejuni immunoglobulin a levels associated with reduced risk of Campylobacter diarrhea in adults traveling to Thailand.

Walz¹,

Baqar

Beecham

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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Abstract. Diarrhea history questionnaires were administered to 369 U.S. military volunteers before and after deployment to Thailand. Additionally, blood samples obtained from a subset of 221 volunteers 1-3 weeks previously and 3-4 weeks after their deployment were tested by enzyme-linked immunosorbent assay for immunoglobulin A to Campylobacter jejuni. Stool samples from personnel (including volunteers) contracting diarrhea in Thailand were cultured for enteric pathogens. Overall, 35.2% (130 of 369) of questionnaire respondents reported one or more diarrhea episodes during their trip. Volunteers with pretravel anti-C. jejuni reciprocal titers Յ 450 were 1.6 times as likely to have had diarrhea during their stay in Thailand compared with those with pretravel titers Ͼ 450 (39.7% versus 25.3%; P ϭ 0.05). The symptomatic seroconversion, or attributable Campylobacter diarrhea attack rate, for the 1-month exercise was 12.7% (28 of 221). The symptomatic seroconversion rate in nonimmune (titer Յ 450) volunteers was 17.1%, whereas that in immune volunteers was only 4.0% (P ϭ 0.002). Campylobacter jejuni or C. coli were recovered from 32.9% (56 of 170) of stool samples cultured and were the most commonly identified enteropathogens. Campylobacter diarrhea was associated with elevated temperatures, fecal red cells, and fecal white blood cells. The results of this study show that Campylobacter continues to represent a significant health threat to Western travelers to Thailand, but many of these travelers have preexisting Campylobacter immunity that protects them from clinically significant Campylobacter enteritis.

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“…Three double-blind RCT have suggested some preventive efficacy of L. rhamnosus GG and S. boulardii (Oksanen et al 1990;von Kollaritsch et al 1993;Hilton et al 1997). Unfortunately, these studies had some methodological problems and the evidence for the effect remains low.…”

Section: Traveller's Diarrhoeamentioning

confidence: 99%

Probiotics and intestinal health effects: a clinical perspective

2002

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Probiotics are viable non-pathogenic micro-organisms which, when ingested, exert a positive influence on host health or physiology. We have critically analysed the evidence for the efficacy of specific probiotic strains in human gastrointestinal diseases. The best evidence can be obtained with randomised controlled trials which avoid bias. Good evidence has been obtained with several strains in the prevention or treatment of antibiotic-associated disorders, in the treatment (and to a lesser extent prevention) of gastroenteritis and acute diarrhoea and in the alleviation of lactose intolerance. We also analysed the recent randomised controlled trials performed in patients with Clostridium difficile or Helicobacter pylori, inflammatory bowel disease, irritable bowel syndrome, non-ulcer dyspepsia and colon cancer.

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Prevention of Travellers Diarrhoea by Lactobacillus GG

Cited by 333 publications

References 4 publications

Probiotic Therapy of the Irritable Bowel Syndrome: Why Is the Evidence Still Poor and What Can Be Done About It?

Probiotic Therapy of the Irritable Bowel Syndrome: Why Is the Evidence Still Poor and What Can Be Done About It?

Pre-exposure anti-Campylobacter jejuni immunoglobulin a levels associated with reduced risk of Campylobacter diarrhea in adults traveling to Thailand.

Probiotics and intestinal health effects: a clinical perspective

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