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Ma Y, Yang D, Huang J, Liu K, Liu H, Wu H, Bao C. Probiotics for inflammatory bowel disease: Is there sufficient evidence? Open Life Sci 2024; 19:20220821. [PMID: 38585636 PMCID: PMC10998680 DOI: 10.1515/biol-2022-0821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/26/2023] [Accepted: 12/11/2023] [Indexed: 04/09/2024] Open
Abstract
Inflammatory bowel disease (IBD) refers to chronic inflammatory disorders of the gut. Ulcerative colitis (UC) and Crohn's disease (CD) are two subtypes of IBD. Evidence suggests that the intestinal microbiota plays a role in the pathogenesis of IBD, so probiotics have garnered a lot of interest as a potential treatment or prevention for IBD. However, clinical evidence of the efficacy of probiotics is still debatable. We performed a literature review. An advanced search considered clinical studies on probiotic for IBD from inception to 2023 in PubMed, Embase, Cochrane Library, and Web of Science. In the treatment of UC with probiotics, only Escherichia coli Nissle 1917 for maintenance treatment of UC in remission, and Bifidobacterium and VSL#3 for induction of remission in patients with mild to moderately active UC have shown strong evidence. Currently, there are no definitive conclusions regarding the effectiveness of probiotics in CD. The mechanism of probiotic treatment for IBD may be related to reducing oxidative stress, repairing the intestinal barrier, regulating intestinal flora balance, and modulating intestinal immune response. Differences in the benefits of probiotics between CD and UC may be attributable to the different lesion extent and immune-mediated pathophysiology. More robust randomized clinical trials are required to validate the efficacy and safety of diverse probiotic strains in IBD.
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Affiliation(s)
- Yueying Ma
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai200437, China
- Shanghai University of Traditional Chinese Medicine, Shanghai201203, China
| | - Dandan Yang
- Hong Kong Baptist University, Hong Kong999077, China
| | - Jin Huang
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai200437, China
- Shanghai University of Traditional Chinese Medicine, Shanghai201203, China
| | - Kunli Liu
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai200437, China
- Shanghai University of Traditional Chinese Medicine, Shanghai201203, China
| | - Huirong Liu
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai200437, China
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai200030, China
| | - Huangan Wu
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai200437, China
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai200030, China
| | - Chunhui Bao
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai200437, China
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai200030, China
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Anderson JL, Tierney AC, Miles C, Kotsimbos T, King SJ. Probiotic knowledge of adults with cystic fibrosis is limited but is associated with probiotic use: A cross-sectional survey study. Nutr Health 2022:2601060221136653. [PMID: 36366805 DOI: 10.1177/02601060221136653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background: Probiotics are used by people with cystic fibrosis (CF) and other chronic diseases to manage gastrointestinal symptoms. Aim: To describe probiotic knowledge; its relationship with probiotic use, probiotic information sources and factors influencing choice in adults with CF and a general population control group. Methods: A cross-sectional questionnaire study was conducted in adults with CF (n = 205) and Controls (n = 158). Probiotic knowledge was compared between CF and Controls using a knowledge score (maximum 5) based on predefined criteria: (1a) bacteria/microorganism; (1b) live; (2a) administered; (2b) adequate dose and (3) health benefit, using independent samples t-test. Two-way analysis of variance explored knowledge scores between CF and Control and between Ever User and Never User groups. Chi-square and Fisher's exact tests compared knowledge criterion, probiotic sources and influences on probiotic choice between groups. Thematic analysis of open-text responses explored probiotic-related knowledge and influences on probiotic decision making. Results: Knowledge scores (mean ± SD) did not differ between CF (1.70 ± 1.12) and Controls (1.89 ± 0.99), p = 0.13. Probiotic use was associated with knowledge score (p < 0.001). More CF Ever Users than Never Users correctly identified criteria 1a (65% vs. 38%), 1b (16% vs. 0%), 2a (45% vs. 22%) and 3 (73% vs. 42%) (all p < 0.005). CF participants considered 'dairy yoghurt' (69%), 'live cultures' (64%) and 'fermented foods' (37%) as 'all/mostly' probiotic sources. The internet was the commonest source of probiotic-related information. Conclusion: Probiotic knowledge and use were associated in adults with CF. Understanding of probiotic characteristics and sources were limited. Education is needed to help guide patient probiotic decision making.
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Affiliation(s)
- Jacqueline L Anderson
- Discipline of Food, Nutrition and Dietetics, School of Allied Health, 2080La Trobe University, Bundoora, Australia
| | - Audrey C Tierney
- Discipline of Food, Nutrition and Dietetics, School of Allied Health, 2080La Trobe University, Bundoora, Australia
- School of Allied Health, Health Implementation Science and Technology Centre, Health Research Institute, 8808University of Limerick, Limerick, Ireland
| | - Caitlin Miles
- Nutrition and Dietetics Department, 2538Monash Health, Clayton, Australia
| | - Tom Kotsimbos
- Cystic Fibrosis Service, Department of Allergy, Immunology and Respiratory Medicine, 5392Alfred Health, Melbourne, Australia
- Department of Medicine, 2541Monash University, Melbourne, Australia
| | - Susannah J King
- Discipline of Food, Nutrition and Dietetics, School of Allied Health, 2080La Trobe University, Bundoora, Australia
- Nutrition Department, 5392Alfred Health, Melbourne, Australia
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3
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Prados-Bo A, Rabassa M, Bosch M, Casino G. Online information in Spanish on probiotics, yoghurt, kefir, kombucha, fibre and prebiotics: an analysis of the quality of information and the certainty of the evidence supporting health claims. BMJ Open 2022; 12:e063316. [PMID: 35922106 PMCID: PMC9352994 DOI: 10.1136/bmjopen-2022-063316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To examine the certainty of the evidence supporting health claims about probiotics, yoghurt, kefir, kombucha, fibre and prebiotics, and to assess the quality of online information in Spanish. DESIGN Content analysis. METHODS We compiled a data set of 114 web pages by searching six popular search phrases in Spanish relating to probiotics, yoghurt, kefir, kombucha, fibre and prebiotics on Google.es and coded them for typology and health claims. We examined the certainty of the evidence for health claims from systematic reviews. Information quality was assessed according to 10 criteria, where a web page: mentions scientific publications and reports their conclusions; quantifies relative and absolute effects; acknowledges some limitations; discusses certainty of evidence; reports the potential harms, alternatives and costs; and does not argue based on personal experiences. RESULTS Gastrointestinal health (86.0%), general health (57.9%), cardiovascular health (53.5%) and immune system health (50.9%) were the most widely mentioned topics. Half of claims (52.6%, 70/133) were supported by evidence from systematic reviews. Probiotics had the highest number of claims supported by evidence and kombucha the lowest. The highest certainty was found for antibiotic-associated diarrhoea, necrotising enterocolitis and otitis (moderate) in probiotics and yoghurt, infectious diarrhoea and hepatic encephalopathy (moderate) in prebiotics, and cardiovascular health (high to moderate) and colorectal cancer (moderate) in fibre. On a scale of 0-10, the median information quality score for all web pages was 3. Only 18.4% reported study conclusions, 7.9% quantified the effects, 28.9% acknowledged some limitations in the research and 42.1% reported potential harms. CONCLUSIONS Most online health claims for dietary interventions intended for improving health through the gut microbiome are supported by low or very low certainty of evidence. Online information does not align with the evidence and is incomplete or unbalanced.
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Affiliation(s)
- Andreu Prados-Bo
- Departament de Comunicació, Universitat Pompeu Fabra, Barcelona, Spain
- Facultat de Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Montserrat Rabassa
- Unitat de Nutrició i Salut, Eurecat, Centre Tecnològic de Catalunya, Reus, Spain
| | - Mireia Bosch
- Unitat de Nutrició i Salut, Eurecat, Centre Tecnològic de Catalunya, Reus, Spain
| | - Gonzalo Casino
- Departament de Comunicació, Universitat Pompeu Fabra, Barcelona, Spain
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
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Medoro C, Cianciabella M, Magli M, Daniele GM, Lippi N, Gatti E, Volpe R, Longo V, Nazzaro F, Mattoni S, Tenaglia F, Predieri S. Food Involvement, Food Choices, and Bioactive Compounds Consumption Correlation during COVID-19 Pandemic: How Food Engagement Influences Consumers’ Food Habits. Nutrients 2022; 14:nu14071490. [PMID: 35406102 PMCID: PMC9003202 DOI: 10.3390/nu14071490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/13/2022] Open
Abstract
The containment measures due to the COVID-19 pandemic affected food-related activities, influencing dietary behavior, food habits, and dietary choices. This study aimed to compare the relationship between food involvement and dietary choices before and during the pandemic, investigating the role played by food in dietary habits. Responses given by 2773 Italian consumers to an online survey were studied through the Food Involvement Scale (FIS) and correlated to eating habits. FIS scores were then used to explain the importance given to food in circumstances related to well-being, health, and protection against COVID-19 and used to study the relationship between FIS and bioactive compound knowledge, use, and efficacy against COVID-19. The consumers more involved in food issues recognized the importance of food in circumstances related to well-being, health, and protection against COVID-19 and improved their diet during the pandemic. Moreover, consumers who gave more importance to food also revealed higher attention to the use of healthy substances, such as bioactive compounds, considering them effective against COVID-19. These results showed that food experiencing and involvement could be important elements to promote healthy dietary habits that are essential to maintain physical and mental health during emergency periods such as the COVID-19 pandemic.
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Affiliation(s)
- Chiara Medoro
- Institute for BioEconomy, National Research Council (CNR), Via Piero Gobetti 101, 40129 Bologna, Italy; (C.M.); (M.M.); (G.M.D.); (N.L.); (E.G.); (S.P.)
| | - Marta Cianciabella
- Institute for BioEconomy, National Research Council (CNR), Via Piero Gobetti 101, 40129 Bologna, Italy; (C.M.); (M.M.); (G.M.D.); (N.L.); (E.G.); (S.P.)
- Correspondence:
| | - Massimiliano Magli
- Institute for BioEconomy, National Research Council (CNR), Via Piero Gobetti 101, 40129 Bologna, Italy; (C.M.); (M.M.); (G.M.D.); (N.L.); (E.G.); (S.P.)
| | - Giulia Maria Daniele
- Institute for BioEconomy, National Research Council (CNR), Via Piero Gobetti 101, 40129 Bologna, Italy; (C.M.); (M.M.); (G.M.D.); (N.L.); (E.G.); (S.P.)
| | - Nico Lippi
- Institute for BioEconomy, National Research Council (CNR), Via Piero Gobetti 101, 40129 Bologna, Italy; (C.M.); (M.M.); (G.M.D.); (N.L.); (E.G.); (S.P.)
| | - Edoardo Gatti
- Institute for BioEconomy, National Research Council (CNR), Via Piero Gobetti 101, 40129 Bologna, Italy; (C.M.); (M.M.); (G.M.D.); (N.L.); (E.G.); (S.P.)
| | - Roberto Volpe
- Health and Safety Unit (SPP), National Research Council (CNR), Piazzale Aldo Moro, 7, 00185 Roma, Italy;
| | - Vincenzo Longo
- Institute of Agricultural Biology and Biotechnology (IBBA), National Research Council, 56124 Pisa, Italy;
| | - Filomena Nazzaro
- Institute of Food Sciences, CNR-ISA, Via Roma 64, 83100 Avellino, Italy;
| | - Silvia Mattoni
- Public Relations Unit, National Research Council (CNR), Piazzale Aldo Moro, 7, 00185 Roma, Italy;
| | - Federica Tenaglia
- Department of Biology, Agriculture and Food Sciences-DiSBA, National Research Council (CNR), Piazzale Aldo Moro, 7, 00185 Roma, Italy;
| | - Stefano Predieri
- Institute for BioEconomy, National Research Council (CNR), Via Piero Gobetti 101, 40129 Bologna, Italy; (C.M.); (M.M.); (G.M.D.); (N.L.); (E.G.); (S.P.)
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5
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Anderson JL, Tierney AC, Miles C, Kotsimbos T, King SJ. PROBIOTIC USE IN ADULTS WITH CYSTIC FIBROSIS IS COMMON AND INFLUENCED BY GASTROINTESTINAL HEALTH NEEDS: A CROSS SECTIONAL SURVEY STUDY. J Hum Nutr Diet 2022; 35:444-454. [DOI: 10.1111/jhn.12991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/10/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Jacqueline L Anderson
- Department of Dietetics, Nutrition and Sport, School of Allied Health La Trobe University Victoria Australia
| | - Audrey C Tierney
- Department of Dietetics, Nutrition and Sport, School of Allied Health La Trobe University Victoria Australia
- School of Allied Health, Health Implementation Science and Technology Centre, Health Research Institute University of Limerick Limerick Ireland
| | - Caitlin Miles
- Nutrition and Dietetics Department, Monash Health Clayton Victoria Australia
| | - Tom Kotsimbos
- Cystic Fibrosis Service, Department of Allergy, Immunology and Respiratory Medicine, Alfred Health Melbourne Victoria Australia
- Department of Medicine Monash University Melbourne Australia
| | - Susannah J King
- Department of Dietetics, Nutrition and Sport, School of Allied Health La Trobe University Victoria Australia
- Cystic Fibrosis Service, Department of Allergy, Immunology and Respiratory Medicine, Alfred Health Melbourne Victoria Australia
- Nutrition Department Alfred Health Melbourne Victoria Australia
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Cunningham M, Azcarate-Peril MA, Barnard A, Benoit V, Grimaldi R, Guyonnet D, Holscher HD, Hunter K, Manurung S, Obis D, Petrova MI, Steinert RE, Swanson KS, van Sinderen D, Vulevic J, Gibson GR. Shaping the Future of Probiotics and Prebiotics. Trends Microbiol 2021; 29:667-685. [PMID: 33551269 DOI: 10.1016/j.tim.2021.01.003] [Citation(s) in RCA: 223] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/15/2022]
Abstract
Recent and ongoing developments in microbiome science are enabling new frontiers of research for probiotics and prebiotics. Novel types, mechanisms, and applications currently under study have the potential to change scientific understanding as well as nutritional and healthcare applications of these interventions. The expansion of related fields of microbiome-targeted interventions, and an evolving landscape for implementation across regulatory, policy, prescriber, and consumer spheres, portends an era of significant change. In this review we examine recent, emerging, and anticipated trends in probiotic and prebiotic science, and create a vision for broad areas of developing influence in the field.
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Affiliation(s)
- Marla Cunningham
- Department of Science and Innovation, Metagenics, PO Box 675, Virginia BC, QLD, 4014, Australia.
| | - M Andrea Azcarate-Peril
- UNC Departments of Medicine and Nutrition, Microbiome Core Facility, University of North Carolina, Chapel Hill, NC, USA
| | | | - Valerie Benoit
- Bell Institute of Health and Nutrition, General Mills, Minneapolis, MN, USA
| | | | - Denis Guyonnet
- Diana Nova, Symrise Nutrition, Clichy-la-Garenne, France
| | - Hannah D Holscher
- Department of Food Science and Human Nutrition and Division of Nutritional Sciences, University of Illinois, Urbana, IL, USA
| | - Kirsty Hunter
- Department of Sport Science, Nottingham Trent University, UK
| | - Sarmauli Manurung
- Emerging Sciences Research, Reckitt Benckiser, Nijmegen, The Netherlands
| | - David Obis
- Danone Nutricia Research, Palaiseau Cedex, France
| | | | - Robert E Steinert
- R&D Human Nutrition and Health, DSM Nutritional Products Ltd, Basel, Switzerland; Department of Surgery, Division of Visceral and Transplantation Surgery, University Hospital Zürich, Switzerland
| | - Kelly S Swanson
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Douwe van Sinderen
- Microbiology BioSciences Institute, University College Cork, Cork, Ireland
| | - Jelena Vulevic
- veMico Ltd, Reading, UK; Department of Food and Nutritional Sciences, University of Reading, Reading, UK
| | - Glenn R Gibson
- Department of Food and Nutritional Sciences, University of Reading, Reading, UK
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7
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Faecal microbiota transplantation for Clostridioides difficile: mechanisms and pharmacology. Nat Rev Gastroenterol Hepatol 2021; 18:67-80. [PMID: 32843743 DOI: 10.1038/s41575-020-0350-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 12/14/2022]
Abstract
Faecal microbiota transplantation (FMT) has emerged as a remarkably successful treatment for recurrent Clostridioides difficile infection that cannot be cured with antibiotics alone. Understanding the complex biology and pathogenesis of C. difficile infection, which we discuss in this Perspective, is essential for understanding the potential mechanisms by which FMT cures this disease. Although FMT has already entered clinical practice, different microbiota-based products are currently in clinical trials and are vying for regulatory approval. However, all these therapeutics belong to an entirely new class of agents that require the development of a new branch of pharmacology. Characterization of microbiota therapeutics uses novel and rapidly evolving technologies and requires incorporation of microbial ecology concepts. Here, we consider FMT within a pharmacological framework, including its essential elements: formulation, pharmacokinetics and pharmacodynamics. From this viewpoint, multiple gaps in knowledge become apparent, identifying areas that require systematic research. This knowledge is needed to help clinical providers use microbiota therapeutics appropriately and to facilitate development of next-generation microbiota products with improved safety and efficacy. The discussion here is limited to FMT as a representative of microbiota therapeutics and recurrent C. difficile as the indication; however, consideration of the intrinsic basic principles is relevant to this entire class of microbiota-based therapeutics.
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Britton RA, Hoffmann DE, Khoruts A. Probiotics and the Microbiome-How Can We Help Patients Make Sense of Probiotics? Gastroenterology 2021; 160:614-623. [PMID: 33307023 DOI: 10.1053/j.gastro.2020.11.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/01/2020] [Accepted: 11/03/2020] [Indexed: 12/19/2022]
Abstract
The notion of probiotics as microbes that confer health benefits has its origins in the speculative ideas that are more than a century old, yet remain largely unsubstantiated by scientific evidence. The recent advances in microbiome science have highlighted the importance of intestinal microbes in human physiology and disease pathogenesis. These developments have provided a boost to the probiotics industry, which continues to experience exponential growth driven mainly by creative marketing. Consumers, patients, and most health care providers are not able to discern the underlying science or differentiate the permitted claims that promise vague health benefits from disease-specific claims reserved for drugs. No probiotic product has been able to satisfy the regulatory requirements to be categorized as a drug, a substance intended to cure, mitigate, or prevent disease. However, patients take probiotic products in the belief that they will help to treat their intestinal or systemic diseases. Thus far, the regulators have failed to create policies that would assist to inform the public in this area. In fact, the existing regulatory regime actually creates formidable barriers to research that could provide evidence for clinical efficacy of probiotic products. We propose a potential solution to this vexing problem, where a committee created through a partnership of academia, professional organizations, and industry, but free of potential conflicts of interest, would be charged with rigorous evaluation of specific probiotic products and the evidence in support of their different claims. Companies that would submit to this process would earn the trust of consumers and healthcare providers, as well as a distinction in the marketplace.
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Affiliation(s)
- Robert A Britton
- Department of Molecular Virology and Microbiology, Alkek Center for Metagenomics and Microbiome Research, Dan Duncan Cancer Center Member, Baylor College of Medicine, Houston, Texas
| | - Diane E Hoffmann
- University of Maryland Francis King Carey School of Law, Baltimore, Maryland
| | - Alexander Khoruts
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Center for Immunology, BioTechnology Institute, University of Minnesota, Minneapolis, Minnesota.
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Affiliation(s)
- Alexander Khoruts
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Center for Immunology, BioTechnology Institute, University of Minnesota, Minneapolis, Minnesota
| | - Diane E Hoffmann
- University of Maryland Francis King Carey School of Law, Baltimore, Maryland
| | - Robert A Britton
- Department of Molecular Virology and Microbiology, Alkek Center for Metagenomics and Microbiome Research, Dan Duncan Cancer Center Member, Baylor College of Medicine, Houston, Texas
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10
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European General Practitioners perceptions on probiotics: Results of a multinational survey. PHARMANUTRITION 2020. [DOI: 10.1016/j.phanu.2020.100178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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11
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Probiotics for Childhood Functional Gastrointestinal Disorders: Do We Know What We Advise? PHARMANUTRITION 2019. [DOI: 10.1016/j.phanu.2019.100160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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12
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Moayyedi P, Andrews CN, MacQueen G, Korownyk C, Marsiglio M, Graff L, Kvern B, Lazarescu A, Liu L, Paterson WG, Sidani S, Vanner S. Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable Bowel Syndrome (IBS). J Can Assoc Gastroenterol 2019; 2:6-29. [PMID: 31294724 PMCID: PMC6507291 DOI: 10.1093/jcag/gwy071] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/04/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND & AIMS Irritable bowel syndrome (IBS) is one of the most common gastrointestinal (GI) disorders, affecting about 10% of the general population globally. The aim of this consensus was to develop guidelines for the management of IBS. METHODS A systematic literature search identified studies on the management of IBS. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Statements were developed through an iterative online platform and then finalized and voted on by a multidisciplinary group of clinicians and a patient. RESULTS Consensus was reached on 28 of 31 statements. Irritable bowel syndrome is diagnosed based on symptoms; serological testing is suggested to exclude celiac disease, but routine testing for C-reactive protein (CRP), fecal calprotectin or food allergies is not recommended. A trial of a low fermentable oligosaccharides, disaccharides, monosaccharides, polyols (FODMAP) diet is suggested, while a gluten-free diet is not. Psyllium, but not wheat bran, supplementation may help reduce symptoms. Alternative therapies such as peppermint oil and probiotics are suggested, while herbal therapies and acupuncture are not. Cognitive behavioural therapy and hypnotherapy are suggested psychological therapies. Among the suggested or recommended pharmacological therapies are antispasmodics, certain antidepressants, eluxadoline, lubiprostone, and linaclotide. Loperamide, cholestyramine and osmotic laxatives are not recommended for overall IBS symptoms. The nature of the IBS symptoms (diarrhea-predominant or constipation-predominant) should be considered in the choice of pharmacological treatments. CONCLUSIONS Patients with IBS may benefit from a multipronged, individualized approach to treatment, including dietary modifications, psychological and pharmacological therapies.
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Affiliation(s)
- Paul Moayyedi
- Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada
| | | | - Glenda MacQueen
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Christina Korownyk
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Lesley Graff
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brent Kvern
- Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Adriana Lazarescu
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Louis Liu
- Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
| | - William G Paterson
- Division of Gastroenterology, Queen’s University, Kingston, Ontario, Canada
| | - Sacha Sidani
- Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada
| | - Stephen Vanner
- Division of Gastroenterology, Queen’s University, Kingston, Ontario, Canada
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Teoh SL, Ngorsuraches S, Lai NM, Bangpan M, Chaiyakunapruk N. Factors affecting consumers' decisions on the use of nutraceuticals: a systematic review. Int J Food Sci Nutr 2019; 70:491-512. [PMID: 30634867 DOI: 10.1080/09637486.2018.1538326] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
There is a high and increasing global prevalence of nutraceuticals use. This study aims to systematically review and critically appraise all available evidence to identify the factors affecting consumers' decisions in taking nutraceuticals. Questionnaire, interview or focus group studies which directly reported factors affecting consumers' decisions in using nutraceuticals were included. A thematic synthesis method was employed to synthesis the findings from the included studies. Out of the 76 studies included, the key factors identified as the most important factors motivating consumers to take nutraceuticals were the perceived health benefits and safety of nutraceuticals, as well as the advice from healthcare professionals, friends and family. The identified barriers to take nutraceuticals were a lack of belief in the health benefit of nutraceuticals, the high cost of nutraceuticals and consumers' lack of knowledge about nutraceuticals. As a chief course of recommendation for the use of nutraceuticals, healthcare professionals should strive to utilise reliable information from clinical evidence to help consumers in making an informed decision in using nutraceuticals. Future studies should explore the possible ways to improve channelling clinical evidence information of nutraceuticals to the public.
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Affiliation(s)
- Siew Li Teoh
- a School of Pharmacy , Monash University Malaysia , Selangor , Malaysia
| | - Surachat Ngorsuraches
- b Department of Health Outcomes Research and Policy, Harrison School of Pharmacy , Auburn University , Auburn , AL , USA
| | - Nai Ming Lai
- c School of Medicine , Taylor's University Malaysia , Selangor , Malaysia.,d Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia Platform in the 21st Century (GA21) Platform , Monash University Malaysia , Bandar Sunway , Selangor , Malaysia
| | - Mukdarut Bangpan
- e Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Department of Social Science, UCL Institute of Education , University College London , London , UK
| | - Nathorn Chaiyakunapruk
- a School of Pharmacy , Monash University Malaysia , Selangor , Malaysia.,d Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia Platform in the 21st Century (GA21) Platform , Monash University Malaysia , Bandar Sunway , Selangor , Malaysia.,f Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences , Naresuan University , Phitsanulok , Thailand.,g School of Pharmacy , University of Wisconsin , Madison , WI , USA
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Sniffen JC, McFarland LV, Evans CT, Goldstein EJC. Choosing an appropriate probiotic product for your patient: An evidence-based practical guide. PLoS One 2018; 13:e0209205. [PMID: 30586435 PMCID: PMC6306248 DOI: 10.1371/journal.pone.0209205] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/30/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Clinicians and patients face a daunting task when choosing the most appropriate probiotic for their specific needs. Available preparations encompass a diverse and continuously expanding product base, with most available products lacking evidence-based trials that support their use. Even when evidence exists, not all probiotic products are equally effective for all disease prevention or treatment indications. At this point in time, drug regulatory agencies offer limited assistance with regard to guidance and oversight in most countries, including the U.S. METHODS We reviewed the current medical literature and sources on the internet to survey the types of available probiotic products and to determine which probiotics had evidence-based efficacy data. Standard medical databases from inception to June 2018 were searched and discussions with experts in the field were conducted. We graded the strength of the evidence for probiotics having multiple, randomized controlled trials and developed a guide for the practical selection of current probiotic products for specific uses. RESULTS We found the efficacy of probiotic products is both strain-specific and disease-specific. Important factors involved in choosing the appropriate probiotic include matching the strain(s) with the targeted disease or condition, type of formulation, dose used and the source (manufacturing quality control and shelf-life). While we found many probiotic products lacked confirmatory trials, we found sufficient evidence for 22 different types of probiotics from 249 trials to be included. For example, several types of probiotics had strong evidence for the prevention of antibiotic-associated diarrhea [Saccharomyces boulardii I-745, a three-strain mixture (Lactobacillus acidophilus CL1285, L. casei Lbc80r, L. rhamnosus CLR2) and L. casei DN114001]. Strong evidence was also found for four types of probiotics for the prevention of a variety of other diseases/conditions (enteral-feed associated diarrhea, travellers' diarrhea, necrotizing enterocolits and side-effects associated with H. pylori treatments. The evidence was most robust for the treatment of pediatric acute diarrhea based on 59 trials (7 types of probiotics have strong efficacy), while an eight-strain multi-strain mixture showed strong efficacy for inflammatory bowel disease and two types of probiotics had strong efficacy for irritable bowel disease. Of the 22 types of probiotics reviewed, 15 (68%) had strong-moderate evidence for efficacy for at least one type of disease. CONCLUSION The choice of an appropriate probiotic is multi-factored, based on the mode and type of disease indication and the specific efficacy of probiotic strain(s), as well as product quality and formulation. TRIAL REGISTRATION This review was registered with PROSPERO: CRD42018103979.
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Affiliation(s)
- Jason C. Sniffen
- Department of Internal Medicine, Infectious Disease Section, Florida Hospital Orlando, Orlando, FL, United States of America
| | - Lynne V. McFarland
- Department of Medicinal Chemistry, School of Pharmacy, University of Washington Medical Center, Seattle, Washington United States of America
| | - Charlesnika T. Evans
- Department of Preventive Medicine and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Veterans Affairs (VA), Center of Innovation of Complex Chronic Healthcare (CINCCH), Edward Hines, Jr. VA Hospital, Hines, IL, United States of America
| | - Ellie J. C. Goldstein
- RM Alden Research Laboratory and David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
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Chey WD, Whelan K. Dietary guidelines for irritable bowel syndrome are important for gastroenterologists, dietitians and people with irritable bowel syndrome. J Hum Nutr Diet 2018; 29:547-8. [PMID: 27599641 DOI: 10.1111/jhn.12413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- William D Chey
- University of Michigan Health System, Division of Gastroenterology, Michigan, USA
| | - Kevin Whelan
- King's College London, Diabetes and Nutritional Sciences Division, London, UK.
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McKenzie YA, Thompson J, Gulia P, Lomer MCE. British Dietetic Association systematic review of systematic reviews and evidence-based practice guidelines for the use of probiotics in the management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet 2016; 29:576-92. [DOI: 10.1111/jhn.12386] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | - P. Gulia
- Dr Ashok Ayurveda Clinic; Birmingham UK
| | - M. C. E. Lomer
- Diabetes and Nutritional Sciences Division; King's College London; London UK
- Department of Nutrition and Dietetics; Guy's and St Thomas' NHS Foundation Trust; London UK
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Hosseini SV, Taghavi SA, Jafari P, Rezaianzadeh A, Moini M, Mehrabi M, Sepehrimanesh M, Safarpour AR. Incidence of Ulcerative Colitis Relapse: A Prospective Cohort Study in Southern Iran. ACTA ACUST UNITED AC 2016. [DOI: 10.17795/acr-34565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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McFarland LV. From yaks to yogurt: the history, development, and current use of probiotics. Clin Infect Dis 2016; 60 Suppl 2:S85-90. [PMID: 25922406 DOI: 10.1093/cid/civ054] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The development of probiotics, which are living bacteria or yeasts used to confer a health benefit on the host, has paralleled our research in food preservation, microbiologic identification techniques, and our understanding of how the complex interactions in microbiota impact the host's health and recovery from disease. This review briefly describes the history of probiotics, where probiotic strains were originally isolated, and the types of probiotic products currently available on the global market. In addition, the uses or indications for these probiotics are described, along with the types of clinical investigations that have been done. Continuing challenges persist for the proper probiotic strain identification, regulatory pathways, and how healthcare providers can choose a specific strain to recommend to their patients.
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Affiliation(s)
- Lynne V McFarland
- Department of Medicinal Chemistry, University of Washington, Seattle
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Zhang L, Zhang W, Hou SC. Nutritional support in inflammatory bowel disease. Shijie Huaren Xiaohua Zazhi 2015; 23:5427-5434. [DOI: 10.11569/wcjd.v23.i34.5427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is a group of autoimmune diseases mainly characterized by chronic inflammation in the small and large intestine. The incidence and prevalence of IBD are high and stable. Since IBD is characterized by the wide range of lesions, recurrence, long duration, severe gastrointestinal symptoms and metabolic change, IBD patients often have nutritional disorders. The drug use and surgical operation in the process of IBD treatment will further aggravate nutritional disorders. Therefore, proper nutrition support in IBD is of great value and significance for the recovery and prognosis of the disease.
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Affiliation(s)
- Graeme D Smith
- Edinburgh Napier University, discusses the existing evidence for the use of probiotics in the treatment of GI conditions
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Saez-Lara MJ, Gomez-Llorente C, Plaza-Diaz J, Gil A. The role of probiotic lactic acid bacteria and bifidobacteria in the prevention and treatment of inflammatory bowel disease and other related diseases: a systematic review of randomized human clinical trials. BIOMED RESEARCH INTERNATIONAL 2015; 2015:505878. [PMID: 25793197 PMCID: PMC4352483 DOI: 10.1155/2015/505878] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 09/04/2014] [Accepted: 09/12/2014] [Indexed: 12/17/2022]
Abstract
Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is a chronic inflammation of the small intestine and colon caused by a dysregulated immune response to host intestinal microbiota in genetically susceptible subjects. A number of fermented dairy products contain lactic acid bacteria (LAB) and bifidobacteria, some of which have been characterized as probiotics that can modify the gut microbiota and may be beneficial for the treatment and the prevention of IBD. The objective of this review was to carry out a systematic search of LAB and bifidobacteria probiotics and IBD, using the PubMed and Scopus databases, defined by a specific equation using MeSH terms and limited to human clinical trials. The use of probiotics and/or synbiotics has positive effects in the treatment and maintenance of UC, whereas in CD clear effectiveness has only been shown for synbiotics. Furthermore, in other associated IBD pathologies, such as pouchitis and cholangitis, LAB and bifidobacteria probiotics can provide a benefit through the improvement of clinical symptoms. However, more studies are needed to understand their mechanisms of action and in this way to understand the effect of probiotics prior to their use as coadjuvants in the therapy and prevention of IBD conditions.
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Affiliation(s)
- Maria Jose Saez-Lara
- Department of Biochemistry & Molecular Biology I, School of Sciences, University of Granada, 18071 Granada, Spain
- Institute of Nutrition & Food Technology “José Mataix”, Biomedical Research Center, University of Granada, 18100 Armilla, Spain
| | - Carolina Gomez-Llorente
- Institute of Nutrition & Food Technology “José Mataix”, Biomedical Research Center, University of Granada, 18100 Armilla, Spain
- Department of Biochemistry & Molecular Biology II, School of Pharmacy, University of Granada, 18071 Granada, Spain
| | - Julio Plaza-Diaz
- Institute of Nutrition & Food Technology “José Mataix”, Biomedical Research Center, University of Granada, 18100 Armilla, Spain
- Department of Biochemistry & Molecular Biology II, School of Pharmacy, University of Granada, 18071 Granada, Spain
| | - Angel Gil
- Institute of Nutrition & Food Technology “José Mataix”, Biomedical Research Center, University of Granada, 18100 Armilla, Spain
- Department of Biochemistry & Molecular Biology II, School of Pharmacy, University of Granada, 18071 Granada, Spain
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Baty V, Mougin B, Dekeuwer C, Carret G. Gut Health in the era of the human gut microbiota: from metaphor to biovalue. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2014; 17:579-597. [PMID: 24610296 DOI: 10.1007/s11019-014-9552-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The human intestinal ecosystem, previously called the gut microflora is now known as the Human Gut Microbiota (HGM). Microbiome research has emphasized the potential role of this ecosystem in human homeostasis, offering unexpected opportunities in therapeutics, far beyond digestive diseases. It has also highlighted ethical, social and commercial concerns related to the gut microbiota. As diet factors are accepted to be the major regulator of the gut microbiota, the modulation of its composition, either by antibiotics or by food intake, should be regarded as a fascinating tool for improving the human health. Scientists, the food industry, consumers and policymakers alike are involved in this new field of nutrition. Defining how knowledge about the HGM is being translated into public perception has never been addressed before. This raises the question of metaphors associated with the HGM, and how they could be used to improve public understanding, and to influence individual decision-making on healthcare policy. This article suggests that a meeting of stakeholders from the social sciences, basic research and the food industry, taking an epistemological approach to the HGM, is needed to foster close, innovative partnerships that will help shape public perception and enable novel behavioural interventions that would benefit public health.
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Affiliation(s)
- Vincent Baty
- Service de Gastroentérologie, Clinique Mutualiste, 107 rue Trarieux, 69003, Lyon, France,
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Editorial: The importance of systematic reviews and meta-analyses of probiotics and prebiotics. Am J Gastroenterol 2014; 109:1563-5. [PMID: 25287086 DOI: 10.1038/ajg.2014.258] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Irritable bowel syndrome (IBS) and chronic idiopathic constipation are prevalent and burdensome gastrointestinal disorders. A systematic review and meta-analysis of the evidence for probiotics, prebiotics, and synbiotics in IBS and chronic idiopathic constipation has recently been performed. By far, the most convincing evidence was for the use of probiotics in IBS, which reported that overall probiotics reduced the risk of symptom persistence by 21%. However, only a minority of the trials were at a low risk of bias, and some used small sample sizes. Meta-analysis is a powerful tool to combine individual small trials to improve the power to detect the direction, size, and consistency of an effect, but it can do little to overcome the poor design of individual trials. Many debate the use of meta-analysis to combine data from different probiotic species, strains, or combinations. It is recommended that all future meta-analyses of probiotics, in any clinical setting, perform subgroup analysis on specific species/strains and specific combinations. It is hoped that the current meta-analysis will empower clinicians in making evidence-based decisions regarding whether probiotics should be recommended for IBS, which species/strain(s) to use, and for which symptoms.
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Bridgman SL, Azad MB, Field CJ, Letourneau N, Johnston DW, Kaplan BJ, Kozyrskyj AL. Maternal perspectives on the use of probiotics in infants: a cross-sectional survey. Altern Ther Health Med 2014; 14:366. [PMID: 25267264 PMCID: PMC4193129 DOI: 10.1186/1472-6882-14-366] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 08/27/2014] [Indexed: 01/09/2023]
Abstract
Background Probiotic products that may modify the intestinal microbiota are becoming increasingly available and known to consumers due to their potential to prevent or treat many pediatric health conditions. As scientific knowledge of the health benefits of probiotics increases, it is important to identify factors that may prevent their successful integration into patient care as well as to ensure effective translation of research findings. The aim of this study was to describe maternal perspectives on probiotics and their use in infants. Methods Mothers with a child aged two years or younger enrolled in the Alberta Pregnancy Outcomes and Nutrition (APrON) study were invited by email to complete a 29 item self-administered web-based questionnaire. Results A total of 413 mothers of the 1327 contacted completed the questionnaire. The majority (99.3%) of respondents had heard of probiotics and were aware that they contained live bacteria (87.0%); 89.3% had used a product containing probiotics themselves but only 50.8% had given one to their infant. Most mothers indicated they believed that probiotics were beneficial (73.1%) and none thought they were harmful. Over a third of mothers did not feel informed enough to make a decision on whether probiotics were safe to use in infants (36.6%). Conclusions The study demonstrates that awareness and understanding of probiotics is high among mothers in Alberta, Canada. However, there is still uncertainty regarding the benefit of probiotics as well as safety in infants which could be important factors determining therapeutic use in the future. Further studies that demonstrate beneficial effects and safety of probiotics in healthy infants as well as targeted knowledge translation should help to address these potential concerns.
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Wall GC, Bryant GA, Bottenberg MM, Maki ED, Miesner AR. Irritable bowel syndrome: a concise review of current treatment concepts. World J Gastroenterol 2014; 20:8796-806. [PMID: 25083054 PMCID: PMC4112883 DOI: 10.3748/wjg.v20.i27.8796] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 03/04/2014] [Accepted: 06/14/2014] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders causing patients to seek medical treatment. It is relatively resource intensive and the source of significant morbidity. Recent insights into the pathophysiology and treatment of IBS has given clinicians more options than ever to contend with this disorder. The purpose of our paper is to review older, "classic" treatments for IBS as well as newer agents and "alternative" therapies. We discuss the evidence base of these drugs and provide context to help develop appropriate treatment plans for IBS patients.
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27
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Lundgren L, Moberg C, Lidén C. Do insulation products of man-made vitreous fibres still cause skin discomfort? Contact Dermatitis 2014; 70:351-60. [PMID: 24684557 PMCID: PMC4264943 DOI: 10.1111/cod.12178] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/02/2013] [Accepted: 11/06/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Man-made vitreous fibres (MMVFs) are used in products for insulation and as reinforcement in materials. Contamination of the skin may arise through direct or indirect contact, and from the deposition of airborne fibres. The scientific basis regarding the effects on skin of MMVFs dates from 1970-1980. OBJECTIVES To investigate whether currently used insulation MMVF products still cause skin discomfort. METHODS Focus group interviews and structured interviews were performed among workers engaged in insulation tasks and among do-it-yourself consumers with a recent experience of MMVF products. RESULTS A majority of interviewees experienced skin discomfort when handling MMVF products. Complaints caused by traditional (yellow) glass fibre products were more severe than those caused by products of rock or slag wool fibres. The wrists, forearms, neck and face were the locations where the skin was most affected. The situations causing problems varied between occupational tasks, but working with the hands over the head or in narrow spaces were described as the worst situations. Building construction apprentices performed insulation tasks more often than senior workers. CONCLUSIONS MMVF insulation products do still cause skin discomfort. Updated knowledge about people's experiences of work with such products should influence legislation.
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Affiliation(s)
- Lennart Lundgren
- Department of Applied Environmental Science, Stockholm UniversitySE-106 91 Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska InstitutetSE-171 77 Stockholm, Sweden
| | - Cecilia Moberg
- Institute of Environmental Medicine, Karolinska InstitutetSE-171 77 Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska InstitutetSE-141 83 Huddinge, Sweden
| | - Carola Lidén
- Institute of Environmental Medicine, Karolinska InstitutetSE-171 77 Stockholm, Sweden
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Asking patients the right questions about herbal and dietary supplements: Cross cultural perspectives. Complement Ther Med 2014; 22:304-10. [DOI: 10.1016/j.ctim.2014.01.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 01/05/2014] [Accepted: 01/07/2014] [Indexed: 11/19/2022] Open
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Chin-Lee B, Curry WJ, Fetterman J, Graybill MA, Karpa K. Patient experience and use of probiotics in community-based health care settings. Patient Prefer Adherence 2014; 8:1513-20. [PMID: 25382972 PMCID: PMC4222242 DOI: 10.2147/ppa.s72276] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To investigate patient experience with probiotics and factors that influence probiotic use among adult patients. METHOD Patients were invited to complete a questionnaire that assessed their experiences and opinions regarding probiotics. Questionnaires were distributed to patients seeking primary health care services at a family and community medicine practice site and a community pharmacy. Patients were invited to complete the questionnaire while awaiting the physician or waiting for prescriptions to be filled. RESULTS Overall, 162 surveys were completed and returned (66% response rate) from patients aged 18 to 89 years of age (mean 49.5 years). Most patients (n=107; 65%) were familiar with the term "probiotic", and 49 patients (29.9%) had personally used the supplements in the past. Of those who had used probiotics, the majority (57%) had used the supplements to maintain "good gastrointestinal health" and most (59%) felt that the supplements had been beneficial. However, most (59%) had not informed their health care provider about their use of the supplements. CONCLUSION Use of probiotic supplements is common among consumers, but may not be reported to health care providers.
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Affiliation(s)
- Blake Chin-Lee
- Department of Family and Community Medicine, Pennsylvania State University, College of Medicine Hershey, PA, USA
| | - William J Curry
- Department of Family and Community Medicine, Pennsylvania State University, College of Medicine Hershey, PA, USA
| | - John Fetterman
- Department of Pharmacology, Pennsylvania State University, College of Medicine Hershey, PA, USA
| | - Marie A Graybill
- Department of Family and Community Medicine, Pennsylvania State University, College of Medicine Hershey, PA, USA
| | - Kelly Karpa
- Department of Pharmacology, Pennsylvania State University, College of Medicine Hershey, PA, USA
- Correspondence: Kelly Karpa, Pennsylvania State University, Department of Pharmacology, College of Medicine, 500 University Drive, Mailcode R130, Hershey, PA, USA 17033, Tel +1 717 531 1621, Fax +1 717 533 2006, Email
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Hungin APS, Mulligan C, Pot B, Whorwell P, Agréus L, Fracasso P, Lionis C, Mendive J, Philippart de Foy JM, Rubin G, Winchester C, Wit N. Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice -- an evidence-based international guide. Aliment Pharmacol Ther 2013; 38:864-86. [PMID: 23981066 PMCID: PMC3925990 DOI: 10.1111/apt.12460] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 07/18/2013] [Accepted: 07/31/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Evidence suggests that the gut microbiota play an important role in gastrointestinal problems. AIM To give clinicians a practical reference guide on the role of specified probiotics in managing particular lower gastrointestinal symptoms/problems by means of a systematic review-based consensus. METHODS Systematic literature searching identified randomised, placebo-controlled trials in adults; evidence for each symptom/problem was graded and statements developed (consensus process; 10-member panel). As results cannot be generalised between different probiotics, individual probiotics were identified for each statement. RESULTS Thirty seven studies were included; mostly on irritable bowel syndrome [IBS; 19 studies; treatment responder rates: 18-80% (specific probiotics), 5-50% (placebo)] or antibiotic-associated diarrhoea (AAD; 10 studies). Statements with 100% agreement and 'high' evidence levels indicated that: (i) specific probiotics help reduce overall symptom burden and abdominal pain in some IBS patients; (ii) in patients receiving antibiotics/Helicobacter pylori eradication therapy, specified probiotics are helpful as adjuvants to prevent/reduce the duration/intensity of AAD; (iii) probiotics have favourable safety in patients in primary care. Items with 70-100% agreement and 'moderate' evidence were: (i) specific probiotics help relieve overall symptom burden in some patients with diarrhoea-predominant IBS, and reduce bloating/distension and improve bowel movement frequency/consistency in some IBS patients and (ii) with some probiotics, improved symptoms have led to improvement in quality of life. CONCLUSIONS Specified probiotics can provide benefit in IBS and antibiotic-associated diarrhoea; relatively few studies in other indications suggested benefits warranting further research. This study provides practical guidance on which probiotic to select for a specific problem.
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Affiliation(s)
- A P S Hungin
- School of Medicine, Pharmacy and Health, Durham UniversityStockton-on-Tees, UK
| | - C Mulligan
- School of Medicine, Pharmacy and Health, Durham UniversityStockton-on-Tees, UK,Research Evaluation Unit, Oxford PharmaGenesis™ LtdOxford, UK
| | - B Pot
- Institut Pasteur de Lille, Centre for Infection and Immunity of LilleLille, France,Université Lille Nord de FranceLille, France,CNRS UMR 8204Lille, France,INSERM U1019Lille, France
| | - P Whorwell
- Centre for Gastrointestinal Sciences, University of Manchester, Wythenshawe HospitalManchester, UK
| | - L Agréus
- Centre for Family Medicine, Karolinska InstituteStockholm, Sweden
| | - P Fracasso
- Gastroenterology Unit, Don Bosco Outpatient ClinicRome, Italy
| | - C Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of CreteHeraklion, Greece
| | - J Mendive
- La Mina Primary Care CentreBarcelona, Spain
| | - J-M Philippart de Foy
- Nutrition Committee of the Scientific Society of General Practice (SSMG, Belgium)Brussels, Belgium
| | - G Rubin
- School of Medicine, Pharmacy and Health, Durham UniversityStockton-on-Tees, UK
| | - C Winchester
- Research Evaluation Unit, Oxford PharmaGenesis™ LtdOxford, UK
| | - N Wit
- Nutrition Committee of the Scientific Society of General Practice (SSMG, Belgium)Brussels, Belgium
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Dasgupta S, Kasper DL. Relevance of commensal microbiota in the treatment and prevention of inflammatory bowel disease. Inflamm Bowel Dis 2013; 19:2478-89. [PMID: 23846489 DOI: 10.1097/mib.0b013e318297d884] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Commensal microbiota that reside primarily in the gut of mammals influence the hosts' health to a great extent. Shaping of host immunity locally, a vital component of this influence, can have pro-inflammatory, anti-inflammatory, or neutral outcomes, presumably depending on the composition of the microbiota in an individual and type of molecules expressed in the individual members of the microbiota. Thus, these microbial species can be thought of as a reservoir of molecules that can be used to improve or worsen the condition of patients suffering from immunity or inflammation-driven pathologies like inflammatory bowel disease. In the current review, we elaborate, based on the literature available from murine models of disease and clinical case studies, the need to identify individual members of commensal microbiota that can precipitate or resolve inflammatory bowel disease. Therapeutic approaches could entail enrichment of members of microbiota (or molecules from these microbes), which induces expansion or enhancement of function of regulatory T cells or tolerogenic dendritic cells and reduce members that cause inflammation either directly or indirectly by influencing metabolic and other host molecules. Efficiency of bacteria-driven therapy would potentially be enhanced as we refine our approaches from the use of complete feces as done in fecal transplantation to utilization of microbiota-derived molecules as exemplified by the capsular polysaccharide A from the human gut commensal Bacteroides fragilis. We also highlight the advantages and disadvantages of each approach, defining a natural alternative to the current chemical-based immunosuppressive regimen for patients with inflammatory bowel disease.
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Affiliation(s)
- Suryasarathi Dasgupta
- Division of Immunology, Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts
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Foligné B, Daniel C, Pot B. Probiotics from research to market: the possibilities, risks and challenges. Curr Opin Microbiol 2013; 16:284-92. [PMID: 23866974 DOI: 10.1016/j.mib.2013.06.008] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 06/20/2013] [Accepted: 06/25/2013] [Indexed: 12/13/2022]
Abstract
Probiotic foods can affect large parts of the population, while therapeutic applications have a less wide scope. While commercialization routes and regulatory requirements differ for both applications, both will need good scientific support. Today, probiotics are mainly used for gastrointestinal applications, their use can easily be extended to skin, oral and vaginal health. While most probiotics currently belong to food-grade species, the future may offer new functional microorganisms in food and pharma. This review discusses the crosstalk between probiotic producers, regulatory people, medical care and healthcare workers, and the scientific community.
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Affiliation(s)
- Benoit Foligné
- Institut Pasteur de Lille, Lactic acid Bacteria & Mucosal Immunity, Center for Infection and Immunity of Lille, 1, rue du Pr Calmette, BP 245, F-59019 Lille, France
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Navarro-Rodriguez T, Silva FM, Barbuti RC, Mattar R, Moraes-Filho JP, de Oliveira MN, Bogsan CS, Chinzon D, Eisig JN. Association of a probiotic to a Helicobacter pylori eradication regimen does not increase efficacy or decreases the adverse effects of the treatment: a prospective, randomized, double-blind, placebo-controlled study. BMC Gastroenterol 2013; 13:5. [PMID: 23311418 PMCID: PMC3558380 DOI: 10.1186/1471-230x-13-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 12/28/2012] [Indexed: 12/17/2022] Open
Abstract
Internet websites are a resource for patients seeking information about probiotics. We examined a sample of 71 websites presenting probiotic information. We found that descriptions of benefits far outnumbered descriptions of risks and commercial websites presented significantly fewer risks than noncommercial websites. The bias towards the presentation of therapeutic benefits in online content suggests that patients are likely interested in using probiotics and may have unrealistic expectations for therapeutic benefit. Gastroenterologists may find it useful to initiate conversations about probiotics within the context of a comprehensive health management plan and should seek to establish realistic therapeutic expectations with their patients.
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Affiliation(s)
- Tomás Navarro-Rodriguez
- Serviço de Gastroenterologia Clínica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av, Dr, Enéas de Carvalho Aguiar, 255-Cerqueira Cezar, São Paulo, SP, Brazil.
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Abstract
PURPOSE OF REVIEW There is direct evidence that the pathogenesis of inflammatory bowel disease (IBD) involves the gastrointestinal microbiota and some evidence that the microbiota might also play a similar role in irritable bowel syndrome (IBS). The aim of this article is to review the emerging evidence for the mechanisms and effectiveness of probiotics in the management of these disorders. RECENT FINDINGS The composition of the gastrointestinal microbiota is strongly influenced by factors including age, diet and disease. Probiotics may be effective through their impact on the host gastrointestinal microbiota and promotion of mucosal immunoregulation. Probiotics are considered to be well tolerated, although the quality of studies and health claims has been variable. There are many short-term studies demonstrating the effectiveness of probiotics in IBS, although recommendations should be made for specific strains and for specific symptoms. Within IBD, a number of trials have shown the benefits of a range of probiotics in pouchitis and in ulcerative colitis, although current evidence in Crohn's disease is less promising. SUMMARY Clearly, some probiotics have considerable potential in the management of IBS and IBD; however, the benefits are strain specific. High-quality trials of probiotics in gastrointestinal disorders as well as laboratory investigations of their mechanism of action are required in order to understand who responds and why.
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Lindfors P, Ljótsson B, Bjornsson E, Abrahamsson H, Simrén M. Patient satisfaction after gut-directed hypnotherapy in irritable bowel syndrome. Neurogastroenterol Motil 2013; 25:169-e86. [PMID: 23051178 DOI: 10.1111/nmo.12022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gut-directed hypnotherapy is an effective treatment option for irritable bowel syndrome (IBS). However, clinical observations suggest that patient satisfaction with hypnotherapy is not always associated with improvement in IBS symptoms. METHODS We evaluated 83 patients with IBS treated with gut-directed hypnotherapy (1 h week(-1), 12 weeks). After the treatment period, patients reported their satisfaction with the treatment (ranging from 1 = not at all satisfied, to 5 = very satisfied) and completed questionnaires to assess IBS symptom severity, quality of life, cognitive function, sense of coherence, depression, and anxiety before and after treatment. KEY RESULTS After hypnotherapy improved IBS symptom severity, quality of life, cognitive function, and anxiety were seen. Thirty patients (36%) were very satisfied with the treatment and 57 (69%) patients scored 4 or 5 on the patient satisfaction scale. Patient satisfaction was associated with less severe IBS symptoms and better quality of life after the treatment. In a multiple linear regression analysis, only the quality of life domain sexual relations was independently associated with patient satisfaction after hypnotherapy, explaining 22% of the variance. Using 25% reduction of IBS symptom severity to define an IBS symptom responder, 52% of the responders were very satisfied with hypnotherapy, but this was also true for 31% in the non-responder group. CONCLUSIONS & INFERENCES Patient satisfaction with gut-directed hypnotherapy in IBS is associated with improvement of quality of life and gastrointestinal (GI) symptoms. However, other factors unrelated to GI symptoms also seems to be of importance for patient satisfaction, as a substantial proportion of patients without GI symptom improvement were also very satisfied with this treatment option.
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Affiliation(s)
- P Lindfors
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Harrison KL, Farrell RM, Brinich MA, Highland J, Mercer M, McCormick JB, Tilburt J, Geller G, Marshall P, Sharp RR. 'Someone should oversee it': patient perspectives on the ethical issues arising with the regulation of probiotics. Health Expect 2012; 18:250-61. [PMID: 23279082 DOI: 10.1111/hex.12027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2012] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Although many probiotic products are currently available in yogurt or pill form in the United States (US), there is uncertainty surrounding the structure of regulation of these products. As more therapeutic probiotics are developed, changes to existing regulatory process in the United States may be required to meet the needs of patients and users in the population. OBJECTIVE This study examined how patients with chronic gastrointestinal (GI) diseases view the regulation of probiotics. DESIGN We conducted a multi-site qualitative study consisting of focus groups of patients with chronic gastrointestinal diseases at three tertiary hospitals: at [institutions removed for blinded review]. RESULTS We conducted 22 focus groups with 136 patients with major gastrointestinal (GI) diseases between March and August 2009. Participants were not familiar with the existing regulation of probiotic products but wanted assurances of accurate labelling of strain as well as safety. Participants raised concerns that regulation of probiotics might be accompanied by greater costs, reduced access and increased involvement of pharmaceutical companies. Although participants voiced significant doubt of government regulators, they felt that products containing genetically modified probiotic strains should have oversight comparable to that of pharmaceutical drugs. DISCUSSION AND CONCLUSION If GI patient perspectives are indicative of public perceptions of therapeutic probiotics in the United States, consumers may expect more rigorous regulation in the future while simultaneously wanting low costs, easy access and low involvement of pharmaceutical companies. Manufacturers, translational scientists, clinicians and regulators should be sensitive to consumer attitudes when designing, testing and regulating new therapeutic probiotics.
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Affiliation(s)
- Krista L Harrison
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Slashinski MJ, McCurdy SA, Achenbaum LS, Whitney SN, McGuire AL. "Snake-oil," "quack medicine," and "industrially cultured organisms:" biovalue and the commercialization of human microbiome research. BMC Med Ethics 2012; 13:28. [PMID: 23110633 PMCID: PMC3512494 DOI: 10.1186/1472-6939-13-28] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 10/15/2012] [Indexed: 12/31/2022] Open
Abstract
Background Continued advances in human microbiome research and technologies raise a number of ethical, legal, and social challenges. These challenges are associated not only with the conduct of the research, but also with broader implications, such as the production and distribution of commercial products promising maintenance or restoration of good physical health and disease prevention. In this article, we document several ethical, legal, and social challenges associated with the commercialization of human microbiome research, focusing particularly on how this research is mobilized within economic markets for new public health uses. Methods We conducted in-depth, semi-structured interviews (2009–2010) with 63 scientists, researchers, and National Institutes of Health project leaders (“investigators”) involved with human microbiome research. Interviews explored a range of ethical, legal, and social dimensions of human microbiome research, including investigators’ perspectives on commercialization. Using thematic content analysis, we identified and analyzed emergent themes and patterns. Results Investigators discussed the commercialization of human microbiome research in terms of (1) commercialization, probiotics, and issues of safety, (2) public awareness of the benefits and risks of dietary supplements, and (3) regulation. Conclusion The prevailing theme of ethical, legal, social concern focused on the need to find a balance between the marketplace, scientific research, and the public’s health. The themes we identified are intended to serve as points for discussions about the relationship between scientific research and the manufacture and distribution of over-the-counter dietary supplements in the United States.
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Affiliation(s)
- Melody J Slashinski
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77030, USA.
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Harrison KL, Geller G, Marshall P, Tilburt J, Mercer M, Brinich MA, Highland J, Farrell RM, Sharp RR. Ethical Discourse about the Modification of Food for Therapeutic Purposes: How Patients with Gastrointestinal Diseases View the Good, the Bad, and the Healthy. AJOB PRIMARY RESEARCH 2012; 3:12-20. [PMID: 22773953 PMCID: PMC3389757 DOI: 10.1080/21507716.2012.662574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND: Researchers have the potential to utilize genetic modification (GM) technologies to create a hybrid of "food" and "medicine" that may challenge traditional understandings of what is "natural". Moral and ethical concerns are likely to arise in any discussion of these therapeutic foods and will affect the integration of products into clinical care and daily life. This study examined how patients with chronic gastrointestinal (GI) diseases view probiotics as future bioengineered therapeutic foods. METHODS: A multi-site qualitative study consisting of focus groups with chronic GI diseases was conducted at Cleveland Clinic, Mayo Clinic, and Johns Hopkins University RESULTS: We conducted twenty-two focus groups with 136 patients with major GI diseases between March and August 2009. GI patients associated the term "natural" with concepts of diminished risk and morally "good"; conversely, patients associated the term "unnatural" with things that are "risky," "foreign", and morally "bad". Readily available unmodified probiotics were more commonly described as "natural" while genetically modified probiotics were more commonly labeled as "unnatural" and "risky". However, patients acknowledged that not all natural products are safe, nor are unnatural products always harmful. CONCLUSIONS: If GI patient perspectives are indicative of public perceptions of therapeutic foods, our findings suggest that the potential benefits and risks of clinical and public health initiatives employing therapeutic foods will be understood in moralistic terms. Bioethicists and others should be sensitive to the implicit normative appeals that are often embedded in the language of what is "natural" and "unnatural".
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Affiliation(s)
- Krista L. Harrison
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, United States
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Gail Geller
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, United States
- Department of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Patricia Marshall
- Department of Bioethics, Case Western Reserve University, Cleveland, OH, United States
- Center for Genetic Research Ethics and Law, Case Western Reserve University, Cleveland, OH, United States
| | - Jon Tilburt
- General Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - MaryBeth Mercer
- Department of Bioethics, Cleveland Clinic, Cleveland, OH, United States
| | | | - Janelle Highland
- Department of Bioethics, Cleveland Clinic, Cleveland, OH, United States
| | - Ruth M. Farrell
- Department of Bioethics, Cleveland Clinic, Cleveland, OH, United States
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, United States
| | - Richard R. Sharp
- Center for Genetic Research Ethics and Law, Case Western Reserve University, Cleveland, OH, United States
- Department of Bioethics, Cleveland Clinic, Cleveland, OH, United States
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, United States
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McCormick JB, Hammer RR, Farrell RM, Geller G, James KM, Loftus EV, Mercer MB, Tilburt JC, Sharp RR. Experiences of patients with chronic gastrointestinal conditions: in their own words. Health Qual Life Outcomes 2012; 10:25. [PMID: 22401607 PMCID: PMC3349594 DOI: 10.1186/1477-7525-10-25] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 03/08/2012] [Indexed: 12/15/2022] Open
Abstract
Background Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are chronic conditions affecting millions of individuals in the United States. The symptoms are well-documented and can be debilitating. How these chronic gastrointestinal (GI) conditions impact the daily lives of those afflicted is not well documented, especially from a patient's perspective. Methods Here we describe data from a series of 22 focus groups held at three different academic medical centers with individuals suffering from chronic GI conditions. All focus groups were audio recorded and transcribed. Two research team members independently analyzed transcripts from each focus group following an agreed upon coding scheme. Results One-hundred-thirty-six individuals participated in our study, all with a chronic GI related condition. They candidly discussed three broad themes that characterize their daily lives: identification of disease and personal identity, medications and therapeutics, and daily adaptations. These all tie to our participants trying to deal with symptoms on a daily basis. We find that a recurrent topic underlying these themes is the dichotomy of experiencing uncertainty and striving for control. Conclusions Study participants' open dialogue and exchange of experiences living with a chronic GI condition provide insight into how these conditions shape day-to-day activities. Our findings provide fertile ground for discussions about how clinicians might best facilitate, acknowledge, and elicit patients' stories in routine care to better address their experience of illness.
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Lee HJ, Zhang H, Orlovich DA, Fawcett JP. The influence of probiotic treatment on sulfasalazine metabolism in rat. Xenobiotica 2012; 42:791-7. [PMID: 22348441 DOI: 10.3109/00498254.2012.660508] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Probiotics are live microorganisms claimed to exert beneficial effects on the host. This study investigated their effect on the metabolism and pharmacokinetics of sulfasalazine (SSZ), a drug whose efficacy depends on metabolism by azoreductase (AR) in the gut microbiota to sulfapyridine (SP) and 5-acetylsalicylic acid (5-ASA). The probiotic strains Lactobacillus acidophilus L10, Bifidobacterium lactis B94 and Streptococcus salivarius K12 possessed AR activity and a corresponding ability to metabolize SSZ. Treatment of male Wistar rats (n = 5) with oral 2 g doses of a mixture of the three probiotics (total dose 1.8 × 10⁹ cfu) every 12 h for 3 days resulted in a significant increase (p < 0.05) in AR activity in ex vivo colon contents with a corresponding increase in SSZ metabolism. Similar probiotic treatment of male Wistar rats (n = 8) followed by an oral 100 mg/kg dose of SSZ produced high plasma levels of SP, but pharmacokinetic parameters of SSZ and SP were not significantly different from control rats given SSZ. These results indicate that probiotic strains possess AR activity and can metabolize SSZ. Treatment with probiotics increases AR activity in the gut microbiota but has no effect on plasma levels of SSZ and SP following a subsequent oral dose of SSZ.
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Affiliation(s)
- Hee Ji Lee
- School of Pharmacy, University of Otago, Dunedin, New Zealand
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