THE INTESTINAL MICROBIOTA AND THE ROLE OF PROBIOTICS IN IRRITABLE BOWEL SYNDROME: a review

Irritable bowel syndrome is a common, chronic relapsing gastrointestinal disorder that affects 7%-22% of the population worldwide. According to Rome III Criteria, the disorder is defined by the coexistence of abdominal discomfort or pain associated with an alteration in bowel habits. Its pathophysiology is not completely understood but, in addition to some important abnormalities, the disturbed intestinal microbiota has also been described supported by several strands of evidence. The treatment of irritable bowel syndrome is based upon several therapeutic approaches but few have been successful or without adverse events and more recently the gut microbiota and the use of probiotics have emerged as a factor to be considered. Probiotics are live micro-organisms which when consumed in adequate amounts confer a health benefit to the host, such as Lactic bacteria among others. An important scientific rationale has emerged for the use of probiotics in irritable bowel syndrome, although the data regarding different species are still limited. Not all probiotics are beneficial: it is important to select the specific strain which should be supported by good evidence base. The mechanisms of action of probiotics are described and the main strains are quoted.

A síndrome do intestino irritável é uma enfermidade crônica recidivante, que afeta 7%-22% da população mundial. Segundo os denominados Critérios de Roma III, a síndrome do intestino irritável é definida pela coexistência de dor ou desconforto abdominal associados à alteração do hábito intestinal. A fisiopatologia não é completamente esclarecida mas, além algumas importantes alterações descritas, alterações na microbiota intestinal têm tambem sido relatadas, suportadas por diferentes graus de evidência. O tratamento da síndrome do intestino irritável é baseado em diversas abordagens terapêuticas, mas, poucas tem resultados efetivamente satisfatórios ou sem a ocorrência de eventos adversos. Mais recentemente, a microbiota intestinal e o uso de probióticos têm sido considerados como fatores importantes a serem considerados. Probióticos são microrganismos vivos que, quando consumidos em quantidades adequadas, contribuem para a saúde do hospedeiro, como por exemplo, Lactobacillus acidophilus, dentre outras. Importantes justificativas científicas têm sido citadas sobre o uso de probióticos na síndrome do intestino irritável, embora sejam ainda limitados dados sobre as diferentes espécies bacterianas constituintes dos probióticos. Não todos os probióticos são benéficos nesse caso: é importante selecionar as cepas específicas as quais devem ser suportadas por evidências científicas satisfatórias. Os mecanismos de ação dos probióticos são descritos e citadas as principais cepas.

Analizan el uso de probióticos en las enfermedades gastrointestinales: [revisión] / The use of probiotics in gastrointestinal disease analysed: [review]

En la ciencia médica ha surgido una nueva era a partir del reconocimiento del importante papel del "órgano olvidado", la flora intestinal, en diferentes funciones para mantener la salud, las cuales, al interrumpirse, pueden asociarse con la aparición de enfermedades. Un elemento central de esta interacción beneficiosa entre la microflora y el ser humano es la modalidad mediante la cual las bacterias del tubo digestivo "se comunican" con el sistema inmunitario y, de modo particular, con las células inmunitarias diseminadas en el propio tubo digestivo, el tejido linfoide asociado con las mucosas (GALT o MALT). En este escenario se describen dos nuevos componentes: los probióticos y los prebióticos. Si bien muchos productos son señalados como probióticos, sólo pueden considerarse como tales aquellos que de modo real y reproducible contienen organismos vivos y se asocian con beneficios para la salud en estudios de alta calidad metodológica con seres humanos. En muchas enfermedades se observaron beneficios relacionados con el uso de probióticos, de manera especial en los síndromes diarreicos, en algunas enfermedades inflamatorias intestinales y en ciertas infecciones. En la actualidad puede incorporarse a esta lista el síndrome de intestino irritable. Los prebióticos, típicamente hidratos de carbono, estimulan el crecimiento de una o más especies de organismos comensales beneficiosos; se dispone de menos datos vinculados con los beneficios de los prebióticos en los seres humanos. Si bien se trata de un tema apasionante con muchos potenciales beneficios terapéuticos, se necesitan más ensayos de alta calidad tanto acerca de los probióticos como de los prebióticos en las enfermedades digestivas, así como investigaciones de laboratorio vinculadas con sus mecanismos de acción

Comorbidities are frequent in patients with gastroesophageal reflux disease in a tertiary health care hospital

INTRODUCTION: Several aspects of gastroesophageal reflux disease (GERD) have been studied, but the frequency of comorbidities is not yet fully understood. OBJECTIVES: To study the prevalence of GERD comorbidities in a tertiary care hospital. METHODS: We prospectively studied 670 consecutive adult patients from the outpatient department of our facility. A diagnosis was established using clinical, endoscopic and/or pHmetry-related findings. Each patient's medical file was reviewed with respect to the presence of other medical conditions and diagnoses. RESULTS: Of the 670 patients, 459 (68.6 percent) were female, and the mean age was 55.94 (17-80 years). We registered 316 patients (47.1 percent) with the erosive form of GERD and 354 patients (52.9 percent) with the non-erosive form. A total of 1,664 instances of comorbidities were recorded in 586 patients (87.5 percent), with the most common being arterial hypertension (21 percent), hypercholesterolemia (9 percent), obesity (9 percent), type II diabetes mellitus (5 percent) and depression (4 percent). Two or more comorbidities were present in 437 individuals (64.8 percent). The occurrence of comorbidities increased with age and was higher in patients with the non-erosive form of GERD. CONCLUSIONS: In a tertiary referral population, comorbidities were very common, and these may have worsened the already impaired health-related quality of life of these patients. Clinicians caring for GERD patients in this setting must be aware of the likelihood and nature of comorbid disorders and their impact on disease presentation and patient management.