Gut microbiota and the use of probiotics in constipation in children and adolescents: systematic review / Microbiota intestinal e emprego dos probióticos na constipação intestinal em crianças e adolescentes: revisão sistemática

ABSTRACT Objective: To perform a systematic review of literature data on gut microbiota and the efficacy of probiotics for the treatment of constipation in children and adolescents. Data source: The research was performed in the PubMed, the Scientific Electronic Library Online (SciELO) and the Latin American and Caribbean Health Sciences Literature (LILACS) databases in English, Portuguese and Spanish. All original articles that mentioned the evaluation of the gut microbiota or the use of probiotics in children with constipation in their title and abstract were selected. Data synthesis: 559 articles were found, 47 of which were selected for reading. From these, 12 articles were included; they studied children and adolescents divided into two categories: a gut microbiota evaluation (n=4) and an evaluation of the use of probiotics in constipation therapy (n=8). The four papers that analyzed fecal microbiota used different laboratory methodologies. No typical pattern of gut microbiota was found. Regarding treatment, eight clinical trials with heterogeneous methodologies were found. Fifteen strains of probiotics were evaluated and only one was analyzed in more than one article. Irregular beneficial effects of probiotics have been demonstrated in some manifestations of constipation (bowel frequency or consistency of stool or abdominal pain or pain during a bowel movement or flatulence). In one clinical trial, a complete control of constipation without the use of laxatives was obtained. Conclusions: There is no specific pattern of fecal microbiota abnormalities in constipation. Despite the probiotics' positive effects on certain characteristics of the intestinal habitat, there is still no evidence to recommend it in the treatment of constipation in pediatrics.

RESUMO Objetivo: Realizar revisão sistemática dos dados da literatura sobre a microbiota intestinal e a eficácia dos probióticos para o tratamento da constipação intestinal em crianças e adolescentes. Fonte de dados: Foi realizada busca nas bases de dados PubMed, Scientific Electronic Library Online (SciELO) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), em inglês, português e espanhol. Foram selecionados, pelo título e pelo resumo, todos os artigos originais que avaliaram a microbiota intestinal ou o emprego de probióticos em crianças com constipação intestinal. Síntese dos dados: Foram encontrados 559 artigos, dos quais 47 foram selecionados para leitura. Destes, foram incluídos 12 artigos que estudaram crianças e adolescentes distribuídos em duas categorias: avaliação da microbiota intestinal (n=4) e avaliação do emprego dos probióticos na terapêutica da constipação intestinal (n=8). Os quatro artigos que analisaram a microbiota fecal utilizaram metodologias laboratoriais diferentes. Não foi observado um padrão típico de microbiota intestinal. Quanto ao tratamento, foram encontrados oito ensaios clínicos com metodologias heterogêneas. Foram avaliadas 15 cepas de probióticos e apenas uma foi avaliada em mais de um artigo. Foram evidenciados efeitos benéficos não uniformes dos probióticos em algumas manifestações da constipação intestinal (frequência evacuatória, consistência das fezes, dor abdominal, dor ao evacuar ou flatulência). Em apenas um ensaio clínico foi obtido completo controle da constipação intestinal sem o emprego concomitante de laxantes. Conclusões: Não existe um padrão específico de anormalidades da microbiota fecal na constipação intestinal. Apesar dos efeitos positivos dos probióticos em determinadas características do hábito intestinal, ainda não existem evidências que permitam sua recomendação no tratamento da constipação intestinal em pediatria.

Antibiotics-associated Diarrhea and Other Gastrointestinal Abnormal Responses Regarding Helicobacter pylori Eradication / 대한소화기학회지

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) is closely related with a wide range of gastrointestinal disease. One-week triple therapy is currently considered as the golden standard for the treatment of H. pylori infection. However, gastrointestinal abnormal responses are major pitfalls in such regimen. The aim of this study was to identify symptoms, frequency and severity of antibiotics-associated gastrointestinal abnormal responses during H. pylori eradication therapy. METHODS: Sixty-seven patients with H. pylori infection between September 2005 and March 2006 were included. After 1 week of H. pylori eradication triple therapy (rabeprazol 10 mg, clarithromycin 500 mg, amoxicillin 1 g bid), we evaluated gastrointestinal abnormal responses (diarrhea, bloating, constipation, abdominal pain, borborygmus, flatulence, stool frequency, belching, and nausea) and severities every week for 4 weeks. RESULTS: The incidence of diarrhea was the highest in week 1, which was 41.28% (n=28) and the lowest in week 4, which was 9.52% (n=6) and decreased from week 1 to week 4 with statistical significance (p<0.0001). The most common gastrointestinal abnormal responses were associated with flatulence in week 1 (n=21, 31.34%), week 2 (n=21, 33.33%) and abdominal distention in week 3 (n=16, 25.40%), week 4 (n=15, 23.81%). Most of gastrointestinal abnormal responses were mild, and the most common symptom with higher than moderate grade was abdominal pain (n=4, 40.00%) in week 1. Alcohol consumption and coexisting medical illness were not associated with diarrhea (p=0.0852, 0.9009 respectively). CONCLUSIONS: H. pylori eradication therapy is commonly associated with antibiotics-associated gastrointestinal abnormal responses, which may result in antibiotics intolerance and H. pylori eradication failure. Even though those symptoms are not so severe, we have to consider the gastrointestinal abnormal responses associated with H. pylori eradication, especially diarrhea.

Avaliação de ionóforos pela técnica da perda do potássio celular e produção de gases in vitro / Ionophores evaluation by intracellular potassium depletion and in vitro gas production

Dois estudos foram realizados com vacas lactantes utilizadas como unidade experimental e doadoras de líquido ruminal, sendo as populações de bactérias utilizadas para avaliar a ação de níveis crescentes de lasalocida e monensina na resistência à perda de potássio intracelular, e para produção de gases in vitro. A perda de potássio (Kmax) da lasalocida foi menor para a população de bactérias obtidas do líquido de rúmen de vacas submetidas a dietas com monensina, óleo de soja e monensina mais óleo de soja (19,4 a 25,4 por cento) quando comparada com a perda de potássio em vacas submetidas a dietas sem ionóforo e óleo de soja (30,1 por cento). O mesmo ocorreu para a perda de potássio da monensina, em que o menor valor foi de 6,5 por cento para monensina mais óleo e o maior, de 29,5 por cento, para o controle. Necessita-se de alta concentração de monensina (Kd= 2,3µM), porém baixa de lasalocida (Kd= 0,2µM) para causar a metade da perda máxima de potássio intracelular da população de bactérias do rúmen de vacas submetidas a dietas com monensina. As populações de bactérias de vacas submetidas às dietas com monensina foram sensíveis à lasalocida. As amostras incubadas com própolis produziram menor volume de gases (12,9ml/100g de MS)

Two studies were carried out with lactating cows as experimental units and ruminal fluid donors. The ruminal bacteria population was used to evaluate the action of increasing levels of lasalocid and monensin on resistance of intracellular potassium depletion and in vitro gas production intracellular depletion potassium (Kmax) of lasalocid was lower to ruminal bacteria population obtained from rumen of cows fed diets with monensin, soybean oil and monensin plus soybean oil (19.4 to 25.4 percent) when compared to cows fed with control diet (30.1 percent). The same occurred for intracellular depletion potassium (Kmax) of monensin, in which the lowest value was 6.5 percent to monensin plus soybean oil and the greatest was 29.5 percent to control. High monensin concentration (Kd= 2.3µM) and low lasalocid concentration (Kd= 0.2µM) were necessary to cause half of maximum potassium depletion in ruminal bacteria population from cows fed diet with monensin. The ruminal bacteria population from cows feed diet with monensin were sensible to lasalocid. In vitro gas production showed the lowest volume when diets were incubated with propolis (12,9ml/100g of DM)