The Role of Prebiotics and Probiotics in Gastrointestinal Disease.

With the advent of the scientific realization that the microbiota of the gastrointestinal tract was more than the cells that exist in the body, the full importance of prebiotics and probiotics has come forth. The importance has been stressed and is available in the new textbook entitled, "The Microbiota in Gastrointestinal Pathophysiology: Implication for Human Health, Prebiotics, Probiotics and Dysbiosis." There is enough evidence now published in the literature so that the scientific world now believes that prebiotics and probiotics are important in gastrointestinal disease.

United States Guidelines for Diverticulitis Treatment.

Guidelines for diverticular disease management were last supported and published by the American Gastroenterology Association and the American College of Gastroenterology 2 decades ago. Guidelines have been published in other countries and by some societies. These guidelines are suggested as United States of America guidelines. In reality, they are what is practiced in Connecticut at Yale New Haven hospitals. The epidemiology and pathophysiology is described. This is still considered a dietary fiber-deficiency disease that results in high intracolonic pressure with resultant outpocketing of diverticula in the weakest point of the colon at the sites of vascular penetration with developing elastin deposition in the colon wall. The age and gender distribution is described. They are most common in the sigmoid. The guidelines of management are described according to accepted classification of the disease at all stages from onset, to early formation, to mild disease, to complicated disease, to rare specific states. The outcomes and mortality are discussed.

Recommendations for Probiotic Use--2015 Update: Proceedings and Consensus Opinion.

This paper describes the consensus opinion of the participants in the 4th Triennial Yale/Harvard Workshop on Probiotic Recommendations. The recommendations update those of the first 3 meetings that were published in 2006, 2008, and 2011. Recommendations for the use of probiotics in necrotizing enterocolitis, childhood diarrhea, inflammatory bowel disease, irritable bowel syndrome and Clostridium difficile diarrhea are reviewed. In addition, we have added recommendations for liver disease for the first time. As in previous publications, the recommendations are given as A, B, or C ratings.

Diverticular disease: paradigm shifts in pathogenesis and treatment.

OPINION STATEMENT: Colonic diverticulosis is one of the most common gastrointestinal conditions affecting the Western world and is recognized as an increasingly common condition since its first description in the 1800s. Despite its widespread prevalence, its exact pathogenesis remains unknown. Additionally, its wide spectrum of clinical manifestations has led to multiple approaches in the management of this disease. Our understanding of the condition has continued to evolve. Newer studies have challenged some long-held beliefs regarding diverticular disease (DD) and put forward some new theories. This has laid the groundwork for further research to be done in this area to improve our understanding of DD. In any individual case, diet therapy, rifaximin, mesalamine, antibiotics, or surgery may be useful depending on the clinical status.

Recommendations for probiotic use in humans-a 2014 update.

Probiotics have gained worldwide use during the last two decades. However, which probiotic to use in which clinical condition has remained confusing in some clinical conditions. We convened a workshop at Yale in conjunction with Harvard in 2005, inviting a spectrum of probiotic authorities to discuss and reach conclusions on recommendations for use in common clinical conditions; the workshop was reconvened again in 2008 and in 2011. Each time the group of authorities was enlarged and varied depending on research studies. This article lists the recommendations updated from 2011 and is amended to bring it up to date in childhood and adult diarrhea, antibiotic-associated diarrhea, necrotizing enterocolitis, inflammatory bowel disorders, irritable bowel syndrome, allergic disorders, and radiation enteritis pending our 4th Triennial Yale/Harvard workshop to be convened in 2015.

Prebiotics, probiotics and digestive health.

PURPOSE OF REVIEW: The human gastrointestinal lumen is inhabited by a wide variety of microbiota. Our understanding of the intestinal microbiota and its full consequences on gastrointestinal health is still evolving. However, it is well accepted that altered colonic flora drives the pathogenesis of many disorders and diseases as seen in antibiotic-associated diarrhea and Clostridium difficile infection. Recent works published in the area of probiotics are reviewed here. RECENT FINDINGS: Alterations in colonic microbiota, or dysbiosis, are now implicated in irritable bowel syndrome and inflammatory bowel diseases. Probiotics and prebiotics are evolving treatment options that are targeted at restoring nonpathogenic digestive flora. There has been great interest in the role of these therapies in treatment of many diseases including childhood diarrhea, antibiotic-associated diarrhea, Clostridium difficile infection, irritable bowel syndrome, and inflammatory bowel disease. SUMMARY: Trials of probiotics have been shown to be helpful in some of these, not in others, and more work is needed in others. We review recent work done in these areas.