Lactobacillus reuteri DSM 17938 and Agave Inulin in Children with Cerebral Palsy and Chronic Constipation: A Double-Blind Randomized Placebo Controlled Clinical Trial.

The main objective was to assess the efficacy of a probiotic (Lactobacillus reuteri DSM 17938), a prebiotic (agave inulin), and a synbiotic on the stool characteristics in children with cerebral palsy and chronic constipation. Thirty-seven children with cerebral palsy and chronic constipation were included. The probiotic group received 1 × 108 colony forming unit (cfu) of L. reuteri DSM 17938 plus placebo, the prebiotic group received 4 g of agave inulin plus placebo, the synbiotic group received L. reuteri DSM 17938 plus agave inulin, and the placebo group received two placebos for 28 days. The probiotic group showed a significant decrease in stool pH (p = 0.014). Stool consistency improved in the prebiotic group (p = 0.008). The probiotic, prebiotic, and synbiotic groups showed a significant improvement in the history of excessive stool retention, the presence of fecal mass in the rectum, and the history of painful defecation. L. reuteri concentration in feces was higher in the probiotic group than in the placebo group (p = 0.001) and showed an inverse correlation with stool pH in the probiotic group (r = -0.762, p = 0.028). This study showed that the use of L. reuteri DSM 17938 and/or agave inulin improved the stool characteristics such as the history of painful defecation and the presence of fecal mass in the rectum against placebo in children with cerebral palsy and chronic constipation.

Lactobacillus reuteri DSM 17938 shortens acute infectious diarrhea in a pediatric outpatient setting / O Lactobacillus reuteri DSM 17938 reduz a diarreia infecciosa aguda no cuidado pediátrico ambulatorial

OBJECTIVE: Two randomized controlled clinical trials have shown thatLactobacillus (L) reuteri DSM 17938 reduces the duration of diarrhea in children hospitalized due to acute infectious diarrhea. This was the first trial evaluating the efficacy of L. reuteri DSM 17938 in outpatient children with acute infectious diarrhea.METHODS: This was a multicenter, randomized, single-blinded, case control clinical trial in children with acute watery diarrhea. A total of 64 children who presented at outpatient clinics were enrolled. The probiotic group received 1 × 108 CFU L. reuteri DSM 17938 for five days in addition to oral rehydration solution (ORS) and the second group was treated with ORS only. The primary endpoint was the duration of diarrhea (in hours). The secondary endpoint was the number of children with diarrhea at each day of the five days of intervention. Adverse events were also recorded.RESULTS: The mean duration of diarrhea was significantly reduced in the L. reuteri group compared to the control group (approximately 15 h, 60.4 ± 24.5 h [95% CI: 51.0-69.7 h] vs. 74.3 ± 15.3 h [95% CI: 68.7-79.9 h], p < 0.05). The percentage of children with diarrhea was lower in the L. reuteri group (13/29; 44.8%) after 48 h than the control group (27/31; 87%; RR: 0.51; 95% CI: 0.34-0.79,p < 0.01). From the 72nd hour of intervention onwards, there was no difference between the two groups in the percentage of children with diarrhea. No adverse effects related to L. reuteri were noted.CONCLUSION:L. reuteri DSM 17938 is effective, safe, and well-tolerated in outpatient children with acute infectious diarrhea.

OBJETIVO: Dois ensaios clínicos randomizados controlados demonstraram que oLactobacillus (L) reuteri DSM 17938 reduz a duração de diarreia em crianças hospitalizadas devido a diarreia infecciosa aguda. Este é o primeiro ensaio que avalia a eficácia do L. reuteri DSM 17938 em crianças com diarreia infecciosa aguda no ambulatório.MÉTODOS: Ensaio clínico multicêntrico, randomizado, único cego, com grupos paralelos e controlado em crianças com diarreia aguda. Foram inscritas 64 crianças internadas na clínica ambulatorial. O grupo probiótico recebeu 1 × 108 CFU L. reuteri DSM 17938 por cinco dias, além de uma solução de reidratação oral (SRO), e o segundo grupo foi tratado apenas com SRO. O desfecho principal foi a duração da diarreia (em horas). O desfecho secundário foi o número de crianças com diarreia em cada um dos cinco dias da intervenção. Os eventos adversos também foram registrados.RESULTADOS: A duração média da diarreia foi significativamente reduzida no grupoL. reuteri em comparação com o grupo de controle (aproximadamente 15 horas; 60,4 ± 24,5 horas [51,0-69,7 horas, IC de 95%] em comparação com 74,3 ± 15,3 horas [68,7-79,9 horas, IC de 95%], p < 0,05). O percentual de crianças com diarreia foi menor no grupo L. reuteri (13/29; 44,8%) após 48 horas do que no grupo de controle (27/31; 87%) (RR: 0,51; 0,34-0,79; IC de 95%, < 0,01). A partir da 72a hora de intervenção, não havia diferença entre os dois grupos no percentual de crianças com diarreia. Nenhum efeito adverso com relação ao L. reuteri foi observado.CONCLUSÃO: O L. reuteri DSM 17938 é eficaz, seguro e bem tolerado por crianças com diarreia infecciosa aguda no ambulatório.

Lactobacillus reuteri DSM 17938 shortens acute infectious diarrhea in a pediatric outpatient setting.

OBJECTIVE: Two randomized controlled clinical trials have shown that Lactobacillus (L) reuteri DSM 17938 reduces the duration of diarrhea in children hospitalized due to acute infectious diarrhea. This was the first trial evaluating the efficacy of L. reuteri DSM 17938 in outpatient children with acute infectious diarrhea. METHODS: This was a multicenter, randomized, single-blinded, case control clinical trial in children with acute watery diarrhea. A total of 64 children who presented at outpatient clinics were enrolled. The probiotic group received 1×10(8)CFU L. reuteri DSM 17938 for five days in addition to oral rehydration solution (ORS) and the second group was treated with ORS only. The primary endpoint was the duration of diarrhea (in hours). The secondary endpoint was the number of children with diarrhea at each day of the five days of intervention. Adverse events were also recorded. RESULTS: The mean duration of diarrhea was significantly reduced in the L. reuteri group compared to the control group (approximately 15h, 60.4±24.5h [95% CI: 51.0-69.7h] vs. 74.3±15.3h [95% CI: 68.7-79.9h], p<0.05). The percentage of children with diarrhea was lower in the L. reuteri group (13/29; 44.8%) after 48h than the control group (27/31; 87%; RR: 0.51; 95% CI: 0.34-0.79, p<0.01). From the 72nd hour of intervention onwards, there was no difference between the two groups in the percentage of children with diarrhea. No adverse effects related to L. reuteri were noted. CONCLUSION: L. reuteri DSM 17938 is effective, safe, and well-tolerated in outpatient children with acute infectious diarrhea.

Diarrhea in preschool children and Lactobacillus reuteri: a randomized controlled trial.

OBJECTIVES: To evaluate whether daily administration of Lactobacillus reuteri DSM 17938 reduces the frequency and duration of diarrheal episodes and other health outcomes in day school children in Mexico. METHODS: Healthy children (born at term, aged 6-36 months) attending day care centers were enrolled in this randomized, double-blind, placebo-controlled trial. They received L reuteri DSM 17938 (dose 10(8) colony-forming unit; n = 168) or identical placebo (n = 168) by mouth, daily for 3 months, after which they were followed-up after a further 3 months without supplementation. RESULTS: Data from all children were included in the final analysis. L reuteri DSM 17938 significantly reduced the frequency and duration of episodes of diarrhea and respiratory tract infection at both 3 and 6 months (P < .05). Additionally, the number of doctor visits, antibiotic use, absenteeism from day school and parental absenteeism from work were significantly reduced in the L reuteri group (P < .05). A cost-benefit analysis revealed significant reductions in costs in the L reuteri-treated children. No adverse events related to the study product were reported. CONCLUSIONS: In healthy children attending day care centers, daily administration of L reuteri DSM 17938 had a significant effect in reducing episodes and duration of diarrhea and respiratory tract infection, with consequent cost savings for the community.

Las posibilidades del empleo de lactobacilos en la gastroenterología y la nutrición humana / Therapeutic potential of the use of lactobacilli in gastroenterology and human nutrition

Lactobacilli are normal inhabitants of the human intestine. They are also present in maternal milk, where Lactobacillus reuteri was first described. This confirms that maternal milk transfers components of the maternal microbiota to the offspring. L. reuteri ATCC 55730 decreases the intensity and duration of infantile colic defined as episodes of strident crying for at least 3 hours, 3 times a week during 3 months. Its etiology is unknown but recent evidence shows that affected infants harbor less Iactobacilli and more Bacteroides in their feces. In 2008 it was shown that this strain carries plasmidia that could transfer resistance to antibiotics. For this reason L. reuteri it was cured of these factors and this resulted in L. reuteri DSM 17938 which is devoid of them; tests in vitro, in laboratory animals and in humans demonstrated that both strains are equivalent. The effect of L. reuteri in infantile colic may be explained by its blocking at the level of the dorsal ganglia of the spinal chord of the transmission to the central nervous system of afferent pain stimuli. L. reuteri has effects on gastroesophageal reflux probably through the acceleration of gastric emptying and it decreases the incidence and severity of necrotizing enterocolitis. Other positive effects are related to chronic constipation and acute diarrhea. L. reuteri synthesizes a molecule with intense bactericidal activity, β-hidroxy propenal o reuterin from glycerol, which may explain some of its effects. Lactobacillus rhamnosus GG ATCC 53103 is probably the probiotic that has been studied the most and for a longer period. It shortens the duration and it decreases the number of evacuations in acute diarrhea as well as the duration and frequency of vomiting. It also induces improvements of antibiotic associated diarrhea and of upper respiratory infections. The positive effects of Lactobacillus GG may be due to the stimulation of innate and adaptive immunity and to the activation of macrophages and of NK lymphocytes. One of its effects refers the response its administration induces in infants with atopy/eccema. Some studies have demonstrated that the severity and extent of the lesions is decreased after Lactobacillus GG administration, that may persist for some years after its administration has been ended. Lactobacillus GG also exerts positive effects on conditions such as the irritable bowel syndrome through mechanisms that are not known with certainty.

Los lactobacilos son habitantes normales de las mucosas de los seres humanos; también están presentes en la leche materna. Lactobacillus reuteri fue descrito en la leche de una madre peruana, lo que confirma que estas bacterias son parte de la microbiota que las madres transfieren a sus hijos. El cólico infantil son episodios de llanto excesivo, estridente, por a lo menos 3 horas 3 veces por semana y por a lo menos 3 meses. L. reuteri ATCC 55730 demostró disminuir su intensidad y duración. La etiología del cólico se desconoce pero en las heces de los lactantes afectados se han demostrado disminuciones de los lactobacilos y aumentos de Bacteroides. En 2008 se demostró que L. reuteri ATCC 55730 era portador de plasmidios capaces de resistencia a antibióticos por lo que fue "curado" de estos factores y resultó una nueva cepa, denominada DSM 17938; pruebas in vitro y en animales mostraron su inocuidad y ensayos en humanos revelaron que ejerce las mismas propiedades benéficas que la cepa original. El efecto de L. reuteri en el cólico infantil puede estar relacionado con su capacidad de bloquear en los ganglios dorsales de la medula espinal la transmisión de estímulos a los centros cerebrales superiores. El efecto antirreflujo de L. reuteri se debería a la aceleración del vaciamiento gástrico. Ambas cepas de esta bacteria disminuyen la progresión, morbilidad y mortalidad de la enterocolitis necrosante. Otros efectos en la constipación crónica y la duración de la diarrea aguda de distintas etiologías. L. reuteri sintetiza una molécula, el β-hidroxipropenal o reuterina, con actividad antibacteriana. Lactobacillus rhamnosus GG ATCC 53103 es probablemente el probiótico más estudiado; acorta la duración de la diarrea aguda, disminuye el número de evacuaciones y la duración de los vómitos e induce mejorías de la diarrea asociada con los tratamientos antibióticos; y disminuiría la intensidad de las infecciones respiratorias altas. Sus efectos se deberían a la estimulación de las inmunidades innata y adquirida y de la activación de los macrófagos y los linfocitos NK. Un efecto notable y discutido de L. ramnosus GG se refiere a sus efectos en la atopia cutánea, ya que disminuiría la extensión e intensidad de sus síntomas, incluso más allá de su administración. También ejercería efectos sobre cuadros funcionales gastrointestinales como el síndrome del intestino irritable, por mecanismos aun no elucidados.