Place of probiotics.
OBJECTIVE
This review reports on the recent progress understanding mechanisms of action and clinical applications of probiotics.


RESULTS
New insights on regulating mechanisms of intestinal commensal bacteria to prevent and treat different gastrointestinal diseases have been reported. Some probiotics, though not all, exert beneficial effects by modulating the mucosal barrier function and immune activity. It seems that a combination of different probiotics is more effective than a single strain. It was demonstrated that not only viable bacteria administered to the intestinal tract but also isolated probiotic DNA is active, even if injected subcutaneously. There is reasonable evidence to recommend probiotics in infectious diarrhoea for prevention and treatment (mainly in children) and to prevent antibiotic-induced gastrointestinal side effects. Furthermore, probiotics are effective in maintaining remission in ulcerative colitis and preventing and treating pouchitis. Promising positive effects were published in major surgery patients (gastric resection, pancreatic resection, liver transplantation) and in severe necrotising acute pancreatitis.


CONCLUSIONS
Increasing knowledge on probiotics is exciting, but in the near future it must be defined which probiotics (single strains or a combination) are most effective in specific diseases. Well-designed, randomized clinical trials are still required to further define the role of probiotics as preventive and therapeutic agents.
Meier
Rémy
R
Division of Gastroenterology, Hepatology and Nutrition, University of Basel, Liestal, Switzerland. remy.meier@ksli.ch
Steuerwald
Michael
M
D003093:Colitis, Ulcerative / Q000178:diet therapy; D003422:Critical Care / Q000379:methods*; D003424:Crohn Disease / Q000178:diet therapy; D004403:Dysentery / Q000178:diet therapy; D005767:Gastrointestinal Diseases / Q000178:diet therapy*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000178:diet therapy; D019990:Perioperative Care / Q000379:methods; D019449:Pouchitis / Q000178:diet therapy; D019936:Probiotics / Q000627:therapeutic use*