The aging gut and the role of prebiotics,probiotics, and synbiotics: A review

The United States (US) Census Bureau estimates the current US population at 301 million with elderly people (>65 years old) accounting for 36 million. Within this group, the fastest growing segment of the population is >85 years of age, which currently numbers ∼5 million and is expected to rise to ∼20 million by 2050. Over the decades there has been speculation that gastrointestinal structure and function decline with age. Therefore, the physiological changes in the gut with aging and their clinical implications have become important topics for discussion. This review also attempts to document the role of probiotics in enhancing gut activity in older persons.     

Clinical and psychological responses to synbiotic supplementation in obese or overweight adults: A randomized clinical trial

BackgroundObesity is highly prevalent worldwide. Emerging clinical studies suggest that pre- and pro- biotic formulations may be effective interventions for the management of obesity and associated metabolic complications. The current trial was conducted to assess the effect of synbiotic supplementation on anthropometric indices, glycemic and lipid profile, blood pressure, and psychological status of adults with overweight or obesity.MethodsThis randomized double-blind, placebo-controlled trial was conducted on 60 adults with overweight or obesity. Participants were randomly assigned into two groups to receive either synbiotics (n = 30) in form of a 500 mg capsule (containing Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium bifidum plus inulin) or placebo (n = 30) for 8 weeks. The level of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FPG), insulin, body weight, body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), stress, anxiety, and depression were measured at the baseline and end of the study.ResultsIn total, 59 subjects (39 men and 20 women) completed the present study. A significant between-group decrease in body weight (P = 0.03), TC (P = 0.01), TG (P = 0.02), LDL-C (P = 0.01), stress (P < 0.001), anxiety (P = 0.03), and depression (P = 0.03) was found in the synbiotic group compared to the placebo. However, synbiotics had no significant effect on HDL-C, SBP, DBP, FPG and fasting insulin concentrations, as well the BMI and WC (P < 0.05).ConclusionThe present study showed that synbiotic supplementation can confer a number of health benefits including improvements in TG, TC, LDL-C, body weight, stress, anxiety, and depression to subjects that are overweight or obesity.Trial registrationIranian Registry of Clinical Trials IRCT20180201038585N3.     

A case report of a patient with near total intestinal aganglionosis followed by the role of extended myectomy and synbiotics therapy

We report our experience with a patient with near-total intestinal aganglionosis who underwent extended myectomy-myotomy of the proximal jejunum. At 45 days of age, the patient underwent rejejunostomy at 34 cm from the ligament of Treiz (LOT) because of enteritis and the bowel rehabilitation therapy was started. Because the patient established the swelling and eating enough at 8 months of age, an extended myectomy-myotomy was performed when she was 245 days old. A 12-cm myectomy from the jejunostomy located at 27 cm from the LOT was coupled with a 30-cm antemesenteric border myotomy. This ultimately left the patient with 65 to 70 cm of small bowel from the LOT. Synbiotics therapy was performed to prevent bacterial translocation, and then central line infection or enteritis was not observed at all. The patient was doing well, weighing 9.65 kg, at 2 years of age. In conclusion, extended myectomy-myotomy has extended the patient's survival period, but it is important and necessary to prevent bacterial translocation and to improve intestinal adaptation by synbiotics therapy.     

合生元对高脂大鼠模型降脂作用研究

目的探讨两株益生菌(嗜热链球菌Streptococcus thermophiluss、植物乳杆菌Lactobacillus plantarum)和两种益生元混合而成的合生元对高脂大鼠降血脂的影响。方法采用Wistar大鼠建立脂代谢紊乱模型,设高、中、低剂量组(分别是2.25、0.45、0.09 g.kg-1)、一个模型组和一个正常组,灌胃30天后取血,采用生化分析仪检测其对大鼠血清总胆固醇(TC)、甘油三酯(TG)和高密度脂蛋白胆固醇(HDL-C)水平,并检测肝脾肾指数。结果合生元对大鼠的采食量、肝脾肾指数无影响;模型组中大鼠的TC和TG与正常组比较有显著性的升高(P<0.01),说明模型成立;三个合生元剂量组(给药组)的TC和TG比模型组显著性的降低(P<0.01)。结论合生元具有很好的降血脂作用。     

The current place of probiotics and prebiotics in the treatment of pouchitis

Pouchitis is a common complication in patients undergoing restorative proctocolectomy for ulcerative colitis. Therapeutic attempts include manipulations of pouch flora composition. In this review, we bring together the evidence supporting the use of probiotics and prebiotics in pouchitis patients, to clarify the place of these treatments in current therapeutic regimens.     

Probiotics and prebiotics in neonatal necrotizing enterocolitis: New opportunities for translational research

Neonatal necrotizing enterocolitis (NEC) in premature infants has been recognized as a defined disease entity for at least four decades. Although survival has increased due to the advent of more sophisticated intensive care, incidence and long term health impacts due to NEC remain unchanged and no preventive therapy is currently available. Different probiotic strains of bacteria have been examined in their ability to prevent NEC with varied but encouraging results. Undigestable prebiotic sugars known to promote the growth of probiotic bacteria in the colon have been used in neonates with no clear benefit. The literature on NEC and probiotics is now cluttered with more reviews and meta-analyses than number of clinical trials. On the other hand, significant new information is available on microbiota and their impact on gut immunity. This review attempts to reiterate the risk factors of NEC and the pathogenesis of NEC with special reference to gut permeability. The reader is then introduced to gut microbiota, uniqueness and differences among probiotic strains, and how multiple resident flora talk to each other in the community setting in the human gut. After presenting a concise review of available clinical research results, the reader is challenged to question as to why no precise answer is available at present. Some modalities to examine the complex microflora and changes in the neonatal gut are then proposed including non-invasive methods and mathematical modeling. The review concludes by attracting the reader's attention to known immunomodulators of inflammation and injury. Justice to this review will be done only if the readers, clinical, and basic science investigators from multiple fields gather courage for a paradigm shift and embark on understanding the pathophysiology of the disease and attempt to discern the difference from equally preterm, equally vulnerable neonates that do not develop NEC. Learning about the developing microbiota in neonatal gut and its immunological impacts on the host in the face of many variables will provide a leap in our pursuit to select better, if not the best candidate probiotics, and put them to work against this stubborn disease that continues to take a toll on our precious neonates and the society.     

Therapies aimed at the gut microbiota and inflammation: antibiotics, prebiotics, probiotics, synbiotics, anti-inflammatory therapies

Several recent observations have raised the possibility that disturbances in the gut microbiota and/or a low-grade inflammatory state may contribute to symptomatology and the etiology of irritable bowel syndrome (IBS). Consequent on these hypotheses, several therapeutic categories have found their way into the armamentarium of those who care for IBS sufferers. These agents include probiotics, prebiotics, antibiotics, and anti-inflammatory agents.     

益生菌(元)联合肠内营养对重症急性胰腺炎大鼠肠道屏障功能的影响

目的:探讨益生菌(元)联合肠内营养(EN)对重症急性胰腺炎(SAP)大鼠肠道屏障及吸收功能的影响.方法:将24只大鼠诱发重症胰腺炎模型后,随机分为四组,分别给予肠内要素营养(A组)、双歧三联活菌 肠内要素营养(B组)、β-葡聚糖 肠内要素营养(C组)以及双歧三联活菌 β-葡聚糖 肠内要素营养,即合生元 肠内要素营养(D组),共持续7天.四组大鼠营养供给为等热量和等氮量.第7天处死大鼠前,先作木糖吸收实验,取血检测血浆二胺氧化酶(DAO)、内毒素、肿瘤坏死因子(TNF)和白细胞介素-6(IL-6)的变化;再处死大鼠,取空肠观察小肠的病理改变,测量黏膜绒毛高度.结果:B组与A组相比,血浆内毒素、DAO、TNF和IL-6明显降低(P＜0.05),C组和D组虽有下降趋势,但无显著性差异(P＞0.05);B组和C组木糖吸收试验较A组明显改善(P＜0.05);病理检查显示,B组小肠结构较完整,黏膜厚度、绒毛高度均比A组明显增加(P＜0.05).结论:益生菌(元)联合EN可保护SAP大鼠肠道屏障及吸收功能;β-葡聚糖对SAP大鼠肠道功能改善不明显.