Introduction:
The gut microbiota has a significant influence on overall well-being. It is crucial to understand its effects on pediatric health to develop targeted approaches for its regulation, particularly in cases where dysbiosis is prevalent, as seen in several chronic gastrointestinal disorders. Modulating the composition and function of the gut microbiota using probiotics that have demonstrated effectiveness for the specific condition seems logical for prevention and treatment purposes.
What Are Probiotics?
Probiotics are living microorganisms usually found in certain bacteria like Lactobacillus, Bifidobacterium, and Streptococcus. These bacteria thrive in environments without oxygen and can produce lactic acid. Their unique characteristics allow them to outcompete harmful bacteria in our digestive system. Scientists believe these helpful bacteria create small substances called postbiotics during their metabolism. These postbiotics can positively impact our body's functions, including our immune system, by acting as regulators.
What Are the Clinical Applications of Probiotics in Pediatric Gastrointestinal Health?
Probiotics have been effective in managing the following pediatric gastrointestinal conditions:
1. Pediatric Acute Infectious Diarrhea (AID):
Breast milk provides excellent protection against infectious gastrointestinal diseases in infants. To enhance cow's milk-based infant formulas, probiotics and prebiotics have been added to replicate some of the immune-boosting benefits of breastfeeding. These additions have shown promising results in preventing AID. Studies had observed significant weight gain and a notable reduction in cases of infectious diarrhea when infants were fed with fermented milk or fortified milk containing specific probiotic strains. These positive effects are likely due to improved nutrient absorption and beneficial changes in the intestinal flora.
Although the evidence regarding the regular use of probiotics for preventing AID is inconclusive, various studies have revealed significant effects of specific probiotic strains in preventing community-acquired diarrhea. The good news is that no adverse side effects have been reported when using probiotic-enriched formulas in healthy children.
These findings highlight the potential advantages of including probiotics in the diet of infants and children facing acute infectious diarrhea. By incorporating probiotics, we may have a valuable tool to help alleviate and prevent this distressing condition, providing relief and improved well-being for our little ones.
2. Antibiotic-Associated Diarrhea (AAD):
Antibiotics can disrupt the normal balance of bacteria in our gut, which can cause different symptoms, with diarrhea being a common one. In children, approximately ten percent of those given antibiotics may develop AAD regardless of the reason. The risk is higher in children under two years old, especially if treated with specific antibiotics or combinations like amoxicillin-clavulanic acid, which can lead to AAD in around 23 % of cases. However, most cases of AAD in children are usually not severe and rarely require hospitalization.
Studies have shown that probiotics can help reduce the risk of AAD in children. When certain probiotics were given preventively, the analysis showed the use of LGG (Lactobacillus rhamnosus GG), S. boulardii (Saccharomyces boulardii), B. lactis (Bifidobacterium lactiis), and Str. thermophilus (Streptococcus thermophilus) significantly reduced the risk of AAD. This means that if seven patients were to develop diarrhea while taking antibiotics, one could be prevented from getting AAD if they also received probiotics.
S. boulardii has shown effectiveness in preventing diarrhea caused by C. difficile (Clostridium difficile), a harmful bacterium that can lead to severe intestinal infections. However, there is currently no scientific evidence to support the use of probiotics in preventing the recurrence of symptoms caused by C. difficile.
3. Traveler's Diarrhea:
Traveler's diarrhea is a common problem that can significantly impact our health and finances. When children travel, they are likely to experience similar causes of diarrhea as adults. They also risk getting the same illnesses that affect adult travelers.
When doctors evaluate a sick child who has traveled, they must consider the location, time of year, and the environment they visited. They also need to check if the child followed any pre-travel advice given to them. Treatment recommendations for traveler's diarrhea in children are based on expert opinions, limited case reports, and guidelines for treating diarrhea in adults.
Several scientific studies have been conducted to assess the effectiveness of probiotics in preventing traveler's diarrhea. One study using L. acidophilus (Lactobacillus acidophilus) and another using LGG (Lactobacillus rhamnosus GG) did not show positive results. However, a randomized controlled trial using S. boulardii demonstrated significant benefits in terms of reducing the occurrence of diarrhea. The effectiveness of S. boulardii varied depending on the dosage, adherence to the treatment, and the specific location where the child traveled.
4. Infantile Colic:
Study to examine whether using L. reuteri (Limosilactobascillus reuteri) as a preventive measure in the first three months of a baby's life can help reduce the occurrence of functional gastrointestinal disorders. The study found that using L. reuteri decreased daily crying time, regurgitation, and constipation, providing evidence for the beneficial effects of this probiotic in preventing these issues.
A study found that adding B. lactis and Str. thermophilus to infant formulas was safe and had a positive effect on reducing colic episodes in children. These probiotics may change how fermentation happens in the gut, resulting in less gas and water formation. This, in turn, might improve the tolerance of the gastrointestinal system, although more research is needed to confirm this theory.
5. Necrotizing Enterocolitis (NEC):
NEC (necrotizing enterocolitis) is a serious gastrointestinal emergency that commonly affects newborns, especially premature babies with low birth weight. It can lead to severe illness and even death. Probiotics have been studied as a possible way to protect high-risk infants from developing NEC or sepsis. They work in several ways to provide this protection. First, they create a barrier that prevents harmful bacteria and their products from crossing the gut lining. They also compete with these harmful bacteria, preventing them from spreading and causing infection. Probiotics can modify the body's response to the presence of bacteria, which helps to reduce the risk of infection. They also enhance the production of mucosal IgA, an antibody that helps fight off infections. Additionally, probiotics improve nutrient digestion and inhibit pathogens' growth while also regulating specific immune responses.
Different strains of probiotics have been studied, including B. breve, S. boulardii, mixtures of Bifidobacterium and Streptococcus, LGG, and L. acidophilus. The use of probiotics in these studies is safe and well-tolerated by infants. Most importantly, the research shows that probiotics significantly reduce the risk of severe NEC and death.
6. Inflammatory Bowel Disease (IBD):
One of the critical reasons why probiotics are considered beneficial for people with Inflammatory Bowel Disease (IBD) is their ability to regulate the immune response in the intestinal lining. The immune and epithelial cells in the small intestine can recognize different microorganisms through specific Toll-like receptors (TLRs). This property of probiotics helps maintain a balanced and healthy immune system in the gut.
7. Functional Gastrointestinal Disorders:
Functional gastrointestinal disorders are prevalent conditions that affect people of all ages, including children. These disorders can cause various symptoms and discomfort. Probiotics have shown promising effects in alleviating the symptoms of these conditions by influencing the way enzymes and metabolism function in the gut.
Conclusion:
Probiotics have shown effectiveness in preventing and treating different health issues, especially those related to the digestive system in children. They can be helpful in specific conditions such as infections, inflammation, and functional disorders. However, the effectiveness of probiotics may vary depending on the specific strain used. Among the extensively studied probiotics, LGG, L. reuteri, and S. boulardii have shown positive results. Some lactobacilli strains and S. boulardii have been particularly effective when introduced early in the treatment.
