Probiotic in prevention and treatment of acute diarrhea in children

randomiziranih kontroliranih kliničkih pokusa ukazali su na učinak probiotika u prevenciji akutnog proljeva u djece no trenutni podaci nisu dovoljni za rutinsku primjenu probiotika u te svrhe.Proljev se definira kao više od 3 stolice u 24 sata, promijenjene konzistencije (mekane ili vodene) i/ili povećanog volumena za jednu trećinu uobičajene stolice, katkad s primjesama sluzi i krvi. Akutni proljev obično traje kraće od 7, ali ne dulje od 14 dana. Akutne crijevne infekcije glavni su uzrok akutnog proljeva u djece. Najviše slučajeva je posljedica virusne infekcije rotavirusom. Terapija ima za cilj spriječiti pojavu dehidracije i uspostaviti ponovnu elektrolitsku i acidobaznu ravnotežu primjenom otopina za oralnu rehidraciju, te iznimno u teškim slučajevima dehidracije, intravenskom rehidracijom. Probiotici su živi mikroorganizmi koji, ako se konzumiraju u odgovarajućoj dozi kao dodatak hrani, imaju pozitivan učinak na zdravlje domaćina. Zbog svojih osobina da blokiraju djelovanje patogenih bakterija natječući se s njima za nutrijente i vezno mjesto, snižavanjem lokalnog pH u lumenu crijeva, lučenjem antibakterijskih supstanci i regulacijom imunološkog odgovora sluznice, probiotici mogu imati ulogu u terapiji određenih bolesti probavnog sustava. Probiotici primijenjeni u terapiji akutnog proljeva, smanjuju intenzitet simptoma i skraćuju trajanje proljeva za 1 dan. Njihov je učinak ovisan o vrsti i dozi probiotika, značajan je za vodenasti virusni, ali ne i za invazivni bakterijski gastroenteritis, očitiji pri što ranijoj primjeni probiotika u tijeku bolesti i kod proljeva u djece u razvijenim zemljama. U posljednjim ESPGHAN/ESPID smjernicama o postupanju u akutnom gastroenteritisu, 2014. godine, preporučena su 3 probiotika, Lactobacillus rhamnosus GG (LGG), Saccharomyces boulardii i Lactobacillus reuteri DSM 17938 kao dodatak oralnoj rehidraciji. Postoje jasni dokazi da i mnogi drugi probiotici imaju jednako terapijsko djelovanje, no potrebne su detaljnije studije o učinku, dozi i sigurnosti svakoga od njih. Rezultati nekoliko randomiziranih kontroliranih kliničkih pokusa ukazali su na učinak probiotika u prevenciji akutnog proljeva u djece no trenutni podaci nisu dovoljni za rutinsku primjenu probiotika u te svrhe.Diarrhea is defined as more than 3 bowel movements in 24 hours, with stools of abnormal (loose or watery) consistency and/or increased volume to one third of usual stool, sometimes also with traces of mucus and blood. Diarrhea typically lasts less than 7 days and no longer than 14 days. Acute intestinal infections are the leading causes of diarrhea in children. Most cases are caused by a rotavirus infection. The therapy is aimed at preventing dehydration and re-establishing electrolyte and acid base balance. This is achieved through the use of oral rehydration solutions and through intravenous rehydration (only in the case of serious dehydration). Probiotics are live microorganisms which, if consumed in appropriate amounts as a food supplement, have a beneficial effect on the health of the host. Because of their characteristic to block the activity of pathogenic bacteria, competing with them for nutrients and biding sites, by lowering the pH value in the intestinal lumen, by secreting antibacterial substances, and regulating the immune response of the mucosa, probiotics can play a role in the therapy of some gastrointestinal diseases. If used in the treatment of acute diarrhea, probiotics alleviate the symptoms and reduce the duration of diarrhea by 1 day. The effect depends on the type and dosage of the probiotic, it is significant in watery, viral diarrhea, but not in invasive bacterial gastroenteritis, and it is more evident when probiotics are applied early in the course of the disease and in sick children from the developed countries. The latest (2014) ESPGHAN/ESPID guidelines for management of acute gastroenteritis recommend 3 probiotics – Lactobacillus rhamnosus GG (LGG), Saccharomyces boulardii and Lactobacillus reuteri DSM 17938 – as supplementary to oral rehydration. There is clear evidence that many other probiotics have the same therapeutic effects. However, there is a need for more detailed studies of the effects, dosage and safety of each of these subtypes. The results of several randomized controlled clinical trials indicate that probiotics may be efficient in the prevention of acute diarrhea in children, but current data is insufficient to warrant routine use of probiotics for this purpose