Michail / Sherman Probiotics in Pediatric Medicine

1. Auflage 2009
ISBN: 978-1-60327-289-6
Verlag: Humana Press
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 352 Seiten

Reihe: Nutrition and Health

Probiotics in Pediatric Medicine provides clinicians a tool to understand the current evidence for the role of probiotics in various pediatric disorders related to the gastrointestinal as well as the extra-intestinal tract. This book provides evidence-based up-to-date information from world experts in their fields to help clinicians make decisions regarding the use of probiotics. A list of resources, web sites, and references relevant to probiotics can be found in the appendix. Currently, the market for probiotics continues to rely heavily on health claims made by manufacturers and retailers. Clinicians have the sole responsibility to understand the various strains and preparations commercially available and to advise patients accordingly. Probiotics in Pediatric Medicine is an indispensable tool and a critical resource for health professionals that will aid in enhancing their ability to make the appropriate decisions regarding the use of probiotics.

Zielgruppe

Professional/practitioner

Autoren/Hrsg.

Michail, Sonia

Sherman, Philip M.

Inhaltsverzeichnis

Probiotics: The Basics.- Basics of GI Physiology and Mucosal Immunology.- What Pediatricians Need to Know about the Analysis of the Gut Microbiota.- Role of Microflora in Disease.- Probiotics 101.- Mechanisms of Probiotic Regulation of Host Homeostasis.- Safety Issues of Probiotic Ingestion.- Probiotics and Infants.- Neonatal and Infant Microflora.- Probiotics in Infant Dietetics.- Necrotizing Enterocolitis: The Role of Probiotics in Prevention.- Probiotics and the Gut.- Irritable Bowel Syndrome.- The Role of Probiotics in the Treatment and Prevention of Infectious Diarrhea in Children.- Probiotics in Crohn's Disease.- Probiotics in Ulcerative Colitis.- Pouchitis.- Probiotics in Antibiotic-Associated Diarrhea and Clostridium difficile Infection.- Probiotics and the Immunocompromised Host.- Role of Probiotics in the Management of Helicobacter pylori Infection.- Probiotics Outside the Gut.- Probiotics in Treatment and/or Prevention of Allergies.- The Role of Probiotics in the Treatment and Prevention of Asthma.- The Impact of Probiotics on Maternal and Child Health: Clinical Evidence.- Probiotics Products.- Probiotics in Foods and Supplements.- The Application of Prebiotics and Synbiotics in Pediatrics.- The Future of Probiotics.- Probiotic Future.- The Quality Control of Probiotics in Food and Dietary Supplements.

Leseproben

INTESTINAL MICROBES AS A SOURCE OF MATURATIONAL SIGNALS TO THE DEVELOPING INTESTINE – A WINDOW OF OPPORTUNITY FOR PROBIOTIC INTERVENTION (S. 46-47)

In addition to affecting gut microbiota composition, probiotics may have direct effects on infant gut. It is well established that the neonatal intestine and the intestinal immune system in particular are dependent on external stimuli to become fully developed. The establishment of indigenous intestinal microbiota coincides with this maturational process and accumulating experimental data demonstrate that, in addition to breast milk, intestinal microbes provide the developing gut with maturational stimuli. It is therefore plausible that these developmental processes may be susceptible to manipulation by probiotics administered in the postnatal period [4] .

Colonization of the sterile neonatal gastrointestinal tract begins with first contact of the extrauterine environment. It is well established that a number of environmental factors, including mode of delivery [36] , feeding practices (breast milk versus formula [37] ) and treatment with antibiotics and/or in a neonatal intensive care unit [38] may have an impact on early microbial colonization.

Moreover, there are data indicating that the differences in intestinal microbiota composition between infants delivered vaginally or by caesarian section are still detectable at one year of age [36] . Disruptions in early colonization have been suggested to play a role in the pathogenesis of NEC in preterm infants [39] and the health benefits of breastfeeding have been partially attributed to the bifidogenic properties of breast milk [40] . As alluded to above, early aberrations in gut colonization have been shown to be associated with subsequent development of atopic eczema [29, 30] .

Given the immunological basis of the pathogenesis of atopic disease, this may be interpreted to imply a significant link between early colonizers and healthy immune development. Consequently, a hypothesis according to which changes in early microbial exposure resulting from lifestyle in the developed world, such as increasing caesarian sections and antibiotic use in infancy, changing pattern of infectious diseases, decreased importance of fermenting as a means to preserve food etc., may underlie the increase of immune-mediated disorders including atopic and autoimmune diseases has been proposed [14] .

This “hygiene hypothesis” was originally devised based on epidemiological findings linking decreased occurrence of infectious diseases in early childhood with increased risk of allergic disease [41, 42] . However, this view has subsequently been revised to emphasize the role of gut microbiota in healthy immune maturation [14] . The immunological processes resulting in gut immune maturation and establishment of tolerance toward indigenous microbes are not fully understood but both innate immune recognition mechanisms and adaptive immune responses orchestrated by dendritic cells and Tlymphocytes are involved. Studies conducted using experimental animal models suggest that toll-like receptors (TLRs), an evolutionarily conserved family of molecules, which recognize microbe-associated molecular patterns, are involved in recognizing and responding to initial pioneer colonizing bacteria.

Initially, TLRs have been implicated in innate immune defense against pathogens, but it appears that they may also have developmental and homeostatic functions. Germ-free rats colonized solely with Bifidobacterium lactis , a predominant component of gut microbiota in breastfed infants, have been observed to exhibit a transient and self-limiting TLR2- mediated inflammatory gene expression response in intestinal epithelial cells without evidence of inflammatory tissue damage [43] .