Organisation practice guidelines : Probiotics and prebiotics

The human gut harbors dense and diverse microbial communities which have an impact on host’s health. The symbiotic relationship between gut microbial communities and host can be optimized by pharmacological or nutritional intervention on the intestinal ecosystem using probiotics or prebiotics. Worldwide research on the use of prebiotics and probiotics in human and animal health has accelerated in recent years. However, there is lack of information about the practical use of probiotics and prebiotics in Medicine. A major area for medical applications has been the prevention or treatment of gastrointestinal diseases. Recently, a group of international experts appointed by the World Gastroenterology Organization prepared a practical guideline on the current indications of probiotics and prebiotics in Gastroenterology. The full text of the guideline is published in the current issue of our Journal. The document underscores strain-specificity of the clinical effects, and provides precise information on which specific probiotic strains or prebiotic compounds are useful for what particular clinical indications (see Table 3). 2009 World Gastroenterology Organisation. Published by Elsevier B.V. All rights reserved. The following article is published in the Arab Journal of Gastroenterology with permission from the World Gastroenterology Organisation (WGO) and its Guidelines and Publications Committee Review Team Francisco Guarner (Chair, Spain) Aamir G. Khan (Pakistan) James Garisch (South Africa) Rami Eliakim (Israel) Alfred Gangl (Austria) Alan Thomson (Canada) Justus Krabshuis (France) Ton Le Mair (The Netherlands) Invited outside experts Pedro Kaufmann (Uruguay) Juan Andres de Paula (Argentina) Richard Fedorak (Canada) Fergus Shanahan (Ireland) Mary Ellen Sanders (USA) Hania Szajewska (Poland) Probiotics – the concept History and definitions A century ago, Elie Metchnikoff (Russian scientist, Nobel laureate, and professor at the Pasteur Institute in Paris) postulated that enterology Organisation. Published lactic acid bacteria (LAB) offered health benefits leading to longevity. He suggested that ‘‘intestinal auto-intoxication” and the resultant aging could be suppressed by modifying the gut microbiota and replacing proteolytic microbes such as Clostridium – which produce toxic substances including phenols, indoles, and ammonia from the digestion of proteins – with useful microbes. He developed a diet with milk fermented with the bacterium he called ‘‘Bulgarian bacillus. ” In 1917, before Sir Alexander Fleming’s discovery of penicillin, the German professor Alfred Nissle isolated a nonpathogenic strain of Escherichia coli from the feces of a First World War soldier who did not develop enterocolitis during a severe outbreak of shigellosis. Disorders of the intestinal tract were frequently treated with viable nonpathogenic bacteria to change or replace the intestinal microbiota. The Escherichia coli strain Nissle 1917 is one of the few examples of a non-LAB probiotic. A Bifidobacterium was first isolated by Henry Tissier (of the Pasteur Institute) from a breast-fed infant, and he named the bacterium Bacillus bifidus communis. Tissier claimed that bifidobacteria would displace the proteolytic bacteria that cause diarrhoea and recommended the administration of bifidobacteria to infants suffering from this symptom. The term ‘‘probiotics” was first introduced in 1965 by Lilly and Stillwell; in contrast to antibiotics, probiotics were defined as microbially derived factors that stimulate the growth of other organisms. In 1989, Roy Fuller emphasized the requirement of viability for probiotics and introduced the idea that they have a beneficial effect on the host. by Elsevier B.V. All rights reserved. al of Gastroenterology 10 (2009) 33–42 Definition 1. 34 WGO practice guidelines / Arab Journ Probiotics Live microorganisms which, when administered in adequate amounts, confer a health benefit on the host Prebiotics Nondigestible substances that provide a beneficial physiological effect on the host by selectively stimulating the favorable growth or activity of a limited number of indigenous bacteria Synbiotics Products that contain both probiotics and prebiotics Fig. 1. Electron micrograph of Lactobacillus salivarius 118 adhering to Caco-2 cells (source: Neurogastroenterol Motil 2007;19:166–72). What are probiotics? Probiotics are live microbes that can be formulated into many different types of products, including foods, drugs, and dietary supplements. Species of Lactobacillus (Fig. 1) and Bifidobacterium are most commonly used as probiotics, but the yeast Saccharomyces cerevisiae and some E. coli and Bacillus species are also used as probiotics. Lactic acid bacteria (LAB), including species of Lactobacillus, which have been used for preservation of food by fermentation for thousands of years, can serve a dual function by acting as agents of food fermentation and, in addition, potentially imparting health benefits. Strictly speaking, however, the term ‘‘probiotic” should be reserved for live microbes that have been shown in controlled human studies to impart a health benefit. Fermentation of food provides characteristic taste profiles and lowers the pH, which prevents contamination by potential pathogens. Fermentation is globally applied in the preservation of a range of raw agricultural materials (cereals, roots, tubers, fruit and vegetables, milk, meat, fish etc.).