Sinnvoller Einsatz von Probiotika in Prävention und Therapie

Zusammenfassung

Probiotika können durch Beeinflussung des intestinalen Schleimhaut und des Immunsystems zahlreiche Effekte hervorrufen, die präventiv und therapeutisch genutzt werden können. So besteht eine starke Evidenz bezüglich des Einsatzes bei nekrotisierender Enterokolitis des Frühgeborenen und bei Pouchitis. Ebenso scheinen durch eine Immunmodulation auch Störungen aus dem atopischen Formenkreis beeinflusst werden zu können, insbesondere bei atopischer Dermatitis. Hinweise für eine Wirksamkeit entsprechend Mesalazin zur Remissionserhaltung bei Colitis ulcerosa, zur Prävention der Pouchitis sowie beim Reizdarmsyndrom lassen einen therapeutischen Einsatz gerechtfertigt erscheinen. Aktuelle Studien bezüglich der Nahrungsverwertung und Stoffwechselbeeinflussung durch die Mikrobiota lassen einen unterstützenden Einsatz auch zur Prävention und Therapie der Adipositas möglich erscheinen.

Abstract

Probiotics exert distinct effects on the intestinal mucosa and the immune system that can be used in preventive and therapeutic settings. There is evidence to support the use of probiotics in necrotizing enterocolitis in preterm infants and pouchitis. Furthermore, the immunomodulatory effects of probiotics seem to ameliorate atopic diseases, in particular atopic dermatitis. The efficacy of probiotics has been shown comparable to Mesalazine regarding the maintenance of remission in ulcerative colitis. In addition there is evidence that probiotics are useful in the prevention of pouchitis or in therapy of irritable bowel syndrome. Recent data indicate that commensals and probiotics could play a role in nutrient fermentation and energy metabolism and may be helpful in the prevention and therapy of obesity.

Schlüsselwörter

Probiotika - Immunsystem - Ernährung - Atopie - chronisch-entzündliche Darmkrankheiten - Reizdarmsyndrom

Keywords

probiotics - nutrition - immune system - atopy - inflammatory bowel diseases - irritable bowel syndrome

Literatur

• 1 Alfaleh K, Bassler D. Probiotics for prevention of necrotizing enterocolitis in preterm infants.  Cochrane Database Syst Rev. 2008;  CD005496
• 2 Bäckhed F, Ding H, Wang T. et al . The gut microbiota as an environmental factor that regulates fat storage.  Proc Natl Acad Sci U S A. 2004;  101 15718-15723
• 3 Besselink M G, van Santvoort H C, Buskens E. et al . Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial.  Lancet. 2008;  371 651-659
• 4 Canani R B, Cirillo P, Terrin G. et al . Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations.  BMJ. 2007;  335 340
• 5 Cremonini F, Di Caro S, Nista E C. et al . Meta-analysis: the effect of probiotic administration on antibiotic-associated diarrhoea.  Aliment Pharmacol Ther. 2002;  16 1461-1467
• 6 Deshpande G, Rao S, Patole S. Probiotics for prevention of necrotising enterocolitis in preterm neonates with very low birthweight: a systematic review of randomised controlled trials.  Lancet. 2007;  369 1614-1620
• 7 Gionchetti P, Rizzello F, Helwig U. et al . Prophylaxis of pouchitis onset with probiotic therapy: a double-blind, placebo-controlled trial.  Gastroenterology. 2003;  124 1202-1209
• 8 Gionchetti P, Rizzello F, Venturi A. et al . Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial.  Gastroenterology. 2000;  119 305-309
• 9 Hermiston M L, Gordon J I. Inflammatory bowel disease and adenomas in mice expressing a dominant negative N-cadherin.  Science. 1995;  270 1203-1207
• 10 Hoveyda N, Heneghan C, Mahtani K R, Perera R, Roberts N, Glasziou P. A systematic review and meta-analysis: probiotics in the treatment of irritable bowel syndrome.  BMC Gastroenterol. 2009;  9 15
• 11 Isolauri E, Salminen S. Probiotics: use in allergic disorders: a Nutrition, Allergy, Mucosal Immunology, and Intestinal Microbiota (NAMI) Research Group Report.  J Clin Gastroenterol. 2008;  42 Suppl 2 S91-S96
• 12 Kalliomaki M, Collado M C, Salminen S, Isolauri E. Early differences in fecal microbiota composition in children may predict overweight.  Am J Clin Nutr. 2008;  87 534-538
• 13 Kruis W, Fric P, Pokrotnieks J. et al . Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine.  Gut. 2004;  53 1617-1623
• 14 Kruis W, Schütz E, Fric P, Fixa B, Judmaier G, Stolte M. Double-blind comparison of an oral Escherichia coli preparation and mesalazine in maintaining remission of ulcerative colitis.  Aliment Pharmacol Ther. 1997;  11 853-838
• 15 Lee J, Seto D, Bielory L. Meta-analysis of clinical trials of probiotics for prevention and treatment of pediatric atopic dermatitis.  J Allergy Clin Immunol. 2008;  121 116-121
• 16 Majamaa H, Isolauri E. Probiotics: a novel approach in the management of food allergy.  J Allergy Clin Immunol. 1997;  99 179-185
• 17 McFarland L V, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome.  World J Gastroenterol. 2008;  14 2650-2661
• 18 McFarland L V. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease.  Am J Gastroenterol. 2006;  101 812-822
• 19 Mimura T, Rizzello F, Helwig U. et al . Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis.  Gut. 2004;  53 108-114
• 20 Moayyedi P, Ford A C, Talley N J. et al . The efficacy of probiotics in the therapy of irritable bowel syndrome: a systematic review.  Gut. 2008, Epub ahead of print; 
• 21 Nikfar S, Rahimi R, Rahimi F, Derakhshani S, Abdollahi M. Efficacy of probiotics in irritable bowel syndrome: a meta-analysis of randomized, controlled trials.  Dis Colon Rectum. 2008;  51 1775-1780
• 22 O’Mahony L, McCarthy J, Kelly P. et al . Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles.  Gastroenterology. 2005;  128 541-551
• 23 Osborn D A, Sinn J K. Probiotics in infants for prevention of allergic disease and food hypersensitivity.  Cochrane Database Syst Rev. 2007;  CD006475
• 24 Penders J, Thijs C, van den Brandt P A. et al . Gut microbiota composition and development of atopic manifestations in infancy: the KOALA Birth Cohort Study.  Gut. 2007;  56 661-667
• 25 Pillai A, Nelson R. Probiotics for treatment of Clostridium difficile-associated colitis in adults.  Cochrane Database Syst Rev. 2008;  CD004611
• 26 Preidis G A, Versalovic J. Targeting the human microbiome with antibiotics, probiotics, and prebiotics: gastroenterology enters the metagenomics era.  Gastroenterology. 2009;  136 2015-2031
• 27 Quigley E M. The efficacy of probiotics in IBS.  J Clin Gastroenterol. 2008;  42 Suppl 2 S85-S90
• 28 Rembacken B J, Snelling A M, Hawkey P M, Chalmers D M, Axon A TR. Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: a randomised trial.  Lancet. 1999;  354 635-639
• 29 van Ruseler-Embden J G, Schouten W R, Van Lieshout L M. Pouchitis: result of microbial imbalance?.  Gut. 1994;  35 658-664
• 30 Sazawal S, Hiremath G, Dhingra U, Malik P, Deb S, Black R E. Efficacy of probiotics in prevention of acute diarrhoea: a meta-analysis of masked, randomised, placebo-controlled trials.  Lancet Infect Dis. 2006;  6 374-382
• 31 Siltanen M, Kajosaari M, Poussa T, Saarinen K M, Savilahti E. A dual long-term effect of breastfeeding on atopy in relation to heredity in children at 4 years of age.  Allergy. 2003;  58 524-530
• 32 Snijders B E, Thijs C, Dagnelie P C. et al . Breast-feeding duration and infant atopic manifestations, by maternal allergic status, in the first 2 years of life (KOALA study).  J Pediatr. 2007;  151 347-351