Diarrhea and Probiotics

The reasons for getting diarrhea can be many; from various infections, antibiotics use, Inflammatory Bowel Disease (IBD), Irritable Bowel Disease (IBS) or intense endurance exercise. In common for all these conditions they influence our gut microbiota, and all benefit from treatment with probiotics [1]. It is known that a changed microbiota can give bile salt deconjugation changes leading to changes in stool volume and consistency. Other important functions of the gut microbiota is metabolic (salvages calories, production of short-chain fatty acids, amino acids, vitamin K and folic acid); prevention of colonization by pathogens and immunologic functions [2].

Antibiotics cause diarrhea by several mechanisms, one is that some antibiotics decrease the concentrations of anaerobes, leading to reduced metabolism of carbohydrates and a resultant osmotic diarrhea. Also, during, and in the recovery phase after antibiotics use, there is a risk of pathogenic bacteria to colonize the gut. One such pathogen is Clostridium difficile, in some severe cases treated with stool transplants [3], or with probiotics [1]. To prevent colonization of pathogens, probiotics supplementation could be used, to “outnumber the bad bacteria”. Generally probiotics are given in conjunction with antibiotics, to prevent diarrhea, and several clinical studies have shown that the risk of antibiotic-associated diarrhea is reduced when given probiotics [4, 5]. A study in mice showed that probiotics do not colonize the intestine themselves, however, probiotic supplementation does significantly change the types of bacteria that are present [6]. Another important issue is that pathogenic bacteria are able to evolve and can acquire resistance to antibiotics. Since probiotics can be used as partial replacement or together with antibiotics treatment, and thereby prevent secondary infections, antibiotic resistance evolvement could be limited [5].

It is common with problems with diarrhea during intense endurance exercise, especially running, and the main causes are ischemic, mechanical, and nutritional factors; all affecting the gut [7]. The gut microbiota have a key role in inflammatory response, metabolism and energy expenditure during intense exercise, and thus probiotics can be an important tool to improve athletes’ general health and performance [8].

The microbiota composition has an important role in conditions like IBD and IBS, and dietary restrictions and the addition of lactic acid bacteria (probiotics) has a good effect on symptoms in these conditions [9-12]. A study comparing double-coated to non-coated probiotics in treatment of diarrhea in IBS patients showed stronger effect in the double-coated group, showing the importance to protect the probiotic bacteria in their way to the colon for better efficacy [13].

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  2. Quigley EM: Gut bacteria in health and disease. Gastroenterol Hepatol (N Y) 2013, 9(9):560-569.
  3. Vogt SL, Finlay BB: Gut microbiota-mediated protection against diarrheal infections. J Travel Med 2017, 24(suppl_1):S39-S43.
  4. Doron SI, Hibberd PL, Gorbach SL: Probiotics for prevention of antibiotic-associated diarrhea. J Clin Gastroenterol 2008, 42 Suppl 2:S58-63.
  5. Ouwehand AC, Forssten S, Hibberd AA, Lyra A, Stahl B: Probiotic approach to prevent antibiotic resistance. Ann Med 2016, 48(4):246-255.
  6. Grazul H, Kanda LL, Gondek D: Impact of probiotic supplements on microbiome diversity following antibiotic treatment of mice. Gut Microbes 2016, 7(2):101-114.
  7. de Oliveira EP: Runner’s diarrhea: what is it, what causes it, and how can it be prevented? Curr Opin Gastroenterol 2017, 33(1):41-46.
  8. Mach N, Fuster-Botella D: Endurance exercise and gut microbiota: A review. Journal of Sport and Health Science 2017, 6:179-197.
  9. Mimura T, Rizzello F, Helwig U, Poggioli G, Schreiber S, Talbot IC, Nicholls RJ, Gionchetti P, Campieri M, Kamm MA: Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis. Gut 2004, 53(1):108-114.
  10. Williams EA, Stimpson J, Wang D, Plummer S, Garaiova I, Barker ME, Corfe BM: Clinical trial: a multistrain probiotic preparation significantly reduces symptoms of irritable bowel syndrome in a double-blind placebo-controlled study. Aliment Pharmacol Ther 2009, 29(1):97-103.
  11. Ki Cha B, Mun Jung S, Hwan Choi C, Song ID, Woong Lee H, Joon Kim H, Hyuk J, Kyung Chang S, Kim K, Chung WS et al: The effect of a multispecies probiotic mixture on the symptoms and fecal microbiota in diarrhea-dominant irritable bowel syndrome: a randomized, double-blind, placebo-controlled trial. J Clin Gastroenterol 2012, 46(3):220-227.
  12. Lee HJ, Choi JK, Ryu HS, Choi CH, Kang EH, Park KS, Min YW, Hong KS: Therapeutic Modulation of Gut Microbiota in Functional Bowel Disorders. J Neurogastroenterol Motil 2017, 23(1):9-19.
  13. Han K, Wang J, Seo JG, Kim H: Efficacy of double-coated probiotics for irritable bowel syndrome: a randomized double-blind controlled trial. J Gastroenterol 2017, 52(4):432-443.

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