South African Family Practice

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Ok, so who wants to colonise my gut? - Overview of Probiotics in certain Gastro-intestinal Disorders

GL Muntingh


Probiotics are being used and perhaps more often than not as a treatment for a variety of gastrointestinal (GI) disorders. With increasing frequency, it is also being advocated as a treatment for several medical conditions, such as allergic diseases (atopic dermatitis, possibly allergic rhinitis), bacterial vaginosis, urinary tract infections, and prevention of dental caries or respiratory infections. Disturbances of bacterial microflora of the GI tract may play an important role in the pathophysiology of some GI disorders. It appears that probiotics being used as a treatment modality may have originated more than a century ago. It may restore normal microflora bacterial colonies and effect the functioning of the GI tract by a variety of mechanisms. Probiotics are not currently regulated and only few authoritative randomised controlled trials exist investigating their efficacy in different GI disorders. The efficacy of probiotics, as either a single strain or a combination of probiotics, has been assessed in antibioticassociated diarrhoea, Clostridium difficile colitis, infectious diarrhoea, ulcerative colitis, Crohn’s disease, and irritable bowel syndrome, among other disorders. Although probiotics appear to be generally safe in an outpatient setting, no studies exist addressing the issue of safety specifically. Because most clinical trials in this respect are not congruent in design, many questions regarding use of probiotics in GI disorders remain to be answered, such as most optimal doses, duration of treatment, physiological and immunological effects and efficacy of specific probiotics in specific disease states.

Keywords: Probiotics, Gastrointestinal disease, Safety, Clinical trials, Clinical effectiveness

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