Novel Effects Associated with the Use of Probiotics, Synbiotics and Prebiotics

To maintain the wellbeing of the human gut, the role of its microflora and their metabolites is fundamental. Probiotics is a Greek term, which is used to define non-living microbes that are beneficial in nature and exert numerous advantages on the host body. The intestinal microflora’s function and activity may also be improved by administering some of the prebiotics (indigestible dietary fibers) independently or in a c combination with probiotics. The term “Synbiotics” is used to denote the combination of both prebiotics and probiotics. It should always be noted that numerous disorders are being associated with the abnormal function of microbiota/microflora that can be regulated and stabilized with the help of ingestion of probiotics, prebiotics or their combination. Multiple benefits are associated with the use of these probiotics, synbiotics and prebiotics including healthier digestive system, proper immune response of the gut and treatment of numerous GI tract disorders. All these issues are encountered because of treatments with new synthetic drugs that affect the digestive system as well as numerous organs in the body. Ulcerative colitis is a term that refers to chronic inflammation of the colon emerging as a result of improper immune response to intestinal microflora of the host. Researchers have studied the effects of synbiotics to treat this chronic condition1. As for the action mechanism of the synbiotics is concerned, it is assumed that they modulate the inflammatory response through expression of the cytokines, probiotic bacteria assisted modulation of the immune cells and prebiotics assisted production of certain short chain fatty acids. Jayanama and Theou studied the consequences of improper ingestion of probiotics and prebiotics in elderly patients. They revealed that physical inactivity, sarcopenia, and polypharmacy could be treated with the help of probiotics, prebiotics or a combination of both2. All the aforementioned disorders can lead to gut dysbiosis. The researchers have also revealed that the gut microbiota homeostasis can be improved with the help of probiotics and prebiotics and they can be a helping hand in the prevention of aging and frailty. It is evident that left and right prescriptions of antibiotics and their use caused antibiotic resistance in the pathogens. This issue can be best resolved with the ingestion of probiotics and prebiotics. The systematic evidence to treat infected chronic wounds has been provided by Brognara et al3. Similarly, chronic wounds and burns treatment is done widely with the use of Lactobacillus plantarum. Some other researchers have reviewed the available data associated with the use of numerous prebiotics in the treatment of idiopathic constipation, and highly prevalent GIT disorrderrs4-6. This is due to the capability of prebiotics to improve the consistency of the stool, bloating and number of bowel movements. A limited data is available regarding the efficacy of prebiotics in the treatment of ulcerative colitis and pouchitis. It is concluded that probiotics, prebiotics and synbiotics have been imparting a role in treating GIT disorders including indigestion, traveler’s diarrhea, IBD etc. Scientific reports have revealed their role in the treatment of cancerous disease, obesity, kidney and brain disorders. Many tools for the research of probiotics, prebiotics and synbiotics are now available; therefore, the future bio-therapeutics are going to be changed with the passage of time.

A Systematic Review and Network Meta-Analysis on the Efficacy of Medications in the Treatment of Chronic Idiopathic Constipation in Japan

Background. In the 2010s, medications with new mechanisms were introduced in Japan for the treatment of chronic idiopathic constipation (CIC). A few systematic reviews have compared medications’ relative efficacy, but the reviews included studies on patients from various races, even though the mechanism of CIC is considered to differ between races. The aim of this study was to use a systematic review and network meta-analysis to compare the relative efficacy of these medications in Japanese patients. Methods. We conducted a meta-analysis and report it here according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We identified studies by searching MEDLINE (via the PubMed interface) and the Cochrane Library and ICHUSHI databases and included randomized clinical trials that compared medications for CIC with placebo in Japanese adults. Two reviewers independently screened and assessed articles, abstracted data, and assessed the risk of bias. We pooled data by random-effects meta-analyses and also performed a Bayesian network meta-analysis to indirectly compare data. Results. The present systematic review and meta-analyses included 1460 patients in 6 randomized clinical trials: 2 on linaclotide, 3 on elobixibat, 2 on lubiprostone, and 1 on lactulose. The results of direct comparisons showed that linaclotide, elobixibat, and lubiprostone were superior to placebo in the change of spontaneous bowel movements (SBMs) within 1 week: linaclotide, 1.95 (95% CI, 1.51-2.39); elobixibat, 5.69 (95% CI, 3.31-8.07); and lubiprostone, 2.41 (95% CI, 0.82-4.01). The Bayesian network meta-analysis showed consistent results. Elobixibat 10 mg was ranked first for the increase in SBMs and complete SBMs within 1 week and the time to first SBM. Lubiprostone 48 μg was ranked first for the proportion of patients with SBM within 24 hours. Conclusion. Our direct and indirect meta-analyses revealed that the new CIC medications available in Japan have equal efficacy but that elobixibat and lubiprostone are highly likely to be more efficacious.

Reducing Constipation-Related Admissions: The Effectiveness of Antegrade Continence Enema Procedures in Children

Introduction Constipation in pediatrics remains a common problem. Antegrade continence enema (ACE) procedures have been shown to decrease the distress of daily therapy. Patients are able to administer more aggressive washouts in the outpatient setting. Therefore, we hypothesize that patients following an ACE procedure would have reduced admissions for constipation. Methods Patients who underwent an ACE procedure at a large children’s hospital from 2015 to 2018 were included. Demographics, diagnosis, procedure, and preoperative/postoperative hospital admissions were analyzed. Results Forty-eight patients were included in the study. Over half were diagnosed with idiopathic constipation. Majority of patients underwent an appendicostomy (88%, n = 42). Preoperatively, 26 patients were admitted for a combined total of 63 times for constipation. Postoperatively, 4 patients were admitted for a total of 5 visits ( P = .021). Twenty-eight patients required a nonscheduled appendicostomy tube replacement. Conclusion This study demonstrates ACE procedures can improve constipation-related symptoms in children and are associated with decrease hospital admissions.