short bowel syndrome
patients acting as their own controls
Gastrointestinal symptoms, including diarrhoea (and dehydration) (17). Based on hydrogen breath test
results, symptom scores and defeca-
Malnutrition; failure to thrive in children
tion rate, the probiotic did not show
Malabsorption problems (fat, carbohydrate, vitamin B12, fat-soluble vitamins) any signifi cant benefi t. In contrast,
Diffi culty in weaning from parenteral nutrition
a placebo-controlled trial (n=22)
conducted by Gaon et al reported
Gross and histological bowel infl ammation
that oral administration of two pro-
Bacterial translocation and septicaemia, particularly with Gram-negative bac-
biotics (L. casei and L. acidophilus)
teria
improved diarrhoea and hydrogen
D-lactic acidosis breath test results (5).
Table 1 Potential consequences of SIBO in SBS (based on Dibaise et al 2006)
More positive results are reported
in case studies with other probiotics,
Candy et al described treatment of a
so there is much interest in exploring mation could be prevented. On the
male baby who had his ileum and co-
any ways to help patients. Probiotics other hand, Lactobacillus GG (and
lon removed shortly after birth, leav-
have been investigated for several of L. plantarum 299V) had previously
ing him with only 60 cm of jejunum
the conditions that may cause SBS, been reported as a successful treat-
(3). SIBO was later diagnosed and at
including Crohn’s disease and necro- ment for SIBO patients (19). A more
12 months he was given a probiotic
tizing enterocolitis. This, together with recent placebo-controlled study
three times a day: 1.5 x 109 CFU Lac-
the frequent observation of SIBO in (n=21) in SBS children with Lactoba-
tobacillus casei Shirota, a strain which
SBS, has suggested that modulation cillus GG did not report any safety
produces predominantly L-lactate.
of the intestinal microbiota by pro- or problems, but the probiotic did not
After this, stool frequency decreased
prebiotics may be benefi cial. apparently improve intestinal perme-
from 12 to 4 per day. An increase in
The current dossier of evidence ability (16).
urinary sodium excretion despite the
for this is based mainly on individual The second concern is that probi-
sodium supplementation remain-
cases, many of which report benefi t. otics might increase the risk of D-
ing constant, indicated that jejunal
But it is important to point out two lactic acidosis, as this is a metabolic
sodium absorption had improved. The
concerns. by-product produced by certain
authors speculated that the probiotic
Firstly, SBS patients have impaired probiotic strains. This was thought
had improved the balance of the
gut barrier function, increasing their to be the case in a report of a boy
intestinal microbiota and possibly
risk of transmigration of gut bacteria with SBS who experienced frequent
modulated the immune function.
across the intestinal mucosa. How- episodes of D-lactic acidosis, whilst
The same probiotic was used in
ever, this risk comes not just from any taking a product containing probiotic
a premature girl left with only 38cm
probiotic consumed (often species L. acidophilus
of lactobacilli or bifi dobacteria, bac- and a Bifi do-
teria normally considered non-patho- bacterium
genic) but also from the indigenous species (9).
bacteria which will include Gram-
e
negative bacteria, whose cell wall Probiotic
is endotoxic. Kunz et al report two studies
cases where sepsis developed in pre- One of the
term babies given Lactobacillus GG, earliest reports
one by gastrostomy tube and one was a trial with
orally (10). Blood cultures from both a Lactobacil-
babies grew Lactobacillus but in only lus fermentum
Urine Na (mmol/litr
one case was this confi rmed by DNA
strain in 17
fi ngerprinting as the probiotic strain.
SIBO patients,
The authors recommended that the
using a dou-
clinical state of patients on probiot-
ble-blinded
ics should be closely watched, and
crossover de-
that it would help if intestinal infl am-
sign with the
Days
NHDmag.com July ‘08 - issue 36 23
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