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click here to print this document The Journal of Alternative and Complementary Medicine.
Volume 10, Number 4. 2004, pp 601
Letters to the Editor
Probiotics in the Prevention and Treatment of Diarrhea
Dear Editor:
Humans are born without any microorganisms inhabiting their gastrointestinal tract. Soon thereafter, strains of bacteria colonize the lining of the digestive system and become an integral part of helping to maintain a person's health. There are several strains of bacteria that can be found in an average human's body. Some of the better known strains are Lactobacillus, Bifidobacterium, Streptococcus, and Escherichia coli. Some bacteria have been found to be useful in treating specific diseases. These particular microorganisms are known as probiotics, also known as “good gut” bacteria. They have been used in the treatment of diarrhea. Some preliminary work has also been done with cancer.
We performed a systematic review of the literature looking at the question of whether probiotics were effective in the prevention and treatment of diarrhea. Using the subject headings and keywords “probiotics” and “diarrhea,” literature searches were completed in MEDLINEª, PubMed, Cochrane Controlled Trials register, and the Cochrane Database of Systematic reviews. Both authors independently reviewed all abstracts. All double-blinded randomized controlled trials regarding probiotics in the prevention or treatment of diarrhea were retrieved and these became the basis of the review. There were 157 articles, of which 20 were randomized clinical trials for review. Diarrhea was defined as three or more watery stools per day.
Subjects with bloody diarrhea or diarrhea caused by an invasive organism, such as salmonella or shigella, were excluded from the studies.
Probiotics are remarkably safe. In the 20 studies involving 2,685 patients, there were no reports of major side-effects with any probiotic.
There were 11 trials that tested the use of probiotics against diarrhea in children. When tested, the use of probiotics reduced the average length of hospital stay for gastroenteritis by 1 day. Probiotics were consistently much more effective in reducing diarrhea in children who were infected with rotavirus. This was true no matter what probiotic was used. Lactobacillus GG was the most extensively studied probiotic for this condition.
Studies also showed effectiveness of probiotics against both antibiotic associated diarrhea and traveler's diarrhea.
In conclusion, probiotics are safe and effective in the prevention and treatment of watery diarrhea. They are especially effective in children under the age of 5 with Rotavirus infection.
Lactobacillus GG is the most extensively studied probiotic.
There is strong evidence to support the expanded use of probiotics in the treatment of watery diarrhea in young children, in the prevention of traveler's diarrhea in adults, and in the prevention of antibiotic-associated diarrhea. More research needs to be done so as to specify the appropriate probiotic strain and the appropriate dose of that strain for the various conditions that can be effectively treated with probiotics.
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Chester H. Fox, M.D.
Clinical Center
Buffalo, NY
Gaurav Dang
University of MassachusettsÑAmherst
Amherst, MA
Address reprint requests to:
Chester H. Fox, M.D.
Department of Family Medicine
Clinical Center
462 Grinder Street
Buffalo, NY 14215
E-mail: cfox@buffalo.edu
