Probiotics in the treatment of gastrointestinal diseases: effectiveness from the standpoint of evidence-based medicine

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Abstract

Probiotics are clinically important microorganisms which have beneficial effects on the gut microbiota and are able to affect the incidence of gastrointestinal diseases. The article provides a scientific review of a large number of meta-analyzes of studies (2004-2019) on assessing the effectiveness of the use of probiotics for the treatment of acute diarrhea, antibiotic-associated diarrhea, eradication therapy for Helicobacter pylori, and functional constipation. According to the data of 9 meta-analyzes (including 2 Cochrane meta-analyzes), the use of probiotics for the treatment of acute diarrhea in adults and children can reliably reduce the duration of diarrhea by more than 1 day and accelerate the achievement of cure in 3-4 days. The most pronounced effect of probiotics in acute diarrhea was noted in children under 5 years of age, and therefore probiotics are included in the European guidelines for the treatment of acute gastroenteritis in children. According to the data of 12 meta-analyzes (including 3 Cochrane meta-analyzes), probiotics have significant effectiveness in the prevention and treatment of antibiotic-associated diarrhea by reducing the risk of diarrhea by 40% or more in different patient populations (adults, the elderly, children). Two Cochrane metaanalyzes have shown the efficacy of probiotics in preventing diarrhea caused by Clostridioides difficile infection via reducing the risk by 60% or more. Fourteen meta-analyzes have demonstrated the effectiveness of probiotics when taking in addition to different regimens of H. pylori eradication therapy, by increasing the rate of eradication and reducing the risk of side effects of antibiotics by 40-50%, which gained significance in the Maastricht V clinical guidelines. In 10 meta-analyzes, the effectiveness of probiotics in influencing intestinal transit in functional constipation was established, in addition, probiotics contributed to the improvement of constipation. Two types of probiotics have the greatest clinical significance for the treatment and prevention of gastrointestinal diseases, they are Lactobacillus and Saccharomyces, namely strains of Lactobacillus rhamnosus GG and Saccharomyces boulardii, for the treatment of functional constipation -probiotics of the genus Bifidobacterium lactis. In addition, a dose-dependent effect of probiotics has been established, and the greatest effect is manifested when using high dosages - at least 109-1010 CFU / day. The evidence for the use of probiotics in the treatment of gastrointestinal diseases in adults and children is also defined in the 2017 Guidelines of the World Gastroenterological Organization.

About the authors

Marina V. Leonova

Association of Clinical Pharmacologists

Email: anti23@mail.ru
д-р мед. наук, проф., чл.-кор. РАЕН, клин. фармаколог, член МОО Marina V. Leonova - D. Sci. (Med.), Prof., Corr. Memb. RANS, Association of Clinical Pharmacologists. «Ассоциация клинических фармакологов»

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