Dismicrobism intestinal probiotics

Interview with Dr. Renato Caviglia, Specialist in Gastroenterology and Digestive Endoscopy Doctor, you probably could find yourself in front of patients suffering from a stomach ache, bloating and abdominal tension, potentially due to an intestinal dismicrobism. How can they be useful probiotics? The presence of symptoms such as abdominal pain, Bloating, abdominal bloating and change in bowel habits is to indicate the presence of an alteration generally functional digestive also known as irritable bowel syndrome. This syndrome accounts for 80% of visits and consultations that we gastroenterologists we face daily. Is defined functional because at the end of a series of clinical evaluations instrumental you can not infer an anatomical, an organic disease of the digestive tract and therefore is defined as functional syndrome namely irritable bowel syndrome. The symptoms present and reported by patients suffering from irritable bowel syndrome are quite different from each other and are attributable to an altered intestinal motility. The only data actually objectified in these patients is an alteration of the microbial content the last section of the digestive tract, namely the colon, what is known today dismicrobism which then determines its clinical manifestations in different ways that account for the symptoms reported by the patient suffering from irritable bowel syndrome. Many therapeutic strategies have been hypothesized and then implemented to treat irritable bowel syndrome but not all of them are recognized really effective. Recently it has been introduced the use of probiotics in the treatment and management of irritable bowel syndrome and it is seen that they have a clinical effectiveness in reducing the clinical manifestations. What do you mean by the term probiotics and what is their history? As the name suggests, are the elements that promote health status. In fact, the definition of the World Health Organization concerning probiotics is to report the cellular elements of living microorganisms which when administered in adequate amounts confer a beneficial effect on the health of the host. The history of probiotics, we can trace it back even to the end of 1800 when a Russian scientist, Elie Metchnikoff, who graduated Nobel, identified of lactic acid producing bacteria who were able to determine a beneficial effect: prolong the life of the host organism. Later this concept was revived by Alfred Nissle who identified in the stool of a fallen soldier during the First World War the presence of non-pathogenic microorganisms, a strain of Escherichia coli presence and was able to connect this to the fact that this soldier did not present symptoms of an acute diarrheal syndrome, infection with Shigella, which had resulted in a major pandemic spread in the population of the German soldiers. This soldier, in reality, he was exempt. The researcher linked the two events in the presence of a microorganism present in the gut of this soldier, had determined that protect against infection with dysentery caused by Shigella. That was back in 1917. Therefore, the natural history of the discovery and use of microorganisms to effect positive dates back to the late 1800s, continued in the early 1900s, up to the present day, when the bacterial strains were identified specific who have these kinds of features: to confer, when administered in adequate amounts, a beneficial effect on the health and protection of the host organization. The two main probiotic Lactobacilli are known today and Bifido bacilli. In reality, then, there are the subspecies in this area. This is a very important concept because we have to think that not all the bacteria and not all probiotics espletano the same clinical efficacy and / or therapeutic but the effects we can define species specific. What are the main characteristics of probiotics? How they act and what is their therapeutic efficacy in the treatment of diseases of the digestive system? The most important characteristics of probiotics are essentially four. We have a protective effect of the intestinal epithelium: we have to imagine that the intestinal epithelium, that goes from the mouth to the anus is around 8 feet of intestines and represents a surface in contact with the external environment of about 400 square meters, almost as much as a football field, and is the widest surface of the body in contact with the external environment and then with pollutants and pathogens of all types. Thanks to this surface so extensive, probiotics espletano a vital role in maintaining the integrity and homeostasis of the intestinal epithelium. What does this mean? The intestinal epithelium represents a sort of barrier between the rest of the wall and the external environment, ie, the luminal contents. The cellular elements are not static structures but are absolutely dynamics connected to each other thanks to those which are called "tight junctions", ie tight junctions. So we have the cellular elements snap to one another through the "tight junctions". Probiotics, that these microorganisms, are located on the luminal side, on the apical surface of the cells and thanks to their action and metabolism of the cellular elements are produced a whole series of substances which have the effect, which are defined trophic that help the survival of the cellular elements with which they are in contact. The first large and important mechanism is to maintain homeostasis and the integrity of the epithelial barrier by reducing the permeability. The second major effect is very important from the point of view of the relationship against the intestinal immune system. We must not imagine the immune system in the gut as something static but dynamic and truly on the move. In every moment of life is to create the so-called bacterial sampling, that is, the cellular elements defensive go to test in the intestinal lumen and take the fragments of luminal contents and bring it within the wall so as to analyze and study and probably, in some cases, to evoke an immune response. There are two aspects of this immune response, diametrically opposed. An excessive immune response when there is a dysregulation of the immune response and, in this case, one can develop certain diseases or auto immune diseases, an excess of defense. On the other hand a lack of defense may enhance the growth, proliferation, pathogens of microbes present in the intestinal lumen that take over and cause damage, injury. This means that you enter probiotics play an immunomodulatory effect: on the one hand reduce the excess of immune response, and, therefore, reduce inflammation, on the other hand, however, stimulate the immune response and, therefore, prevent bacterial overgrowth and damage caused by pathogenic bacteria. As I said before, not all probiotics are the same. There are strains that promote the immune response and and strains, however, that are predominantly immunomodulating and therefore reduce the immune response. A further effect of probiotics is that of competition for food with other bacteria in the intestinal lumen they steal, basically, foods, nutrients, bacteria pathogens thereby preventing the proliferation. Finally, the fourth hypothesized mechanism, is that thanks to the nutritional metabolism, therefore the use and production of nutritional elements resulting from their metabolism, -form the trophic effect and bring the body of micronutrients necessary for its survival: imagine the vitamin B complex, B12, in particular, folic acid, polyunsaturated fatty acids and a number of other micronutrients is essential to homeostasis of the epithelial barrier that the very survival of the organism. Then enclose in a single term many bacterial strains different from each other is an understatement. We identify the class of bacterial probiotics as those elements and those living microorganisms which when administered in adequate amounts, afford a positive effect on the health of the organism. When we then turn to that class of people, to those patients who have a certain pathology, remember, as I said before, that not all probiotics are the same. To conclude then, we can say, that the effectiveness of treatment with probiotics, in diseases of the digestive system, monotherapy and combination therapy or as a supplement, is having more and more scientific evidence. The safety, and especially the low costs of administration of probiotics and prebiotics in functional syndromes and digestive system require the development of controlled clinical trials, randomized that can demonstrate a clear therapeutic efficacy as now we have only assumed. The results were case-control, studied in randomized, actually we might have science that evidence that could allow us to use these microorganisms in association or monotherapy with those who are the standard drugs today for the various diseases not only functional but also organic digestive tract.