Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII Bergamo.
Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa.
Curr Opin Pediatr. 2019 Oct;31(5):661-669. doi: 10.1097/MOP.0000000000000808.
There is growing evidence encouraging the use of probiotics in many conditions in children. However, given the wide number of probiotics available and contradictory data in the literature, the health-care provider is often faced with uncertainness about whether or not to use probiotics and which one(s) to choose. We here review current hypotheses regarding the efficacy and safety of probiotics and evaluate the available data on the use of probiotics in most common diseases in children. Considering that probiotics have strain-specific effects, we will focus on individual probiotic strains rather than on probiotics in general.
Strain-specific efficacy was clearly demonstrated with Lactobacillus rhamnosus GG and Saccharomyces boulardii I-745 in the treatment of acute infectious diarrhea, Lactobacillus reuteri DSM 17938 in infantile colics, Lactobacillus rhamnosus GG, and VSL#3 in irritable bowel syndrome. In addition, encouraging results are seen for use of probiotics in necrotizing enterocolitis, food allergy, and nonalcoholic fatty liver disease. However, the data available for constipation are to be considered somewhat equivocal.
The clinical relevance of these findings indicates that healthcare providers need to take strain-specificity and disease specificity of probiotics into consideration when recommending probiotic for their patients.
越来越多的证据表明益生菌在儿童多种疾病中具有应用价值。然而，鉴于可用的益生菌种类繁多，且文献中存在相互矛盾的数据，临床医生常常难以确定是否使用益生菌以及选择哪种益生菌。本文回顾了目前关于益生菌的疗效和安全性的假设，并评估了益生菌在儿童最常见疾病中的应用的现有数据。考虑到益生菌具有菌株特异性的作用，我们将重点关注个别益生菌菌株，而不是一般的益生菌。
鼠李糖乳杆菌 GG 和布拉氏酵母菌 I-745 可明确治疗急性感染性腹泻，罗伊氏乳杆菌 DSM 17938 可治疗婴儿绞痛，鼠李糖乳杆菌 GG 和 VSL#3 可治疗肠易激综合征，这些益生菌的疗效具有菌株特异性。此外，益生菌在坏死性小肠结肠炎、食物过敏和非酒精性脂肪性肝病中的应用也取得了令人鼓舞的结果。然而，目前关于便秘的可用数据尚存在一些争议。
这些发现的临床意义表明，临床医生在为患者推荐益生菌时，需要考虑益生菌的菌株特异性和疾病特异性。
