Surrounded by the familiar beeps and glow of the hospital surgical theatres I had a thoroughly enjoyable chat with scrubs-donned Dr Johan Van Den Bogaerde Gastroenterologist and researcher. We discuss probiotics and the various relevant themes around them. Topics we discuss include: - What are probiotics and some important principles - How do they work? - Evidence for different conditions - IBD, IBS, diarrhoeal disorders, helicobacter pylori, atopic eczema and others - Research bias - Working with real people who are suffering but that don't fit the guidelines = the clinicians dilemma Summary of the POSSIBLE uses: IBD Ulcerative Colitis and Pouchitis - VSL3, E. coli nissle and saccharomyces boulardi may help for remission. No clear evidence for chron's disease IBS - VSL3, bifido infantis - mixed studies, some positive and some only as good as placebo (~50% reduction in pain) Diarrhoeal disorders (antibiotics associated, childrens diarrhoea, c.dif and preventing travellors diarrhoea) = Lacto. rhamnosus, saccharomyces boulardii and Lacto. reuteri may be of assistance e.g. reduce duration of infectious diarrhoea by Helicobacter pylori - Saccharomyces boulardii and Lacto. reuteri - may reduce side effects to antibiotics and improve eradication rate Atopic eczema - Lacto. rhamonsus and Bifido. lactis reduce rate of atopic eczema in children by 80% if taken by mother during pregnancy and breastfeeding Atopic eczema - not clear, mixed studies as a treatment of atopic eczema Other possible use though studies are limited and early - bacterial vaginosis, major depression disorder, autism spectrum disorder, other CNS disorders, hepatic encephalopathy Doses and duration's vary Risks: Do not use in critically unwell or marked immunosuppression Side effects may include - constipation, flatulence, nausea, rash and others Don't forget the price tag Some of the many references: IBD - https://www.ncbi.nlm.nih.gov/pubmed?term=20517305, https://www.ncbi.nlm.nih.gov/pubmed?term=14684584, https://www.ncbi.nlm.nih.gov/pubmed?term=22161412 IBS - https://www.ncbi.nlm.nih.gov/pubmed/25780308 Diarrhoeal disorders - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748908/ , H pylori - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4588086/ Atopic disease pregnancy - https://www.racgp.org.au/your-practice/guidelines/handi/interventions/children/probiotics-in-pregnancy-for-infant-atopic-eczema/ Eczema in children - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828648/

Probiotics and intestinal permeability-- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4253991/

CNS disorders = https://www.ncbi.nlm.nih.gov/pubmed/27413138