Probiotics when consumed regularly may be able to prevent many acute diarrhoea cases in children. In 2010, diarrhoea killed more than 210,000 children aged less than five years in India, The Lancet reported recently. The mortality figures were nearly 19,000 in neonates and 193,000 in children aged 1-59 months.

The Food and Agriculture Organisation (FAO) and World Health Organisation (WHO) describe probiotics as “microorganisms that exhibit beneficial health effects for hosts when a sufficient amount of them are ingested.”

Masanobu Nanno, Associate Director of Yakult Central Institute for Microbiology Research, Yakult Honsha Co Ltd, Tokyo, told a group of journalists that a clinical trial using the company’s probiotic drink — Lactobacillus casei strain Shirota (LcS) — in an urban slum community in Kolkata showed promise.

The clinical trial, funded by the company, was conducted by the Kolkata-based National Institute of Cholera and Enteric Diseases. “The funding agency had no role in the design, data collection, data analysis, data interpretation or writing the report,” the paper noted. The trial was community-based, randomised, double-blind and placebo-controlled involving 3,758 children aged 1-5 years from ward 66 in Kolkata Municipal Corporation.

While 608 subjects in the study group consumed the company’s probiotic drink every day for 12 weeks, the control group (674 children) received a placebo. The children were followed up for a further 12 weeks. At the end of the 24-week study period, the group that received the probiotic drink showed reduced occurrence of acute diarrhoea. “The level of protective efficacy for the probiotic group was 14 per cent,” stated the paper published in the journal Epidemiology and Infection.

But the authors warn that there is insufficient evidence for “extrapolation of these results for global recommendation.”

Besides good sanitation and safe drinking water, probiotics may probably have a role in preventing many deaths caused by diarrhoea. The 25-35 feet long gastrointestinal tract of an adult human has about 100 trillion bacteria — good, neutral and pathogenic microorganisms. This is approximately ten times the total number of cells in the human body. In all, the digestive tract has some 400 different types of bacteria that keep the harmful bacteria under check.

The intestinal epithelium by itself acts as a physical barrier to the pathogenic bacteria. However, when the number of good bacteria declines, pathogenic micro-organisms can destroy the integrity of the intestinal wall and cause many illnesses, diarrhoea included.

The rationale of the study was therefore to populate the digestive tract with good bacteria using the drink rich in Lactobacilli casei strain Shirota.

“It is reasonably well established that probiotics can shorten the duration of diarrhoea by half-a-day,” said Dr. B.S. Ramakrishna, Professor and Head of Gastroenterology, CMC, Vellore. “In a community the incidence of regular diarrhoea can come down by 15 per cent [if people have probiotics daily].”

Similar benefits have been seen in other two types of diarrhoea as well — travellers’ diarrhoea and antibiotic-induced diarrhoea. “Probiotics has shown some beneficial effects in the case of travellers’ diarrhoea,” Dr. Ramakrishna said. “There is clear evidence of prevention and shortening of duration by half-a-day in the case of antibiotic-induced diarrhoea.”

The effectiveness of probiotics in preventing and even reducing the duration of diarrhoea has been reported in several studies. For instance, a 2006 meta-analysis found probiotics as “safe and effective for both treatment and prevention of acute paediatric diarrhoea.” The study was published in the International Journal of Probiotics and Prebiotics.

A 2002 study published in the European Journal of Clinical Nutrition found Lactobacilli casei to“significantly reduce the duration of diarrhoea in children.” The study was carried out on 75 subjects at the Delhi University College Hospital and another 75 in a resettlement colony in East Delhi.

“Probiotics are generally beneficial in treatment and prevention of gastrointestinal diseases,” noted a 2012 PLoS ONE paper. It went on to state that “the type of disease and probiotic species (strain) are the most important factors to take into consideration” when choosing to use probiotics for treatment or prevention of gastrointestinal disease.

(This Correspondent was a member of a group of journalists who visited Tokyo to attend the “Spring 2012 Japan tour for journalists from oversees” at the invitation of Yakult Honsha Co Ltd, Tokyo)

Keywords: WHOdiarrhoea

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