Childhood functional gastrointestinal disorders: rational therapy

Introduction. Gastrointestinal dysfunctions remain one of the most frequent problems in young children (0 to 2 years). Among the main causes are immaturity of the enzymatic system, morphology and function of the gastrointestinal tract, regulatory mechanisms of the nervous system, immune response. The composition of intestinal microflora in children in the first years of life is unstable and can easily change under the influence of unfavorable factors: feeding disorders, infectious pathogens, congenital defects, incomplete immunity. Modern scientific literature and clinical guidelines most accurately reflect the results of studies on the positive role of probiotics, for example, in the prevention and treatment of antibiotic-associated diarrhoea and acute diarrhoea of various genesis. The research base is so large that in 2012 the World Gastroenterology Organization developed an international practical guide to the use of probiotics in clinical practice, recommending the use of probiotics that meet certain criteria.

The review is devoted to evaluating the effectiveness and safety of treatment with probiotics containing Bifidobacterium lactis, BB-12 and Streptococcus thermophilus TH-4 in children aged 0 to 2 years. Data from meta-analyses of the Cochrane library, PubMed, EMBASE, CENTRAL, and Russian open clinical randomized, placebo-controlled studies on the use of probiotics containing Bifidobacterium lactis, BB-12, and Streptococcus thermophilus TH-4 in pediatric practice are presented. Study objective. A comparative description of the most popular commercial drugs used for the treatment and prevention of functional disorders of the gastrointestinal tract in children aged 0 to 2 years, containing at least one of these strains, is presented.

Results. Evidence of the significance of probiotic therapy for various disorders of the gastrointestinal tract in children aged 0 to 2 years with complex drugs containing a combination of Bifidobacterium lactis, BB-12 and Streptococcus thermophilus TH-4 strains in children aged 0 to 2 years is presented. There is no reliable evidence of the effectiveness of multi-strain drug combinations in this age group.

Conclusion. The combination of Bifidobacterium lactis, BB-12 and Streptococcus thermophilus TH-4 is an effective and safe combination for the treatment of gastrointestinal disorders in children aged 0 to 2 years.

1. Evsiutina Iu.V. Probiotics in the prevention and treatment of diseases of the gastrointestinaL tract. Russkiy meditsinskiy zhurnal. Meditsinskoe obozrenie = Russian medical journal. Medical review. 2018;2(3):18-22. (In Russ). AvaiLabLe at: https://www.rmj.ru/articLes/gastroenteroLogiya/Probiotiki_vprofiLaktikeiLechenii_zaboLevani-ygheLudochno-kishechnogo_trakta/.

2. Mischke M., PLosch T. The Gut Microbiota and their MetaboLites: PotentiaL ImpLications for the Host Epigenome. Adv Exp Med Biol. 2016;902:33-44. doi: 10.1007/978-3-319-31248-4_3.

3. Ruzhenczova T.A. The roLe of probiotics in the formation of immunity. Lechashchiy vrach = Attending physician. 2018;(4):27. (In Russ). AvaiLabLe at: https://www.Lvrach.ru/2018/04/15436940/

4. Andreeva I.V., Steczyuk O.U. The pLace of probiotics in practicaL recommendations for gastroenteroLogy: reaLity and immediate prospects. Consilium Medicum. 2018;20(8):67-72. (In Russ). doi: 10.26442/2075-1753_2018.8.67-72.5.

5. Guarner F., Sanders M.E., ELiakim R. et aL. World Gastroenterology Organization practice guideline: Probiotics and prebiotics. 2017. AvaiLabLe at: https://www.worLdgastroenteroLogy.org/UserFiLes/fiLe/guideLines/probiotics-and-prebi-otics-russian-2017.pdf.

6. GoLdenberg J.Z., Yap C., Lytvyn L., Lo C.K.-F., BeardsLey J., Mertz D., Johnston B.C. Probiotics for the prevention of CLostridium difficiLe-associated diarrhea in aduLts and chiLdren. Cochrane Database Syst Rev. 2017;12:CD006095. doi: 10.1002/14651858.CD006095.pub4.

7. Martins F.S., SiLva A.A., Vieira A.T., et aL. Comparative study of Bifidobacterium animaLis, Escherichia coLi, LactobaciLLus casei and Saccharomyces bouLardii probiotic properties. Arch Microbiol. 2009;191(8):623-630. doi: 10.1007/s00203-009-0491-x.

8. Basu S., PauL D.K., GanguLy S., Chatterjee M., Chandra P.K. Efficacy of high-dose LactobaciLLus rhamnosus GG in controLLing acute watery diarrhea in Indian chiLdren: a randomized controLLed triaL. J Clin Gastroenterol. 2009;43(3):208-213. doi: 10.1097/MCG.0b013e31815a5780.

9. Saavedra J.M., Abi-Hanna A., Moore N., YoLken R.H. Long-term consumption of infant formuLas containing Live probiotic bacteria: tolerance and safety. Am J Clin Nutr 2004;79(2):261-267. doi: 10.1093/ajcn/79.2.261.

10. Deshpande G., Rao S., PatoLe S. Probiotics for prevention ofnecrotizing enterocoLitis in preterm neonates with very Low birthweight: a systematic review of randomized controLLed triaLs. Lancet. 2007;369(9573):1614-1620. doi: 10.1016/S0140-6736(07)60748-X.

11. Andreeva I.V Evidence for the use of probiotics for the treatment and prevention of gastrointestinaL diseases. Meditsinskiy sovet = Medical Council. 2007;(3):60-63. (In Russ). AvaiLabLe at: https://cyberLeninka.ru/articLe/n/dokazateLnoe-obosnovanie-primeneniya-probiotikov-dLya-Lecheniya-i-profiLaktiki-zaboLevaniy-zhkt/viewer.

12. Bragin E.A., PogoreLsky I.P., Yanov S.N. EvaLuation of the survivaL rate of microorganisms in commerciaL probiotic preparations. Advanced Science. 2017;(2):2. (In Russ). AvaiLabLe at: http://advanced-science.ru/assets/mgr/docs/2(2017)/Биологические/bragin-pogore-Liskii-yanov-k-pechati-ispr.pdf.

13. Chicherin I.Yu., PogoreLsky I.P., Lundovskikh I.A., Darmov I.V., ShabaLina M.R., PodvoLotsky A.N. Comparative experimentaL evaLuation of the effectiveness of modern probiotics, prebiotics, synbiotics and metabiotics for correction of intestinaL microbiocenosis in animaLs with antibiotic associated dysbiosis. Eksperimental’naia i klinicheskaia gastroenter-ologiia = Experimental & clinical gastroenterology. 2016;(7):106-120. (In Russ). AvaiLabLe at: http://nogr.org/images/ArticLe/2016/G_07_2016_in_-19_106-120.pdf.

14. Kushnareva M.V., Keshishyan E.S., Prytkina M.V. Efficiency of using the probiotic “Linex for chiLdren" in infants with acute respiratory viraL diseases. Rossiyskiy Vestnik Perinatologii i Pediatrii = Russian Bulletin of Perinatology and Pediatrics). 2014;59(5):109-114. (In Russ.) AvaiLabLe at: https://www.ped-perinatoLogy.ru/jour/articLe/view/245/284.

15. Sugyan N.G., Zakharova I.N. Bac-Set muLtiprobiotic: resuLts of russian and foreign cLinicaL research. Meditsinskiy sovet = Medical Council. 2017;(19):104-110. (In Russ.) doi: 10.21518/2079-701X-2017-19-104-110.

16. Sichinava I.V., GoreLov A.V. evaLuation of the efficiency of symbiotic normobact in the prevention of dysbiosis in chiLdren during eradication antiheLicobacter therapy. Pharmateca = Farmateka. 2015;(11):58-62. (In Russ). AvaiLabLe at: https://pharmateca.ru/ru/archive/arti-cLe/31674.

17. StekoLshchikova I.A., Voronova Y.O., Borovkova M.G., Andreeva L.V., DaniLova Y.V. Experience in cLinicaL using normobact L sinbiotic in combination therapy of acute intestinaL infections of virus etioLogy in chiLdren. Meditsinskiy sovet = Medical Council. 2018;(11):154-157. (In Russ.) doi: 10.21518/2079-701X-2018-11-154-157.

18. GoreLov A.V., Kanner E.V., Maximov M.L., ErmoLaeva A.S., Voznesenskaya A.A., Dadasheva K.N. LactobaciLLus rhamnosus GG: cLinicaL aspects of the use from the perspective of evidence-based medicine. Meditsinskiy sovet = Medical Council. 2018;(17):66-73. (In Russ.) doi: 10.21518/2079-701X-2018-17-66-73.

19. Lazdin O.A. Modern concept of pathogenesis and treatment of irritabLe boweL syndrome. Verkhnevolzhsky medical journal = Upper Volga Medical Journal. 2018;17(1):27-32. (In Russ). AvaiLabLe at: http://medjournaL.tvergma.ru/356/1/05.pdf.

20. Trukhan D.I., Viktorova I.A. Correction of infringements of intestinaL microbiocenosis in the aspect of prevention of respiratory infections of respiratory tract: opportunities of LactobaciLLus rhamnosus GG. Gastroenterology. Surgery. Intensive care. Consilium Medicum. 2018;(2):39-44. (In Russ). AvaiLabLe at: https//www.eLibrary.ru/item.asp?id=37217590.

21. Andreeva I.V., Dovgan E.V., Stetsyuk O.U. Modern approaches to preventive and therapeutic use of probiotics in infectious diseases in pediatric practice. Meditsinskiy alfavit = Medical alphabet. 2017;2(19):16-21. (In Russ.) AvaiLabLe at: https://www.eLibrary.ru/item.asp?id=30674757.

22. PLotnikova E.Y., Zakharova Y.V., Gracheva T.Y. The cLinicaL potentiaL of Linex Forte® in systemic antibiotic therapy. Meditsinskiy sovet = Medical Council. 2017;(5):94-98. (In Russ.) https://doi.org/10.21518/2079-701X-2017-5-94-98

23. Voevodina N.V., KaLashnikova P.M., NovoseL'ceva T.D., KaLashnikova A.P., GavriLov S.N. Mechanisms of action of probiotic strains in h. pyLori eradication. Molodezhnyy innovatsionnyy vestnik = Youth innovation Bulletin. 2017;6(2):144-145. (In Russ.) AvaiLabLe at: https://www.eLibrary.ru/item.asp?id=29409766.

24. Gurova M.M., Tsirkunova V.V. The importance of correcting the intestinaL microfLora in maintaining remission in children with chronic gas-troduodenitis. Voprosy detskoy dietologii = Pediatric Nutrition. 2016;11(2):44-50. (In Russ). doi: 10.20953/1817-7646-2016-2-44-50.

25. Khoroshilova I.A., Granitov V.M. Pro- and prebi-otics in the treatment of infectious intestinal lesions. Meditsinskoe obozrenie. Nauka i praktika = Medical review. Science and practice. 2016;(1):20-24. (In Russ). Available at: https://cyberleninka.ru/article/n/primenenie-pro-i-prebiotikov-v-lechenii-infektsionnyh-poraz-heniy-kishechnika/viewer.

26. Khavkin A.I., Komarova O.N. The effectiveness of using monoand polycomponent probiotics in paediatric practice. Voprosy detskoy dietologii = Pediatric Nutrition. 2015;13(2):35-42. (In Russ.). Available at: http://www.phdynasty.ru/katalog/zhurnaly/voprosy-detskoy-dietologii/2015/tom-13-nomer-2/24771.

27. Kornienko E.A., Minina S.N. Probiotics in the treatment of helicobacter pylori infection. Meditsinskiy sovet = Medical Council. 2015;(14):69-72. (In Russ.) doi: 10.21518/2079-701X-2015-14-69-72.

28. Zheng X., Lyu L., Mei Z. Lactobacillus-containing probiotic supplementation increases Helicobacter pylori eradication rate: evidence from a meta-analysis. Rev Esp Enferm Dig. 2013;105(8):445-453. doi: 10.4321/s1130-01082013000800002.

29. Li S., Huang X.L., Sui J.Z. et al. Meta-analysis of randomized controlled trials on the efficacy of probiotics in Helicobacter pylori eradication therapy in children. Eur J Pediatr. 2014;173(2):153-161. doi: 10.1007/s00431-013-2220-3.

30. Lu M., Yu S., Deng J. Efficacy of Probiotic Supplementation Therapy for Helicobacter pylori Eradication: A Meta-Analysis of Randomized Controlled Trials. PLoS One. 2016;11(10):e0163743. doi: 10.1371/journal.pone.0163743.

31. Goldenberg J.Z., Ma S.S., Saxton J.D., Martzen M.R., Vandvik P.O., Thorlund K., et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children. Cochrane Database Syst Rev. 2013;(5):CD006095. doi: 10.1002/14651858.CD006095.pub3.

32. Zhao L.-N., Yu T., Lan S.-Y., Hou J.-T., Zhang Z.-Z., Wang S.-S., et al. Probiotics can improve the clinical outcomes of hepatic encephalopathy: An update meta-analysis. Clin Res Hepatol Gastroenterol. 2015;39(6):674-682. doi: 10.1016/j.clin-re.2015.03.008.

33. Shukla S., Shukla A., Mehboob S., Guha S. Metaanalysis: the effects of gut flora modulation using prebiotics, probiotics and synbiotics on minimal hepatic encephalopathy. Aliment Pharmacol Ther. 2011;33(6):662-671. doi: 10.1111/j.1365-2036.2010.04574.x.

34. Gionchetti P., Rizzello F., Morselli C., Poggioli G., Tambasco R., Calabrese C., et al. High-dose probiotics for the treatment of active pouchitis. Dis Colon Rectum. 2007;50(12):2075-2082. doi: 10.1007/s10350-007-9068-4.

35. Singh S., Stroud A.M., Holubar S.D., Sandborn WJ., Pardi D.S. Treatment and prevention of pouchitis after ileal pouch-anal anastomosis for chronic ulcerative colitis. Cochrane Database Syst Rev. 2015;(11):CD001176. doi: 10.1002/14651858.CD001176.pub3.

36. McFarland L.V. Probiotics for the Primary and Secondary Prevention of C. difficile Infections: A Meta-analysis and Systematic Review. Antibiotics. 2015;4(2):160-178. doi: 10.3390/antibiotics4020160.