Gut microbiota, probiotics and prebiotics in pediatrics

Abstract

Intestinal microbiota plays an important role in gut metabolism, defense against environmental pathogens, motility and immune system regulation. Microbiota is gradually aquired from the environment during and after delivery, with several factors, such as feeding habits, disease and antibiotic treatment, importantly influencing its composition. Growing awareness about the importance of the intestinal microbiota for the host physiologic processes and health has led to development of different strategies how to influence its composition and function. Probiotics, specific live microorganisms which when ingested in sufficient amount can promote health benefit to the host, and prebiotics, nondigestible food ingredients that benefit the host by selectively stimulating the favorable growth and/or activity of a limited number of health-promoting bacteria, have been increasingly used in the last decades. They exert their beneficial effects through three main mechanisms: by changing gut ecology, affecting the intestinal mucosal barrier, and by modulating the immune response. The efficacy of pro- and prebiotics in clinical practice has been extensively studied. The results of clinical studies with the specific strain or strains in a defined dose and vehicle should not be extrapolated to the use of other products. There is strong scientific evidence for the use of specific probiotics in acute gastroenteritis, antibiotic-associated diarrhea, prevention and treatment of atopic dermatitis, prevention of relapses of ulcerative colitis and pouchitis, as well as enhancing immune response, and some evidence of efficacy in prevention of necrotizing enterocolitis, treatment of Clostridium difficile-associated diarrhea, active ulcerative colitis, and functional gastrointestinal disorders.