Turkiye Klinikleri Pediatric Sciences - Special Topics

Probiyotikler Özel Sayısı
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Probiyotikler, Genel Özellikleri ve Etki Mekanizmaları
Probiotics, General Characteristics and Mechanisms of Action
Turgay COŞKUNa
aÇocuk Metabolizma ve Beslenme Ünitesi, Hacettepe Üniversitesi Tıp Fakültesi, Ankara
Turkiye Klinikleri J Pediatr Sci. 2012;8(3):1-11
Article Language: TR
ÖZET
Probiyotikler, besinlerle veya destek şeklinde alındıklarında konakçının bağırsaklarında mikroorganizmalararası dengeyi sağlayarak sağlığını olumlu etkileyen canlı mikroorganizmalardır. Probiyotik olarak kullanılan başlıca mikroorganizmalar; Lactobacillus sp., Bifidobacterium sp., Streptococcus thermophilus ve Saccharomyces boulardii'dir. İnsan vücudunda 100 trilyon mikroorganizma bulunmaktadır (tüm vücudu oluşturan hücre sayısının 10 katı). Bağırsak bakterileri insan sağlığı ve metabolizmasına katkıda bulunur. İnsan bağırsağında yararlı (iyi) ve zararlı (kötü) bakteriler arasında hassas bir denge vardır. Bu dengenin bozulması çeşitli bağırsak ve bağırsak dışı hastalıkların ortaya çıkmasına neden olur. Probiyotikler; bağırsak pH'sının düşürülmesi, zararlı mikroorganizmaların kolonizasyonunun engellenmesi ve immün sistemin düzenlenmesi gibi mekanizmalar ile yararlı etkilerde bulunur. Çocuklarda probiyotiklerin akut viral ishallerdeki etkisi iyi bir şekilde ortaya konulmuştur. Bazı probiyotik suşları akut viral ishallerde süreyi kısaltmaktadır. Probiyotiklerin antibiyotik ilişkili ishal, Clostridium difficile enfeksiyonu, seyahat edenlerin ishallerinde, irritabl bağırsak sendromu, ülseratif kolit, Crohn hastalığı ve vulvovajinal kandidiyazisteki etkinliği konusunda daha ileri çalışmalara gereksinim vardır. Çok düşük doğum ağırlıklı (1000-1500 gr) bebeklerde probiyotik desteğinin nekrotizan enterokolit (NEC) gelişimini önleyebildiğine ilişkin veriler elde edilmiştir. Diğer olası kullanım alanları arasında; aşı adjuvanı olarak kullanımını, obesite, tip I diyabet mellit ve kötü ağız hijyeninin önlenmesinde kullanımını sayabiliriz. Çocuklarda Helicobacter pylori gastritlerinin ve infantil koliğin tedavisinde kullanılmakta olup, laktoz intoleransı, hiperkolesterolemi, kalp hastalıkları ve ateroskleroz tedavisinde kullanımı konusunda da çalışmalar devam etmektedir. Çocuklarda atopik hastalıkların önlenmesi ve tedavisinde kullanımı ile cesaret verici sonuçlar elde edilmiştir. Bazı suşlar annelere gebeliğinde verildiğinde bebeklerinde erken çocukluk döneminde egzema gelişme riskini azaltabildiği gösterilmiştir. Çalışmalar probiyotiklerin romatizmal hastalıklarda, kanserlerin önlenmesinde, kemik iliği nakli yapılmış hastalarda graft-versus-host hastalığının tedavisindeki etkinliğini saptamak üzere devam etmektedir. Ancak, probiyotiklerin etkinliğinin suşa özgü olduğu, bir probiyotik suşla elde edilen etkinin bir başka suş için geçerli olmayabileceği unutulmamalıdır. Gelecekte insan ve mikroorganizmalardaki ileri genetik ve metabolomik çalışmalar ışığında vüdumuzdaki yararlı mikroorganizmalar ve probiyotiklerin sağlığımız üzerindeki olumlu etkilerini ne yolla yaptıklarını daha iyi anlayabileceğiz. Probiyotiklerin ne şekilde davrandığını ayrıntılarıyla kavramış sağlık çalışanları da onları çeşitli hastalıkların önlenmesi ve tedavisinde daha sık olarak kullanmaya başlayacaktır.

Anahtar Kelimeler: Probiyotikler; Laktobasiller; Bifidobakteriler; bağırsak bakterileri; disbiyozis; viral ishaller; atopi; gastrointestinal hastalıklar
ABSTRACT
Probiotics are live microorganisms that produce a benefit to the host, by improving microbial balance in the gut, when provided in adequate amounts from food or supplements. Species commonly used include Lactobacillus sp., Bifidobacterium sp., Streptococcus thermophilus and Saccharomyces boulardii. Humans have and hold 100 trillion intestinal bacteria (10 times the number of the cells in the human body) that are essential for health. Gut bacteria contributes to human health and metabolism. There is a delicate balance between beneficial (good) and harmful (bad) bacteria in the gastrointestinal tract. Distruption of this balance results in various intestinal and extra-intestinal diseases. Probiotics exert their beneficial effects through various mechanisms, including lowering intestinal pH, decreasing colonization and invasion by pathogenic organisms, and modifying the host immune response. The effect of probiotics in acute viral diarrhea, particularly in children, is well studied. Selected probiotic strains seem to be effective in reducing the duration of acute diarrhea. More research is needed to clarify the role of probiotics for preventing antibiotic-associated diarrhea, Clostridium difficile infection, travelers' diarrhea, irritable bowel syndrome, ulcerative colitis, Crohn's disease, and vulvovaginal candidiasis. There is some evidence that probiotics prevent necrotizing enterocolitis in very low birth weight infants (birth weight between 1000 and 1500 g), but more studies are needed. Among the other possible areas of probiotic use are as vaccine adjuvant, obesity, type I diabetes mellitus, and poor oral health. Probiotics were used to treat childhood Helicobacter pylori gastritis, and infantile colic and are gaining importance because of their innumerable benefits, e.g. treating lactose intolerance, hypercholesterolemia, cardiac diseases and managing cardiac problems like atherosclerosis. Encouraging evidence is also emerging for the effectiveness of probiotics in the prevention and management of pediatric atopic diseases. Some probiotic strains seem to lower the risk of developing eczema if taken by pregnant women and their infants in early life. Areas of future research include the use of probiotics for the treatment of rheumatoid arthritis, prevention of cancer and the treatment of graft-versus-host disease in bone marrow transplant recipients. It should be borne in mind that the efficacy of probiotics is strain-dependent. Therefore, probiotic benefits associated with one species or strain do not necessarily hold true for others. In the future, human and microbial genomic and metabolomic studies will provide a better understanding how the commensal and probiotic organisms beneficially effect human health. As the health care professionals understand the beneficial effects of probiotic microorganisms more, they may be commonly used as a preventive and therapeutic tool in near future.

Keywords: Probiotics; Lactobacilli; Bifidobacteria; gut microbiota; dysbiosis; viral diarrhea; atopy; gastrointestinal disorders

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