Abstract title:
Clinical application of synbiotics using galactooligosaccharides
(whey component as prebiotics; use with patients undergoing surgery
to prepare for better recovery)
Author’s Names: Takuya Takahashi
Authors Affiliations: Yakult Central Institute for Microbiological Research,
Mailing Address: 1796 Yaho, Kunitachi-shi, Tokyo 186-8650, Japan
Phone: 001-81-425-77-8960
Fax: 001-81-425-77-3020
Email: takuya-takahashi@yakult.co.jp
Presenting Author’s Name: Takuya Takahashi
Summary for publication after the conference:
Prevention of infectious complications after surgery for digestive organs is a major
clinical task in the field of pediatric and digestive surgery. Considering that postoperative
administration of antibiotics at a high dose for a long period promotes bacteria with low
sensitivity to antibiotics, such as Methicillin-resistance Staphylococus aureus (MRSA),
the basic attitude in digestive organ surgery is to refrain from the use of antibiotics. How,
then, are the essential problems to be treated? To address these issues, probiotics and
prebiotics have recently been introduced.
‘Viable bacteria that exhibit beneficial effects for health based on improvement of
balance of intestinal bacterial flora’ was the common definition of probiotics, but the
diversity of their action mechanisms, including immune regulation, has been clarified,
and probiotics have recently been broadly defined as ‘live microorganisms which when
administered in adequate amounts confer a health benefit on the host’(1). Prebiotics
have been defined as ‘non-digestible food fiber components that contribute to host
health by activating proliferation and function of beneficial intestinal bacteria’(2).
Galactooligosaccharides (GOS) contained in human and bovine breast milk, are one of
the representative prebiotics. GOS are produced commercially by enzymic
(-galactosidase) transglycosylation of lactose, which is derived from fresh sweet whey.
Synbiotics, a combination of probiotics and prebiotics have also been established as
medical expressions.
Kanamori et al . reported aggravation of intestinal bacterial flora in various diseases
(short bowel syndrome. Hirschsprung disease, and Laryngotracheoesophageal
schistasis) in consideration that aggravation of intestinal microflora caused not only by
organic disorder of the digestive organs but also repeated of antibiotics is an important
issue to investigate in patients who have serious disorders in the pediatric surgery field
immediately after birth (3, 4). In these patients, useful anaerobes represented by
Bifidobacterium decrease and facultative anaerobes such as E. coli markedly increase,
and the detection rate of Pseudomonas aeruginosa , Candida, and MRSA is also high.
Furthermore, it has been reported that synbiotics therapy (enteral or intragastric
admnistration) consisting of Lactobacillus casei Shirota strain (LcS), Bifidobacterium
breve Yakult strain (BbY), and GOS improved intestinal microflora and intestinal
function (peristalsis and absorption or Na+ salt) with marked improvement of systemic
symptoms.
Kanazawa et al. added probiotics (LcS, BbY) and prebiotics (GOS) to postoperative
enteral nutrition for patients with infectious complications such as wound infection,
peritoneal abscess, and sepsis that occur at a high incidence after hepatectomy and
extrahepatic bile duct resection and reconstruction of the biliary tract in patients, with
highly invasive biliary tract cancer, and investigated the protection from infections (5).
The above synbiotics therapy markedly improved intestinal microflora in the patients
after surgery for bile duct cancer, and significantly decreased the incidence of infectious
complications. The intestinal organic acid concentration, was also improved lo the
normal level. Sugawara et al. showed that consecutive preoperative and postoperative
synbiotic treatment reduced the infectious complications more effectively than
postoperative synbiotic treatment alone in patients undergoing high-risk hepatobiliary
resection. Furthermore, patients' quality of life was also improved in a group of pre and
postoperative synbiotics, with shortening of the duration of postoperative hospital stay
and the antibiotics administration period (6).
These results suggests that the synbiotics therapy using GOS inhibited
postoperative proliferation of intestinal etiologic bacteria of opportunistic infections, such
as MRSA, Candida, P. aeruginosa, and E.coli, and their invasion into the body, by
improving the intestinal environment in the field of pediatric and digestive surgery.
References
1.
Reid, G., Jass, J., Sebulsky, M. T., and McCormick, J. K. Potential uses of
probiotics in clinical practice. Clin Microbiol Rev, 16: 658-672, 2003.
2.
Gibson, G. R. and Roberfroid, M. B. Dietary modulation of the human colonic
microbiota: introducing the concept of prebiotics. J Nutr, 125: 1401-1412, 1995.
3.
Knamori, Y., Sugiyama, M., Goishi, K., Kano, H., Yuki, N., Takahashi, T.,
Morotomi, M., and Tanaka, R. Abnormal intestinal microbiota in pediatric surgical
patients and the effects of a newly designed synbiotic therapy. Int. J. Prob. Preb,
1: 149-160, 2006.
4.
Knamori, Y., Sugiyama, M., Komura, M., Nakahara, S., Sato, K., Iwanaka, T.,
Yuki, N., Morotomi, M., Takahashi, T., and Tanaka, R. Synbiotic therapy: an
important supportive therapy for pediatric patients with severe respiratory
distress. Int. J. Prob. Preb, 1: 161-168, 2006.
5.
Kanazawa, H., Nagino, M., Kamiya, S., Komatsu, S., Mayumi, T., Takagi, K.,
Asahara, T., Nomoto, K., Tanaka, R., and Nimura, Y. Synbiotics reduce
postoperative infectious complications: a randomized controlled trial in biliary
cancer patients undergoing hepatectomy. Langenbecks Arch Surg, 390: 104-113,
2005.
6.
Sugawara, G., Nagino, M., Nishio, H., Ebata, T., Takagi, K., Asahara, T., Nomoto,
K., and Nimura, Y. Perioperative synbiotic treatment to prevent postoperative
infectious complications in biliary cancer surgery: a randomized controlled trial.
Ann Surg, 244: 706-714, 2006.