#106
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Óâàæàåìûå êîëëåãè, à îñîáåííî íåðîññèéñêèå!
À êàê ëå÷àò ó äåòåé â äðóãèõ ñòðàíàõ òî, ÷òî ó íàñ íàçûâàþò äèñáàêòåðèîçîì?Ñèòóàöèÿ ó ìåíÿ ïåðåä ãëàçàìè: Ðåáåíîê 4 ìåñÿöà. Ñòðàäàåò òåì, ÷òî â íàøåé ñòðàíå íàçûâàåòñÿ ýêññóäàòèâíî-êàòàðàëüíûì äèàòåçîì. Ïîëíîñòüþ íà ãðóäíîì âñêðàìëèâàíèè. Ìàìà åãî ñèäèò íà ñòðîãîé äèåòå. Ïåäèàòðû, åñòåñòâåííî, äåëàþò âûâîä, ÷òî ðåáåíêà äèñáàêòåðèîç çàìó÷àë. Äàþò íàïðàâëåíèå íà àíàëèç, íàçíà÷àþò ëèííåêñ, ôåðìåíòû. À êàê áû åãî ëå÷èëè íå ó íàñ? |
#107
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Öèòàòà:
Ññûëî÷êà íå ñîâñåì ïî òåìå, íî â ýòîì èçäàíèè àêòèâíî ïèøóò íà ýòó òåìó [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#108
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Ñïàñèáî! Íî ÿ õîòåëà óçíàòü íåñêîëüêî äðóãîå. Êîãäà ñòîèò äèàãíîç àòîïè÷åñêèé äåðìàòèò, åãî ëå÷åíèå ïîíÿòíî. Íî âåäü åãî íå ñðàçó âûñòàâëÿþò ðåáåíêó ñ âûñûïàíèÿìè?
Ìåíÿ èíòåðåñóåò, ÷òî äåëàþò èíîñòðàííûå êîëëåãè íà òîì ýòàïå, íà êîòîðîì íàøè èññëåäóþò ôåêàëèè è êîðìÿò ðåáåíêà áàêòåðèÿìè. |
#109
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Àíòèáèîòèêè îïàñíåå, ÷åì SARS: 79 óìåðøèõ â Êàíàäå
Ìàñøòàáíàÿ ýïèäåìèÿ çàáîëåâàíèÿ, íàçûâàþùåãîñÿ àíòèáèîòèêîàññîöèèðîâàííàÿ äèàðåÿ, çàðåãèñòðèðîâàíà â Êàíàäå. Îá ýòîì ïèøåò ñåãîäíÿ àâòîðèòåòíîå áðèòàíñêîå ìåäèöèíñêîå èçäàíèå British Medical Journal. Ïî äàííûì æóðíàëà, çà ïîñëåäíèå 18 ìåñ. â êëèíèêàõ Ìîíðåàëÿ è Êàëãàðè îò ýòîé áîëåçíè ñêîí÷àëèñü 79 ÷åëîâåê. Äëÿ ñðàâíåíèÿ BMJ ïðèâîäèò äàííûå îá ýïèäåìè÷åñêîé îáñòàíîâêå â Êàíàäå â ïåðèîä ýïèäåìèè SARS. Òîãäà æåðòâàìè áîëåçíè ñòàëè ìåíåå 50 ÷åëîâåê. Àíòèáèîòèêîàññîöèèðîâàííûå äèàðåè ðàññìàòðèâàþòñÿ ó÷åíûìè êàê êîìïëåêñíûé ñèíäðîì, âîçíèêàþùèé ó ÷åëîâåêà, íàõîäÿùåãîñÿ íà ñòàöèîíàðíîì ëå÷åíèè è ïîëó÷àþùèì àíòèáàêòåðèàëüíóþ òåðàïèþ. Àíòèáèîòèêè, ïîïàäàÿ â îðãàíèçì ïàöèåíòà, íàðóøàþò íîðìàëüíûé áèîöåíîç êèøå÷íèêà è â íåãî óñòðåìëÿþòñÿ ïàòîãåííûå áàêòåðèè, êîòîðûõ âñåãäà ìíîãî â ëþáîé áîëüíèöå. Íà ñåãîäíÿøíèé äåíü íàèáîëåå ÷àñòûì âîçáóäèòåëåì àíòèáèîòèêîàññîöèèðîâàííîé äèàðåè ÿâëÿåòñÿ áàêòåðèÿ Clostridium difficile. Îáëàäàÿ ñïîñîáíîñòüþ ê îáðàçîâàíèþ ñïîð, ýòîò ìèêðîá ñòàíîâèòñÿ ïðàêòè÷åñêè íåóÿçâèìûì äëÿ îáû÷íûõ äåçèíôåêöèîííûõ ìåðîïðèÿòèé. Èíôîðìàöèÿ îá ýïèäåìèè àíòèáèîòèêîàññîöèèðîâàííîé äèàðåè âïåðâûå ïîÿâèëàñü â êàíàäñêîé ïðåññå 4 èþíÿ. Êàíàäñêèå æóðíàëèñòû îòìå÷àëè, ÷òî ìíîãèå êëèíèêè Ìîíðåàëÿ è Êàëãàðè ñîçíàòåëüíî ñêðûâàþò ìàñøòàáû ýïèäåìèè, íå îñîçíàâàÿ åå îïàñíîñòü â íàöèîíàëüíîì è ìèðîâîì ìàñøòàáå. Ïðè ýòîì íà ñòðàíèöàõ ìåäèöèíñêèõ æóðíàëîâ, èçäàþùèõñÿ â Êàíàäå, óæå ïîÿâèëñÿ ïðèçûâ ê äîêòîðàì ïî âîçìîæíîñòè íå ãîñïèòàëèçèðîâàòü ïëàíîâûõ áîëüíûõ è áåç êðàéíåé íåîáõîäèìîñòè íå íàçíà÷àòü àíòèáèîòèêè. Íåêîòîðûå èç ìåäèêîâ, íàïðèìåð, ðóêîâîäèòåëü òåðàïåâòè÷åñêîãî îòäåëåíèÿ áîëüíèöû Ñâÿòîé Ìàðèè â Ìîíðåàëå äîêòîð Òîää ÌàêÊîííåë, óæå çàÿâèëè î íà÷àëå ïàíäåìèè, âûçâàííîé Clostridium difficile è ñäåëàëè "ñåðüåçíîå ïðåäóïðåæäåíèå" ìåäèöèíñêîé îáùåñòâåííîñòè ïî âñåìó ìèðó. ×òî êàñàåòñÿ Ðîññèè, òî äî 90% ãîðîäñêîãî íàñåëåíèÿ ÐÔ ñòðàäàåò ðàçëè÷íûì âèäàìè äèñáàêòåðèîçîâ. Òàêèå äàííûå ïðåäñòàâèë äèðåêòîð ÍÈÈ âàêöèí è ñûâîðîòîê èì. È.Ìå÷íèêîâà, àêàäåìèê ÐÀÌÍ Áîðèñ Ñåìåíîâ. Ïî åãî ìíåíèþ, òàêàÿ ñèòóàöèÿ îáóñëîâëåíà íèçêèì óðîâíåì ïðîñâåùåíèÿ íàñåëåíèÿ íà ôîíå ðàñïðîñòðàíåííîé ïðàêòèêè ëå÷åíèÿ àíòèáèîòèêàìè, ïîäàâëÿþùèìè ìèêðîôëîðó îðãàíèçìà ÷åëîâåêà. Äðóãîé ïðè÷èíîé, ïî ìíåíèþ ñïåöèàëèñòîâ, ÿâëÿåòñÿ íèçêàÿ ýêîíîìè÷åñêàÿ ýôôåêòèâíîñòü ïðîèçâîäñòâà ïðåïàðàòîâ, êîòîðûå íå äàþò ïðîèçâîäèòåëþ âûñîêîé ïðèáûëè, íî â òî æå âðåìÿ äîñòàòî÷íî äîðîãè äëÿ ïîòðåáèòåëÿ. Ïî îöåíêå ÐÀÌÍ, ïîòðåáíîñòü òîëüêî Ìîñêâû â ïðîáèîòè÷åñêèõ ïðåïàðàòàõ, ñïîñîáíûõ ðåøàòü ïðîáëåìó äèñáàêòåðèîçîâ, ñîñòàâëÿåò îêîëî 1 ìëðä äîç â ìåñÿö, â òî âðåìÿ êàê ïðèìåðíî òàêîé îáúåì íà ñåãîäíÿ èìååò ãîäîâîé îáîðîò ðîññèéñêîãî ðûíêà ïðîáèîòèêîâ. Ïî ñëîâàì Á.Ñåìåíîâà, ñèòóàöèÿ íèçêîãî óðîâíÿ ïðèìåíåíèÿ ïðîáèîòèêîâ â Ðîññèè íå îïðàâäàíà, òàê êàê Ðîññèÿ èìååò ìèðîâîå ïåðâåíñòâî â ðàçðàáîòêàõ â îòðàñëè ïðîáèîòè÷åñêèõ ïðåïàðàòîâ. " íàñòîÿùåå âðåìÿ èñïîëüçîâàíèå ïðîáèîòèêîâ â êëèíè÷åñêîé ïðàêòèêå ÿâëÿåòñÿ îäíèì èç íàèáîëåå ïåðñïåêòèâíûõ íàïðàâëåíèé â ìåäèöèíå, êàê àëüòåðíàòèâà àíòèáèîòèêî- è õèìèîòåðàïèè", - ïîä÷åðêíóë Á.Ñåìåíîâ. Ïî îöåíêå ñïåöèàëèñòîâ, ïî ñðàâíåíèþ ñ àíòèáèîòèêàìè, ïðîáèîòèêè èìåþò ðÿä ïðåèìóùåñòâ - îíè íàòóðàëüíû è íå âûçûâàþò àëëåðãè÷åñêèõ ðåàêöèé, ïðè èõ ïðèìåíåíèè íå óíè÷òîæàþòñÿ âñå ÷óâñòâèòåëüíûå ê íèì ìèêðîîðãàíèçìû (êàê âîçáóäèòåëè çàáîëåâàíèÿ, òàê è ïîëåçíûå áàêòåðèè), âîññòàíàâëèâàåòñÿ ìèêðîôëîðà êèøå÷íèêà è àêòèâèçèðóåòñÿ èììóííàÿ ñèñòåìà îðãàíèçìà ÷åëîâåêà.  ÐÀÌÍ îòìå÷àþò, ÷òî ïîêà òîëüêî â Ðîññèè ïðîèçâîäèòñÿ ÷åòâåðòîå ïîêîëåíèå ïðîáèîòèêîâ, ïðèìåíÿåìûõ äëÿ ëå÷åíèÿ îñòðûõ êèøå÷íûõ èíôåêöèé è ïèùåâûõ òîêñèêîèíôåêöèé â êà÷åñòâå áåçîïàñíîé àëüòåðíàòèâû àíòèáèîòèêàì, à òàêæå èìåþùèõ äëèòåëüíûé ñðîê õðàíåíèÿ è î÷èùåííûõ îò ïðîäóêòîâ æèçíåäåÿòåëüíîñòè áàêòåðèé. Äî íà÷àëà 90-õ ãîäîâ â ÐÔ ïðàêòè÷åñêè íå ïðîèçâîäèëèñü â ïðîìûøëåííûõ ìàñøòàáàõ ïðîáèîòèêè, ïîçæå îíè ñòàëè èñïîëüçîâàòüñÿ òîëüêî äëÿ âûïóñêà äåòñêîãî ïèòàíèÿ. Ïî îöåíêå ÐÀÌÍ, íà ñåãîäíÿ íå íàáëþäàåòñÿ äåôèöèòà êàê ñàìèõ ïðåïàðàòîâ, òàê è ôóíêöèîíàëüíûõ ïðîäóêòîâ ïèòàíèÿ íà èõ îñíîâå. Òàê, ïî äàííûì ìàðêåòèíãîâûõ èññëåäîâàíèé "Ðîññèéñêèé èíäåêñ ïîïóëÿðíîñòè òîðãîâûõ ìàðîê", ïðîäóêòû ñ ñîäåðæàíèåì áèôèäîáàêòåðèé ÿâëÿþòñÿ íàèáîëåå ïîòðåáëÿåìûìè êèñëîìîëî÷íûìè èçäåëèÿìè â ÐÔ. Òåì íå ìåíåå, â ÐÀÌÍ ñ÷èòàþò, ÷òî ïðîáëåìà äåôèöèòà ïðîáèîòèêîâ â ïèòàíèè è ïðîôèëàêòèêå êèøå÷íûõ çàáîëåâàíèé íàñåëåíèÿ åùå äàëåêà îò ðåøåíèÿ. P.S. Î÷åðåäíûå ÷åðíûå øàðû çà ýòî ñîîáùåíèå – ïðèâåòñòâóþòñÿ. |
#110
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Äàåøü ÎÇÎÍ ÂÎ ÂÑÅ ÎÒÂÅÐÑÒÈß, ÓÐÀ!
ÓÂÀÆÀÅÌÛÉ ÂËÀÄÈÌÈÐ ßÊÎÂËÅÂÈ×! ÑÅÐÄÅ×ÍÎ ÏÎÇÄÐÀÂËßÞ ÂÀÑ (êàê àêòèâíî ñî÷óâñòâóþùåãî âðà÷àì íó î÷åíü "âåäóóóóùèõ êëèíèê") È ÂÑÅÕ ÊÎËËÅÃ Ñ ÄÍÅÌ ÌÅÄÈÖÈÍÑÊÎÃÎ ÐÀÁÎÒÍÈÊÀ, ÆÅËÀÞ ÂÑÅÃÎ ÍÀÈËÓ×ØÅÃÎ, ÂÑÅÕ È ÂÑß×ÅÑÊÈÕ ÓÑÏÅÕÎÂ. Âû, êîíå÷íî íå îòêðûâàåòå Àìåðèêó. Åùå ëó÷øå óçíàòü ñêîëüêî íàðîäó óìèðàåò îò ìèêðîâîëíîâîê, êîôå, ÷àÿ, ñåêñà, òàáàêà, ïñèõîòðîïíûõ ïðåïàðàòîâ, ãîðìîíîâ è ïð. È ÷òî? À ñêîëüêî ëþäåé ãèáíåò â àâòîêàòàñòðîôàõ? Íî âñå æå ïðîäîëæàþò åçäèòü, ëåòàòü, óïîòðåáëÿòü è ò.ï. Ä-È-À-Ë-Å-Ê-Ò-È-Ê-À! Îò ìåíÿ âû ÷åðíûõ øàðîâ íå äîæäåòåñü. Òîëüêî àïëîäèñìåíòû! Äèñêóòèðîâàòü ñ Âàìè äàëüøå - ýòî íàäî íó ñîâñåì íå èìåòü ÷óâñòâà þìîðà. Âñåãäà Âàø! |
#111
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Óâàæàåìûé Àëåêñåé Âèêòîðîâè÷!
Âîîáùå-òî ýòà äèñêóññèÿ î äèñáàêòåðèîçàõ, êàê Âû êðàñî÷íî îõàðàêòåðèçîâàëè – «âûãðåáíîé ÿìå ðîññèéñêîãî êëèíè÷åñêîãî íåâåæåñòâà». Íî Âû ñîâåðøåíî ëîãè÷íî çàìåòèëè çäåñü îçîí. ×òî êàñàåòñÿ ÷óâñòâà þìîðà, òî óæå íè ðàç îòìå÷àë, ÷òî íà ôîíå ñèëüíîãî ðàçäðàæåíèÿ ïðè ïîÿâëåíèè ìàòåðèàëîâ, íå óêëàäûâàþùèõñÿ â ïðåäñòàâëåíèÿ, âûñêàçûâàíèÿ î÷åíü óâàæàåìûõ íà ôîðóìå ó÷àñòíèêîâ – îíî íàïðî÷ü èñ÷åçàåò. P. S. Âàñ òàê æå ñ ïðàçäíèêîì! ( Âîò ïîçäðàâëåíèå èñêðåííåå, áåç åõèäñòâà) |
#112
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Ñïàñèáî Ãàëèíà Àôàíàñüåâíà è Âàñ ïåðñîíàëüíî ñ íàøèì ïðîôïðàçäíèêîì!
Âëàäèìèð ßêîâëåâè÷ óâàæàåìûé, Äà ÿ íå åõèäíè÷àþ âîâñå. Ïðîñòî Âû âñåãäà íàâåâàåòå ìíå ñîâåðøåííî îïðåäåëåííûå àññîöèàöèè. Âîò êîãäà Âû íà÷èíàåòå ãîâîðèòü î ðàçâåäóùèõ êëèíèêàõ, ó ìåíÿ ñîâåðøåííî îïðåäåëåííûå ôèçèîíîìèè ìîñêîâñêèå è ïèòåðñêèå ïåðåä ãëàçàìè âñòàþò. Îíè, ýòè ôèçèîíîìèè, òîæå ëþáÿò íàçûâàòü ñåáÿ ïðîôåññîðàìè/äîöåíòàìè è ïð. âåäóùåé-ïðåâåäóùåé êàôåäðû ðàçâûäàþùåãîñÿ ìåäÂÓÇà ñòðàíû. Íî êîãäà ýòè ïåðñîíàæè, äàâ ìàõó íå ïîíÿâ òîãî, ïðèõîäÿò íà òó æå åâðîïåéñêóþ øêîëó óðîëîãèè ïîãîâîðèòü ñ çàïàäíîåâðîïåéñêèìè ïðîôåññîðàìè è â ïåðâóþ î÷åðåäü ïîñëóøàòü èõ - òóò òðóáà. Ãîâîðèòü ñ åâðîïåéöàìè ìîãóò äâà-òðè-÷åòûðå ÷åëîâåêà, îñòàëüíûå 86 ñèäÿò òàê êàê áóäòî îíè ðàáîòàþò íå óðîëîãàìè, à ìîëåêóëÿðíûìè ãåíåòèêàìè, áèîõèìèêàìè èëè áîòàíèêàìè, à âñå ýòè óðîëîãè÷åñêèå ðàçãîâîðû äëÿ íèõ ñòîëü æå íîâû è ñòðàííû êàê ðàññóæäåíèÿ î íîâîñòÿõ ðàñøèôðîâêè ãåíîìà ÷åëîâåêà ñî âñåé ýòîé êîíêðåòèêîé â âèäå ìîëåêóë è ôîðìóë. Ýòî äèêîñòü ñòðàøíàÿ! Ýòèì äÿäÿì/òåòÿì ìîæíî âòþõèâàòü ëþáóþ ìÿêèíó. Ó íèõ â ãîëîâå íåò íè êðèòåðèåâ íè âîîáùå êàêèõ-ëèáî ïå÷åê îò êîòîðûõ ìîæíî òàíöåâàòü. Âîò îíè òî, ýòè ïðåäñòàâèòåëè ðàçâåäóùèõ ó÷ðåæäåíèé è îçîíèðóþò ìîçãè âñåì ïîäðÿä íà ðàäîñòü Âëàäèìèðó ßêîâëåâè÷ó (áåç çëîáû è åõèäñòâà). Õîòåëîñü áû, ÷òîáû â ñëåäóþùèå äíè ðîñññèéñêîãî ìåäðàáîòíèêà ìîçãè ýòîãî ñàìîãî ðàáîòíèêà ñòàíîâèëèñü âñå ñâåòëåå. À ïðîïàñòü ìåæäó íàìè è îñòàëüíûì ìèðîì âñå æå ñîêðàùàëàñü. |
#113
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Óâàæàåìûå êîëëåãè!
Ñïîðèòå Âû ïî-ïóñòîìó íåäîðàçóìåíèþ, ãëóáîêî âíåäðèâøåìóñÿ â êëèíè÷åñêóþ ïðàêòèêó ïî áåäíîñòè ìèêðîáíîé äèàãíîñòèêè â ñòàíäàðòíîé êëèíè÷åñêîé áàêòåðèîëîãè÷åñêîé ëàáîðàòîðèè. Âíèêíèòå â ñèòóàöèþ: âû òîâîðèòå î äèñáàêòåðèîçå êèøå÷íèêà, à âåäü â ëàáîðàòîðèè àíàëèçèðóþò íå êèøå÷íóþ ìèêðîáèîòó (áèîïëåíêó), à ñîâñåì äðóãóþ ñóáñòàíöèþ - ìèêðîáíóþ ñìåñü ôåêàëèé - òî åñòü òó ñàìóþ "âûãðåáíóþ ÿìó". Ñâåäåíèÿ î ìèêðîôëîðå êèøå÷íèêà, ïîëó÷àåìûå ïðè áàêòåðèîëîãè÷åñêîì àíàëèçå ôåêàëèé, îãðàíè÷åíû ïî ÷èñëó êîíòðîëèðóåìûõ âèäîâ è òî÷íîñòè îïðåäåëåíèÿ â ñèëó îòñóòñòâèÿ âîçìîæíîñòåé êóëüòóðàëüíîãî ìåòîäà èññëåäîâàíèÿ ñ îäíîé ñòîðîíû è åñòåñòâåííûõ êîëåáàíèé èõ ñîñòàâà â çàâèñèìîñòè îò äèåòû, âîçðàñòà, ïîëà è äðóãèõ ôàêòîðîâ. Íàïðèìåð, âàðèàöèè â ñîñòàâå ìèêðîîðãàíèçìîâ êèøå÷íîé ñòåíêè ðàçíûõ ëþäåé â íîðìå íå ïðåâûøàþò 50% îòíîñèòåëüíûõ ïî îòäåëüíûì âèäàì è ìåíåå 20% ïî ñóììå, òîãäà êàê â ôåêàëèÿõ ñóáúåêòèâíûå îòêëîíåíèÿ â êîíöåíòðàöèè ñîñòàâëÿþò ïîðÿäîê âåëè÷èíû ïî ñóììàðíîé áèîìàññå è äâà ïîðÿäêà ïî îòäåëüíûì âèäàì. Êîððåêòíàÿ èíòåðïðåòàöèÿ äàííûõ â òàêèõ óñëîâèÿõ òðåáóåò ïî êðàéíåé ìåðå áîëüøîãî îïûòà è èíòóèöèè. Ïðîöåññ – ïîäîáíûé âîññîçäàíèþ øåäåâðà êëàññèêà ëèòåðàòóðû ïî ñîäåðæèìîìó åãî ìóñîðíîé êîðçèíû. Òàêàÿ íåñòàáèëüíîñòü áèîìàññû ìèêðîîðãàíèçìîâ è èõ ñîñòàâà â ôåêàëèÿõ ÿâëÿåòñÿ ñëåäñòâèåì ïîääåðæàíèÿ ãîìåîñòàçà ïðèñòåíî÷íîé ìèêðîôëîðû. Âñå ëèøíåå – èçáûòî÷íûé ðîñò ìèêðîáîâ, òðàíçèòîðíûå ìèêðîáû, íåóñâîåííûé õèìóñ âìåñòå ñ ïîòîêîì ìóêîçà ÿâëÿåòñÿ åñòåñòâåííûì ñòîêîì êèøå÷íèêà, êîòîðûé è ôîðìèðóåò ôåêàëèè. Òî åñòü ôåêàëèè – òîò áóôåðíûé ðåçåðâóàð, â êîòîðûé îñóùåñòâëÿåòñÿ ñáðîñ èçëèøíåé, íåïðîïîðöèîíàëüíîé ïî îòíîøåíèþ ê ãîìåîñòàòè÷íîìó ñîîáùåñòâó êèøå÷íîé ñòåíêè, ìèêðîôëîðû è íå ïðèíÿòûõ ê òðàíñïîðòó ÷åðåç ñëèçèñòóþ îáîëî÷êó êèøå÷íèêà êîìïîíåíò õèìóñà è îòðàáîòàííîãî ìóêîçà ñ ìåòàáîëèòàìè ìèêðîîðãàíèçìîâ, íå óãîäíûõ ìàêðîîðãàíèçìó. Ñâÿçü ìåæäó ïàòîëîãèåé è äèñáàêòåðèîçîì ïîÿâèòüñÿ, êîãäà âìåñòî ôåêàëèé áóäóò àíàëèçèðîâàòü ïðèñòåíî÷íóþ ìèêðîáèîòó. Ïîäðîáíåå ñì. ìàòåðèàë "Íåâèäèìûé îðãàí - ìèêðîôëîðà ÷åëîâåêà" - íà íàøåé ñòðàíèöå "Ìèêðîáíàÿ äèàãíîñòèêà" www.rusmedserv.com\microbdiag |
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Óâàæàåìûé Àëåêñåé Âèêòîðîâè÷!
Âû ìåíÿ íåäîïîíÿëè, ÿ î ñâîåì åõèäñòâå, à íå î âàøåì. Íî ýòî äåòàëè. Î Ðîññèéñêîé è çàïàäíîé ìåäèöèíå (âðà÷àõ) íà ôîðóìå ãîâîðèëîñü î÷åíü ìíîãî è äàííîé äèñêóññèè, ïîëàãàþ, ïðîäîëæàòü ýòó òåìó íå îáÿçàòåëüíî. Ñîîáùåíèå î ëåòàëüíûõ ñëó÷àÿõ â Êàíàäå îò àíòèáèîòèêî-àññîöèèðîâàííîé äèàðåè ÿ ïðèâåë, â ïåðâóþ î÷åðåäü, íå äëÿ êðèòèêè àíòèáèîòèêîâ. Âû ïðàâû, îíè ïîêà âî ìíîãèõ ñëó÷àÿõ íåîáõîäèìû, îñîáåííî, ïðè îñòðûõ ñîñòîÿíèÿõ. Äðóãîå äåëî, ÷òî èìè ïðèâû÷íûìè, ðîäíûìè, à ïîýòîìó â ñîçíàíèå –áåçîïàñíûìè, ÿâíî «ïåðåêàðìëèâàþò» íàäî èëè íå íàäî.  òîì ÷èñëå è â Àìåðèêå. Ïðèâåäåííàÿ èíôîðìàöèÿ óêëàäûâàåòñÿ â òåìó äàííîé äèñêóññèè î äèñáàêòåðèîçå. Óæå ïèñàë çäåñü (ïîñò 97), «ïî ïðè÷èíå, ÷òî íåëüçÿ òî÷íî îáîçíà÷èòü, ãäå êîí÷àåòñÿ íîðìà è íà÷èíàåòñÿ ïàòîëîãèÿ çàïàäíàÿ ìåäèöèíà ñêðîìíî ýòîò âîïðîñ îáõîäèò, íå çàìå÷àåò, âåäü ïîä ñòàíäàðò åãî íå ïîäâåäåøü. Íî, âåäü äàæå åñëè ïðèêðûòü ïëàòî÷êîì ìèêðîáèîöåíîç è åãî âîçìîæíûå êëèíè÷åñêè çíà÷èìûå íàðóøåíèÿ (äèñáàêòåðèîç) íå èñ÷åçíóò». Áîëüíûå íå óìèðàþò îò òîãî, ÷åãî íà ñâåòå íåò. Äîáàâëþ, ýòî ôàêò íå ñìîãóò èçìåíèòü ïàôîñíûå, íðàâîó÷èòåëüíûå âûñòóïëåíèÿ âûñîêèõ àâòîðèòåòîâ íàøåãî ôîðóìà, íàëè÷èå äèïëîìîâ è çâàíèé, êîëëåêòèâíîå áðîñàíèå ÷åðíûõ øàðîâ è äàæå ïðèäàíèå Çàéöåâà àíàôåìå. P.S. Óâàæàåìûé Ãåîðãèé Àíäðååâè÷!  äèñêóññèè ðå÷ü èäåò íå î äèàãíîñòèêå. Î íåé íèêòî íå ñïîðèò. Óâàæàåìûå îïïîíåíòû óâåðåíû, ÷òî, âîîáùå, êëèíè÷åñêè çíà÷èìûå íàðóøåíèÿ ìèêðîáèîöåíîçà – áåçãðàìîòíàÿ ÷óøü, «ãàëëþöèíàöèÿ â âîñïàëåííîì ìîçãó ðîññèéñêèõ âðà÷åé». |
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Óâàæàåìûé Âëàäèìèð ßêîâëåâè÷ !
Îò èìåíè îïïîíåíòîâ õî÷ó çàìåòèòü ñëåäóþùåå - äàæå ýíäîêðèíîëîãó, è òîìó ÿñíî , ÷òî òåðìèíîì "äèñáàêòåðèîç" ïðèêðûâàåòñÿ öåëûé ðÿä ñîñòîÿíèé, òðåáóþùèõ óòî÷íåíèÿ , â ïåðâóþ î÷åðåäü, äèàãíîçà -îò ñòåðòîé öåëèàêèè äî äèàðåè , âûçâàííîé , íïðì, ìåäóëëÿðíîé êàðöèíîìîé ( êóäà çàáàâíåå , åñëè èñïîëüçîâàíèåì îïðåäåëåííûõ òèïîâ ñàõàðîçàìåíèòåëåé ), íà ìîåì âåêó - äàæå ñ-ìó Øâàõìàíà , è òîìó , ðîäèìîìó, äèñáàêòåðèîç ïîñòàâèëè .ß óæ ìîë÷ó î äèàáåòè÷åñêîé ýíòåðîïàòèè... Ïîíèìàåòå , ìû â ñâîèõ ðàññóæäåíèÿõ èñõîäèì èç ðàáîòû ñ íàøèìè áîëüíûìè, ó êîòîðûõ ðåàëüíûå ïðîáëåìû ïîäìåíÿþòñÿ áîéêèì "ôåêàëüíûì äèàãíîçîì" - ò.å. ìû íå òåîðåòèêè, íå îò õîðîøåé æèçíè î çëîóïîòðåáëåíèè ýòèì äèàãíîçîì ( è ,ñîîòâåòñòâåííî, äà÷åé ïðîáèîòèêîâ êàê ïàíàöååé) çàãîâîðèë ( è áëåñòÿùå ) äàæå Âàñèëåíêî - ìëàäøèé - ñûí ñàìîãî Â.Õ. Âàñèëåíêî ( ò.å. ãîëîñ íàñëåäîâàíèÿ ãàñòðîýíòåðîëîãèè ïî êðîâè ) è çàâ êàôåäðîé ïðîïåäåâòèêè ÌÌÀ àêàä. Â.Ò. Èâàøêèí ( ò.å ãîëîñ íàñëåäîâàíèÿ ãàñòðîýíòåðîëîãèè ïî àêàäåìèè ). Íî åñëè Âàì òàê äîðîã ýòîò ôåêàëüíûé äèàãíîç ñ ïðîáèîòèêàìè êàê ðåøåíèåì ïðîáëåìû - íó çàïðåòèòå ðåøàòü ïðîáëåìó äèàðåè ñ ïðèâëå÷åíèåì íåñêîëüêî áîëüøåãî ñïåêòðà èññëåäîâàíèé, ÷åì ïîñåâ ôåêàëèé íèâåñòü íà ÷òî è ÷óòü áîëüøèì êðóãîì èäåé , ÷åì äèñáàêòåðèîç. Âû æå â ñâîèõ ðàññóæäåíèÿõ èñõîäèòå èç êîíöåïöèè î çîìáèðîâàííûõ âðà÷àõ - íåâåæäàõ , ðàññûïàþùèõ àíòèáèîòèêè íàïðàâî è íàëåâî - ìû ïðîñòî ãîâîðèì î ðàçíûõ âåùàõ .
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Ã.À. Ìåëüíè÷åíêî |
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Óâàæàåìàÿ Ãàëèíà Àôàíàñüåâíà!
Ñìåþ íàïîìíèòü, ÷òî â ýòîé äèñêóññèè ðàçãîâîð íå øåë î "ôåêàëüíîì äèàãíîçå" èëè î òîì, ÷òî âîçìîæíûå äðóãèå ïàòîëîãè÷åñêèå ñîñòîÿíèÿ îøèáî÷íî äèàãíîñòèðóþòñÿ êàê äèñáàêòåðèîç. À ÒÎËÜÊÎ î òîì ñóùåñòâóþò ëè âîîáùå êëèíè÷åñêè çíà÷èìûå íàðóøåíèÿ ìèêðîáèîöåíîçà êèøå÷íèêà, âëàãàëèùà, êîòîðûå A. Nissle îáîçâàë «äèñáàêòåðèîç». Ëþáûå íàðóøåíèÿ è ïðè äèçåíòåðèè, â ÷àñòíîñòè. Ïðè÷åì ïîä÷åðêèâàëîñü, ÷òî äèñáàêòåðèîç – íå ñàìîñòîÿòåëüíàÿ íîçîëîãè÷åñêàÿ ôîðìà, à ïàòîëîãè÷åñêîå îòêëîíåíèå, êîòîðîå ìîæåò ñîïðîâîæäàòü öåëûé ðÿä çàáîëåâàíèé. Íî ïðîñòèòå, âåäü, ê ïðèìåðó, áîëåâîé ñèäðîì, òàê æå íå ÿâëÿåòñÿ ñàìîñòîÿòåëüíûì çàáîëåâàíèåì, à ëèøü ñîïðîâîæäàåò ìíîãèå èç íèõ. Íî ýòî âåäü íå ïîâîä óòâåðæäàòü, ÷òî åãî íå ñóùåñòâóåò, à åñòü - «ãàëëþöèíàöèÿ â âîñïàëåííîì ìîçãó ðîññèéñêèõ âðà÷åé» |
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Ïåðâîå ñîîáùåíèå â ëèñêóññèè
"Óâàæàåìûå êîëëåãè! ×àñòî âñòðå÷àþ â ëèòåðàòóðå íà ðóññêîì ÿçûêå óïîìèíàíèå î "äèñáàêòåðèîçå" è äëèòåëüíûõ, çà÷àñòóþ áåçóñïåøíûõ ïîïûòêàõ åãî ëå÷åíèÿ, âêëþ÷àÿ ïðèìåíåíèå àíòèáèîòèêîâ. Íå ìîãëè ëè áû Âû ïîÿñíèòü ìíå î ÷åì èäåò ðå÷ü. Çàðàíåå áëàãîäàðåí, Âëàäëåí." ×àñòü âòîðàÿ ìåðëåçîíñêîãî áàëåòà "Èòàê, óâàæàåìûå êîëëåãè, ïîõîæå âû íå íàìåðåíû îñòàíîâèòü ïðîâåäåíèå áåññìûñëåííûõ îáñëåäîâàíèé è ëå÷åíèé ò.í. "äèñáàêòåðèîçà êèøå÷íèêà". Ñêàæèòå, âû ïðîäîëæàåòå ëå÷èòü áîëüøèíñòâî êèøå÷íûõ èíôåêöèé è ñëó÷àè íîñèòåëüñòâà àíòèáèîòèêàìè?" Òðåòüÿ ÷àñòü - "Ñ ãîðàçäî áîëüøèì èíòåðåñîì ÿ áû ïðî÷èòàë îòâåò íà íåñêîëüêî ïîñòàâëåííûõ â ýòîì îáñóæäåíèè ïðîñòûõ âîïðîñîâ. Íàïðèìåð, íàìåðåíû ëè âû ïðåêðàòèòü áåññìûñëåííûå è äîðîãîñòîÿùèå îáñëåäîâàíèÿ ïî ïîâîäó ò.í. "äèñáàêòåðèîçà", ïðåäñòàâëÿþùèå ñîáîé íè÷òî èíîå êàê îáìàí ïàöèåíòîâ, íàìåðåíû ëè âû ïðåêðàòèòü ëå÷åíèå áîëüøèíñòâà êèøå÷íûõ èíôåêöèé è íîñèòåëüñòâà àíòèáèîòèêàìè, ïðåäñòàâëÿþùåå ñîáîé íè÷òî èíîå, êàê ñâèäåòåëüñòâî ïðîôåññèîíàëüíîé ìàëîîáðàçîâàííîñòè è íàíîñÿùåå íåñîìíåííûé âðåä ïàöèåíòàì è ò.ä. Çàðàíåå áëàãîäàðþ. __________________ Ñ íàèëó÷øèìè ïîæåëàíèÿìè, Vladlen. " Òàê î ÷åì åùå íàäî ïðîäîëæàòü äèñêóññèþ ?È î ÷åì îíà áûëà ?
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Ã.À. Ìåëüíè÷åíêî |
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Ðàç óæ ïîøëè öèòàòû.
1. Óâàæàåìûé Vladlen! Ðàç ýòà òåìà ïîñòîÿííî âñïëûâàåò íà ôîðóìå. Íå ìîãëè áû Âû âñå æå îòâåòèòü íà íåñêîëüêî ïðîñòûõ âîïðîñîâ? Âîîáùå –òî, ìèêðîáèîöåíîç êèøå÷íèêà (âëàãàëèùà, ðîòîâîé ïîëîñòè) ñóùåñòâóåò èëè ýòî âûìûñåë? Åñëè âñå æå èìååò ìåñòî, âîçìîæíî ëè íàðóøåíèå ýòîãî ìèêðîáèîöåíîçà èëè òàêîå íåâåðîÿòíî? Èëè âñå äåëî â òîì, ÷òî îðãàíèçìó íàïëåâàòü êàêèå ó íåãî òàì ìèêðîáû êîïîøàòñÿ? È êàê òàêèå íàðóøåíèÿ íóæíî îáîçâàòü? Íå íðàâèòñÿ òåðìèí äèñáàêòåðèîç? Õîðîøî â äðóãèõ ñòðàíàõ èñïîëüçóåòñÿ dysbiosis (äèñáèîç). È, íàêîíåö, äâàæäû ïðåäëàãàë ðàññìîòðåòü ýòîò âîïðîñ ïîä òàêèì óãëîì. «Äèñáàêòåðèîç – ÏÐÎßÂËÅÍÈÅ òåõ èëè èíûõ çàáîëåâàíèé, íî åãî íåïðàâèëüíî ðàññìàòðèâàòü, êàê ñàìîñòîÿòåëüíóþ íîçîëîãè÷åñêóþ ôîðìó». Íî âåäü áîëüøîå êîëè÷åñòâî âñÿêèõ äðóãèõ ìåòàáîëè÷åñêèõ íàðóøåíèé, êîòîðûå íå êâàëèôèöèðóåò, êàê ñàìîñòîÿòåëüíûå íîçîëîãè÷åñêèå ôîðìû íèêòî íå îòâåðãàåò è ëå÷àò, òî÷íåå ïîìîãàþò îðãàíèçìó ëèêâèäèðîâàòü ýòè íàðóøåíèÿ. Èëè Âû âñå æå íàñòàèâàåòå íà ôîðìóëèðîâêå: íå÷åãî ëå÷èòü òî, ÷åãî â ïðèðîäå íå ñóùåñòâóåò? __________________ Â. Çàéöåâ Óâàæàåìûé Âëàäèìèð ßêîâëåâè÷! Âîçìîæíî ÿ çàáëóæäàþñü, íî ìíå êàæåòñÿ, ÷òî ñâîþ ïîçèöèþ ïî ïîâîäó " äèçáàêòåðèîçà ó äåòåé" ÿ èçëîæèë âïîëíå ÿñíî. Ýòîãî ñîñòîÿíèÿ, êàê êëèíè÷åñêè î÷åð÷åííîé ïðîáëåìû, íà ñåãîäíÿ íå ñóùåñòâóåò.  ñâÿçè ñ ýòèì åãî ò.í. äèàãíîñòèêà è ëå÷åíèå íå îïðàâäàíû, à,âåðîÿòíî, è âðåäíû, õîòÿ áû òîëüêî ïîòîìó,÷òî çà ýòèì òåðìèíîì çà÷àñòóþ ñêðûâàþòñÿ íåäèàãíîñòèðîâàííûå çàáîëåâàíèÿ, êîòîðûå ìîæíî óñïåøíî ëå÷èòü. __________________ Vladlen. Óâàæàåìûé Vladlen! Íå ìîãëè áû âñå æå Âû ñôîðìóëèðîâàòü: â ÷åì íàøè ïîçèöèè ïðèíöèïèàëüíî íå ñîãëàñóþòñÿ?  òîì, ÷òî äàæå åñëè îïðåäåëåííûå íàðóøåíèÿ ìèêðîáèîöåíîçà òîëñòîé êèøêè èëè òàì âëàãàëèùà è ÿâëÿþòñÿ êëèíè÷åñêè çíà÷èìûìè ïàòîëîãèÿìè ïðè ðÿäå çàáîëåâàíèé, îáðàùàòü íà íèõ âíèìàíèå è òåì áîëåå ëå÷èòü, ïîêà î íèõ íå áóäåò óïîìÿíóòî â çàïàäíûõ ñòàíäàðòàõ, êàê, ê ïðèìåðó, î ñèíäðîìå óñèëåííîãî ðîñòà áàêòåðèé â òîíêîì êèøå÷íèêå (SBBO), íåëüçÿ? Ïðîñòèòå, à ÷åì çàíèìàåòñÿ ä-ð Æèâîâ, êîãäà «ëå÷èò ïàòîëîãè÷åñêóþ êîíòàìèíàöèþ âëàãàëèùà» ? Èëè àíòèáèîòèêàìè ëå÷èòü ìîæíî, à ê ïðèìåðó, ïðîáèîòèêàìè, íåëüçÿ. Ïîòîìó ÷òî ñòàòèñòè÷åñêèå ïîäòâåðæäåíèÿ îòñóòñòâóþò è, âîîáùå, ïî ìíåíèþ Àëåêñåé Âèêòîðîâè÷à, íåïîíÿòíî, êàê îíè ðàáîòàþò? __________________ Â. Çàéöåâ Óâàæàåìûé Âëàäèìèð ßêîâëåâè÷! òóò Âû äåëàéòå îñíîâíóþ îøèáêó â "îñíîâíîì âîïðîñå" - ïîäìåíÿåòå ïîíÿòèÿ. Îòêóäà íàì èçâåñòíî, ÷òî "äèñáàêòåðèîç" ÿâëÿåòñÿ ïàòîëîãè÷åñêèì íàðóøåíèåì ìèêðîôëîðû êèøå÷íèêà? Ïàòîëîãè÷åñêèå íàðóøåíèÿ êèøå÷íîé ôëîðû îáùåèçâåñòíû , íàïðèìåð, äèçåíòåðèÿ. Óïîìÿíóòûé Âàìè "äèñáàêòåðèîç" ê íèì íå îòíîñèòñÿ __________________ Vladlen. Óâàæàåìûé Vladlen! Îòâå÷ó, íà Âàø ïðåäïîñëåäíèé ïîñò. «Îòêóäà íàì èçâåñòíî, ÷òî "äèñáàêòåðèîç" ÿâëÿåòñÿ ïàòîëîãè÷åñêèì íàðóøåíèåì ìèêðîôëîðû êèøå÷íèêà?» Äà, ïî îïðåäåëåíèþ! A. Nissle îáîçâàë òàê ïàòîëîãè÷åñêèå íàðóøåíèÿ ìèêðîáèîöåíîçà, à â Ðîññèè ýòîò òåðìèí ïðèæèëñÿ. Ïîä ýòî îïðåäåëåíèå ïîäõîäÿò ëþáûå, ïîâòîðÿþ ËÞÁÛÅ, ïàòîëîãè÷åñêèå íàðóøåíèÿ ìèêðîôëîðû, âíå çàâèñèìîñòè ñîïðîâîæäàþò îíè îñòðûå ñîñòîÿíèÿ (äèçåíòåðèþ) èëè õðîíè÷åñêèå çàáîëåâàíèÿ. È ä-ð Æèâîâ, êîãäà «ëå÷èò ïàòîëîãè÷åñêóþ êîíòàìèíàöèþ âëàãàëèùà», êàê ÿ óæå îòìå÷àë âûøå, ëå÷èò èìåííî òîò ñàìûé äèñáàêòåðèîç. Íî ñòîëü «íåöåíçóðíîå» íàçâàíèÿ òàêîãî ñîñòîÿíèÿ âûçûâàåò ó íåãî æãó÷èé ïðîòåñò. Èìåííî ïîýòîìó, ïî ìîåìó ìíåíèþ, ñòîëü íåñóðàçíî âûãëÿäèò òàêàÿ íåñóñâåòíàÿ êðèòèêà íà ôîðóìå ýòîãî òåðìèíà, íà îñíîâàíèè òîãî, ÷òî â çàïàäíîé ìåäèöèíñêîé ëèòåðàòóðå îí íå èñïîëüçóåòñÿ. À âîò, êàêèå íàðóøåíèÿ ìèêðîáèîöåíîçà è ó êîãî ÿâëÿþòñÿ êëèíè÷åñêè çíà÷èìûìè, à êàêèå êîëåáàíèÿ íåïðèíöèïèàëüíû – ýòî óæå ÄÐÓÃÎÉ âîïðîñ, êîòîðûé òðåáóåò áîëåå ïðèñòàëüíîãî âíèìàíèÿ è èçó÷åíèÿ. __________________ Â. Çàéöåâ Òàê î ÷åì æå äèñêóññèÿ óâàæàåìàÿ Ãàëèíà Àôàíàñüåâíà? |
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À ÷åðò åãî çíàåò , óâàæàåìûé Âëàäèìèð ßêîâëåâè÷ !
Êàê îáû÷íî ó ðóññêèõ - ó Âàñ îá îäíîì , ó íàñ î äðóãîì. Âû íå ìîæåòå ñïàòü , íå ðàçîáðàâøèñü â áèîöåíîçå äîñêîíàëüíî - ìû ðàññòðîåíû òåì , ÷òî íå äèàãíîñòèðóåòñÿ öåëèàêèÿ â ÷àñòíîñòè è íèçîê óðîâåíü âðà÷åáíîãî îáðàçîâàíèÿ â öåëîì .
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Ã.À. Ìåëüíè÷åíêî |
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Óâàæàåìûå êîëëåãè, ðàç óæ ðåàíèìèðîâàëè íàøó ñòàðóþ òåìó. Íèæå - ôðàãìåíò èç êëèíè÷åñêèõ ðåêîìåíäàöèé ïî ïèùåâûì äîáàâêàì Àìåðèêàíñêîé àññîöèàöèè êëèíè÷åñêèõ ýíäîêðèíîëîãîâ.
"11.12 Probiotics 11.12.1. General Discussion of Underlying Physiology and Biochemistry The term “probiotic” refers to microorganism supplements intended to improve health or treat a specific disease. To be classified as a probiotic, the organism must have scientifically proven beneficial physiologic effects, must be safe for human consumption, must be stable in bile and acid, and must be able to adhere to the intestinal mucosa (372). “Prebiotics” are metabolic substrates for probiotic agents, such as various dietary fibers, inulin, and oligofructosaccharides. The term “synbiotics” refers to the administration of a mixture of probiotics and prebiotics. Probiotics protect the intestinal mucosa by competing with pathogens for attachment sites. Probiotics also up-regulate a specific glycosyltransferase enzyme (373). This enzyme affects the glycoconjugate receptor on glycolipid and protein microvillus membrane surface molecules (373). Moreover, probiotics strengthen tight junctions and improve mucosal immunity through crosstalk with epithelial cells (373). Probiotics also provide maturational signals for gut-associated lymphoid tissues. These signals continually prime gut inflammatory responses (374). Some probiotic strains induce proinflammatory cytokine release, such as tumor necrosis factor-and interleukin-6 (375). Some lactic acid bacteria prevent carcinogenesis in animals by abrogating the effects of carcinogens on proto-oncogene activation or tumor-suppressor gene inactivation (376). Colonic anaerobic microflora salvage energy by means of bacterial fermentation of undigested carbohydrate and protein into short-chain FAs, which are trophic to colonocyte physiology. Beneficial genera are Bifidobacterium and Lactobacillus, and detrimental species are Clostridium perfringens and Escherichia coli. Abnormal gut flora results from overgrowth of various enteric pathogens, such as Clostridium difficile, which, in turn, results in disturbance of colonic salt and water resorption, nutrient absorption, and gas formation. Lactobacillus GG can survive the digestive process, is not killed by gastric pH or bile (377), and can persist in the colon for more than a week (378). 11.12.2. Claimed Benefits and Controlled Clinical Trial Data With a 15-g daily dose of oligofructosaccharide or inulin, Bifidobacterium becomes the dominant genus in feces (379). Several small experimental studies have yielded positive and negative results of probiotics on antibiotic-associated diarrhea (380-386). Lactobacillus GG treatment has been used successfully for the management of recurrent Clostridium difficile colitis (387). Recently, however, this result has been challenged in a randomized, placebo-controlled trial involving 267 adult hospitalized patients in whom Lactobacillus GG failed to decrease the rate of antibiotic-associated diarrhea (388). Vanderhoof et al (389) found a significant decrease in antibiotic-associated diarrhea with use of Lactobacillus GG in a randomized, placebo-controlled study of 188 children. Symptoms resulting from secondary lactose intolerance in adults may also be alleviated after correction of gut dysbiosis, slowing of gastric emptying, and partial fermentation of lactose after probiotic use (374). Both Lactobacillus rhamnosus strain GG and Lactobacillus acidophilus strain La1 enhance phagocytosis in humans (390,391). Besides stabilizing indigenous gut microflora, probiotics also reduce the duration of rotavirus shedding (386), reduce the increased gut permeability resulting from rotavirus infection (392), and increase IgA-secreting cells in response to rotavirus (393,394). Moreover, probiotics can reduce the generation of local gut cytokines and reverse immunologic abnormalities found with food allergies (395), rheumatoid arthritis (396), and atopic eczema (392). In two controlled studies by Malin et al (396,397) of 14 children with Crohn’s disease and 9 children with juvenile chronic arthritis, Lactobacillus GG therapy for 10 days was associated with an increased gut IgA immune response. In a double-blind, randomized, placebo-controlled study of 40 patients with ulcerative colitis, a mixed-organism probiotic (VSL-3: 4 strains of lactobacilli, 3 strains of bifidobacteria, and 1 strain of Streptococcus salivarius) prevented flare-ups of chronic pouchitis (398). This effect is thought to be due to the ability of antibiotic and probiotic treatment to increase tissue interleukin-10 levels and to decrease proinflammatory cytokines, inducible nitric oxide synthase, and matrix metallopro-teinase activity (399). Probiotics have also been found to reduce atopy by (1) modifying the structure of potentially harmful antigens and thus decreasing their immunogenicity, (2) controlling excess formation of IgE and development of helper T cell subtype 2-skewed immune responsiveness, and (3) reducing interleukin-4 elaboration (392,393,400). In a recent metareview of 143 human clinical trials involving more than 7,500 subjects between 1961 and 1998, no adverse events were associated with probiotic use, generally at doses of 10 6 to 10 9 colony-forming units daily for up to 1 year (401). In rare cases of Lactobacillus bacteremia, the source has not been identified as food or translocation of native colonic flora (402)." |