/4,*-M^duk-

!:""
The Gastro-IntestinalMicroflora

l0ramicroorganisms, mainlybacterialive in the gastlo-intestinal tract.The numberandtypesof

nicroorganismsvary greatly along with the digestiveffact. ln tb€ stomaa,h, the numberof
micrcorganisms is the smallestbecause the gastricacidkills manybacteriain the smallint€stin€,
rner)Umber ofmicroorgani.ms incrcase. agrin
A particularlylargeoumberof bacleriasettlein the largeintestine.Heretheyact like a
biological fennentationchamberto break down still undigesledfood constituents.The
variety/speciesof microorganisms in the largeintestineis also gfeatest.Takentogelh€r,all of
thesemicrcorganisnsare termed as intestinalmicloflora.Bacteriaaccountfor approx.50-60%
ofthe stoolmass,
ln the largeiDtestine, anaerobes arc presentin largernumberthanaerobes. Therefore,the
environment heremLrstbe asfreefrom oxygenas possible.Partic larly.Escherichia coli bacteria.
which alreadycolonizethe inlant intestine,createthe living conditionin the iDtestine. They
consllneoxygenthat is continuosly transpoftedby the blood to the cells of the inlestinal
mucosa. This alsoallowsaDaerobes to settle.Thecomposilionofihe intestinalmicroflomon the
oxygen-containing intestinalwall differs from thatwithii the intestineor in thestool.
lluman AerobicMicroflora in Stomach
Microorganisms CFU/ml
0 ,1 0
Rare
. tt(jph_\)lococci 0-r0 '
. Enterobdcteria o,l o'
' Yeasts 0-10 '
Ilum:rn AnnerobicMicroflora in Stomach
Microorganisms CFU/ml
. Peptostreplococci o-ro'
. Rilidobdckria o-to'
0-r0'
o-l()r
. Clostridia Rare
. Prerotello.Porphyromonas 0-10'
a Bacteroides.fragilh group Rare
. Fu$ohact?tiLt 0-l0l

Human icreflora in Jejunum

Anrerobic mioroorgatrfums. C!-U/ml
o-lo'
0-10'
o-1oo
o - lo '
Rare
Prev oIeIIa, Porp h)r ononds 1 0-1 0 '
Bacterc idesf agi I ii gtoLtp o - to '
Fusobdcteria o - lo '
Human Aerobic Microllora in Ileum
Aerobic microorgruisms CFU/ml
Strcpbcocci 10'-10'

I
 1o'?-t01
l0',10'
l o'r,lo'
l0r-10 1

HumanAerobicMicrollora in Colon
A€robic microorganisms CFU/g
l 0 '-l 0'
l or,to'o
l04,l0r
1 0 " -10' "
Yeasts r0 r 1 05

HumanAnaerobicMicroflora in Colon
Ana€robic microorganisms CFU/s
lor o- laD
Bilidabdcterid 103- r 0
I06-Ioe
toir 06
10",I0"
Prer oteIld, Parp hw omonas tol-t05
Bac! erc ides-fragil is groLtp I olo-lol2
106t og

How do disturbanc€softhe intestinalmicrofloraoccur

Thesensitive ecosystem ofthe intestinalmicroflorais constantlvin contactwith the eDvircnment

All sirbstances that rve take in throughllte mouth-foodbut also medicaments can exeft a
favourable or inhibiliDg effect on the inlestinalmicroflora. Often.the intestinalmicroflora is
destroyed by necessary therapeutic measures. This is mainlythe use of antibiotics,but radiation
therapycanalsodamagethe intestinalmicroflora-
Taking antibioticsfor other r€asonsmay leadto severedisturbances of the intesti:lal
microflora.The symptomsin the gastrointestittal tractcanlastmonthsor yearsandareusuallyno
longerassociated with previousantibioticadministration.
Therefore,persistentafterefTectssuchas diafoheaocclLrvery often after 4ntibioticor
radiationtherapysuchsymptomcan persistfor monthsor years.Suchsynptomscan persistfor
lnontbsor years!which is a sign thal the intestinalmicroflotal1asnot beencompletelyrestofed.
Thealteredconcentration ofihe short-chainfattyacidsin the stoolofpatientswith initablebowel
syndromealso ird;catesan abnormalconpositionof the intestina!nlicroflora An intostinal
|nicroflorawith decreased m6tabolicactivitycancontribute to constipation.

Treatmentwith Probiticsdrugs

Probioticmicroorganisms aredefinedassupplemeDts ofliving microorganisms foundin the

nomal florawith low or no pathogeDicity
blrfwith positiveeffectson the healtbofthe host.

Propertiesof ProbioticMicrborganisms
. Adhere1()cellsandmlrcus
. Exclutleor reducepathogen adhesion
'Persistand nultiply in the host
. Produce acids,hydrogenperoxide,andbacteriocins to grouth ofpathogens
antagonistic
. Be safe,noninvasive, aridnonpathogenic
noncarcinogenic,
. Coaggregate flora
to form a normal'balanced

BenefitsofProbioticsin the Int€stinalTrsct

. Incrcase to infectiousdiseases
in r€sistance
. Decrease ofdiarrhoea
in duration
' Reductionin bloodpressure
. Reduc t io rll n .e ru m L h o l c s l e fo lc o l l c e n trati ol l
. Reduction in allergy
. Stimulationofphagocytosis by peripher.lbloodleukocltes
' Modulation ofcytokine gene expression
. Regression oftumours
. Reduction in cafcinogen productioll
. Lessening ofthe effectoflactoseintolerance
. AlleviationofsymptomsofCrohn'sdisease
' Establishment ofnormalfloraafterantibiotictreatment
. Reduction in development ofcollagen-inducedArthdtis
. Adjuvanteflect

Probiotics in Treatme\t of Helicobacterpy,,ri Infections

. LuctobaciIlus acidoPhilu\
.Loctobacil lusgrdsseri
.Lactobaci|lusJarme tum
.LactobaciI lusp lantdrum
' Ldctobocil Ius reuleri
' Lactohdcil lusr humnosus

ProbioticTreatmentof Ent€robacterialInlections
.Enterococcus Jdectum
.Lactohacillus acidophillts
' Lactohdcillu\ b lSaric llt
,LdcIobacillat.fermentunl
. Lactobacillus I ha lnosus

ProbioticTreatmentoflnfectiousDiarrho€nin Children
. LaLIobaciIIus acidoPhilus
.Lactobacillus bulgdricus
' Lactahdcil lusreuteri
.Lactobacil lus r hdmnosus

Probiotic TreAtment of Clostridiurn difJicile lnlections

.Sdccharcmlc es boulaftlii
. LdclobaciI lust hamnosus
,Lactobdcil lusacidophilus
.Lactobacillus 6ulgaricus
.EnIet ococcus,faeciunI
ProbioticTreatmentof InflammatoryBorv€lDisease

. LacIobaci I lusr hamnosus

.Bifdobacteriun spp
.Sauharcry,ces bo aftlii

Pr€vention ofTumour Growth by Probiotics

.Ldctobacilluscasei postpotedrecurrenceofbladdertumors in 87 patients
.Excretionofmutagens in urine was loweredwith Lactobacillusacidophilus

Safety olProbiotics
.Normalhurnanmicroflordi)olale-
'No intrinsicresistanceto antimictobial agents
.Molecular charactedzation
.Risk of opportunisticinfections
. Immonocompromised pelsons
.lnfants and young children
.Elderly persons

l)