Dr Yordan Popov
Dr Dimitar* Angelov
Zdrave Integrated Hospital for Active Treatment OOD, Pulmed Hospital, Plovdiv, Bulgaria.

Probiotics are widely and successfully used to treat and prevent most diseases, especially those of the gastrointestinal tract, including diarrhoea and constipation of various aetiology, implications resulting from antibiotic treatment, food poisoning, acute intestinal infections, chronic colitis and enterocolitis, weakened immunity, bad breath, chemotherapy and radiation therapy implications, as well as other conditions. To this end, probiotics should comply with these requirements:

• High viability.
• Biological activity.
• Resistance to stomach pH.
• Belong to normal GIT inhabitants.
• Be resistant to antibiotics.
• Ability to suppress the growth of pathogenic bacteria and/or viruses.
• Restore and maintain the balance of gastrointestinal microbiota.

As products containing live microorganisms, probiotics also require specific conditions for storage and use. In order to be effective, probiotics should be taken separately from medication and food, at least 20-30 minutes before or after meals with a sufficient amount of water. ( See American Journal of Internal Medicine, NY, 2011.)

Probiotics and probiotic-based products have now taken their well-deserved place in health care, both as adjunctive therapy with antibiotic treatment and as agents used in treating a number of conditions, including IBS, IBD, polychemotherapy implications, antibiotic-associated diarrhoea syndrome, necrotizing enterocolitis, and travelers’ diarrhoea. These products are also used in the reconvalescent period after infectious and viral gastroenterocolitis. In addition, according to most recent publications, probiotic products aid in eradicating H. pylori (based on the biological principle of competition). .

Probiotics help digestion and aid in eliminating and excreting waste from the body and function in the synthesis of vitamins, as well as the inhibition of pathogenic microorganisms and conditional pathogens. Probiotics also facilitate the elimination of toxins. In general, the small intestine and colon host hundreds of types of bacteria which play an active role in building our self-image and health. Gastrointestinal microbiota is constantly subjected to environmental impact and coordinates the function of the immune and digestive systems. Gastrointestinal microbiota maintains the balance and internal environment in the intestines and suppresses the growth of pathogenic microorganisms and conditional pathogens. When the functioning of the GIT is impaired, the growth of pathogens and conditional pathogens is commonly observed, which leads to motility disorders and dysfunction in the processes of resorption and elimination in the GIT. This is where probiotics come into play—restoring biological equilibrium, as well as the balance of gastrointestinal microbiota. (See UK J of Gastroenterology, L., 2011, ch.4, p.256.)

Probiotics contain various microbiological strains of microorganisms that normally exist in our GIT, including the most common and popular ones: Lactobacillus acidophilus, Bifidobacterium bifidum, Lactobacillus casei, Bifidobacterium longum, Lactobacillus rhamnosus, Bifidobacterium infantis, Streptococcus thermophillus, and Lactobacillus bulgaricus. If used properly and regularly and stored appropriately, probiotics are very efficacious in treating and preventing a number of diseases, mostly gastrointestinal tract disorders. (Journal of Clinical Bacteriology, NY, 2010).

In this context, we would like to share our clinical experience in the administration of probiotics. According to WHO (World Health Organization), irritable bowel syndrome (IBS) accounts for some 40% of the cases in gastroenterologists’ routine practice. (Ann J of Gastroenterology, WHO, Geneva, 2012) Administering probiotics in IBS patients has become an established standard in day-to-day medical practice. According to WHO (Ann J of Bact Deseases, WHO, Geneva, 2012), antibiotic-associated dysbacteriosis and diarrhea syndrome account for 25-28% of functional gastrointestinal disorders.

From 01 June to 01 October 2013, 87 patients with IBS were referred to our clinic. Single probiotic therapy was recommended to 70 patients. During follow-up visits, a clinical effect was reported in 60 patients, such results as improved self-image, discontinued bloating, lack of gas and flatulation, regular physiological rhythm in bowel movements. Double therapy was recommended to 17 patients—6 patients received probiotics and concentrated and standardised extracts (via gelatine capsules), and 11 patients received Simethiconе. A clinical effect (in the above indicators) was observed in 14 patients.

The data presented above support the routine administration of probiotics as a monotherapy and their administration in combination with other drugs influencing gastrointestinal motility and adsorption and evacuation of gas that is produced in larger amounts in specific functional and fermentation-associated GI disorders.

From 01 August to 01 October 2013, 23 patients with antibiotic-associated dysbacteriosis and diarrhoea syndrome were referred to our clinic. It was concluded that 12 of these patients had classic antibiotic-associated diarrhoea syndrome, resulting from antibiotic treatment for pulmonary pathology and upper respiratory tract pathology. These patients were treated with a probiotic monotherapy. An effect (in the above indicators) was reported in all 12 patients. The remaining 11 patients received combination therapy, including a probiotic product and Otilonium bromide. A clinical effect (in the above indicators) was observed in 10 of these patients. The above data convincingly demonstrate the effect of administering probiotic agents in routine clinical practice.

In patients who were prescribed probiotic products manufactured by Kendy Pharma* *Да се поправи в БГ текста- Kendy, а не Kandy- има го на 4 места до края на този текст (Lactoflor Probiotic and Lactoflor BioPlus capsules), the following effects were reported:

1. In the group of 87 patients with IBS, probiotics (manufactured by Kendy Pharma) were prescribed to 56 patients. An effect was reported in all 56 patients. (Effect means that a response was observed in at least two of the aforementioned indicators.) 2. In the group of 23 patients with antibiotic-associated dysbacteriosis and diarrhoea syndrome, probiotics (manufactured by Kendy Pharma) were prescribed to 20 patients. An effect was reported in 17 patients.

CONCLUSIONS: The above data convincingly demonstrate the effectiveness of probiotic products manufactured by Kendy Pharma in cases of:

1. IBS.
2. Dysbacteriosis.
3. Post-antibiotic diarrhoea.
4. Probiotics manufactured by Kendy Pharma are reliable products. There have been no reports of any adverse effects that could be associated with the intake of this type of probiotics.