Probiotics for gastrointestinal disorders: Proposed recommendations for children of the Asia-Pacific region

Recommendations for probiotics are available in several regions. This paper proposes recommendations for probiotics in pediatric gastrointestinal diseases in the Asia-Pacific region. Epidemiology and clinical patterns of intestinal diseases in Asia-Pacific countries were discussed. Evidence-based recommendations and randomized controlled trials in the region were revised. Cultural aspects,health management issues and economic factors were also considered. Final recommendations were approved by applying the Likert scale and rated using the GRADE system. Saccharomyces boulardii CNCM I-745(Sb) and Lactobacillus rhamnosus GG(LGG) were strongly recommended as adjunct treatment to oral rehydration therapy for gastroenteritis. Lactobacillus reuteri could also be considered. Probiotics may be considered for prevention of(with the indicated strains): antibiotic-associated diarrhea(LGG or Sb); Clostridium difficile-induced diarrhea(Sb); nosocomial diarrhea(LGG); infantile colic(L reuteri) and as adjunct treatment of Helicobacter pylori(Sb and others). Specific probiotics with a history of safe use in preterm and term infants may be considered in infants for prevention of necrotizing enterocolitis. There is insufficient evidence for recommendations in other conditions. Despite a diversity of epidemiological,socioeconomical and health system conditions,similar recommendations apply well to Asia pacific countries. These need to be validated with local randomized-controlled trials.

Gastrointestinal and liver infections in children undergoing antineoplastic chemotherapy in the years 2000

AIM: To review gastrointestinal and liver infections in children undergoing antineoplastic chemotherapy. To look at gut microflora features in oncology children.METHODS: We selected studies published after year 2000, excluding trials on transplanted pediatric patients. We searched English language publications in MEDLINE using the keywords: "gastrointestinal infection AND antineoplastic chemotherapy AND children", "gastrointestinal infection AND oncology AND children", "liver infection AND antineoplastic chemotherapy AND children", "liver abscess AND chemotherapy AND child", "neutropenic enterocolitis AND chemotherapy AND children", "thyphlitis AND chemotherapy AND children", "infectious diarrhea AND children AND oncology", "abdominal pain AND infection AND children AND oncology", "perianal sepsis AND children AND oncology", "colonic pseudo-obstruction A N D o n c o l o g y A N D c h i l d A N D c h e m o t h e r a p y ", "microflora AND children AND malignancy", "microbiota AND children AND malignancy", "fungal flora AND children AND malignancy". We also analysed evidence from several articles and book references.RESULTS: Gastrointestinal and liver infections represent a major cause of morbidity and mortality in children undergoing antineoplastic chemotherapy. Antineoplastic drugs cause immunosuppression in addition to direct toxicity, predisposing to infections, although the specific risk is variable according to disease and host features. Common pathogens potentially induce severe diseases whereas opportunistic microorganisms may attack vulnerable hosts. Clinical manifestations can be subtle and not specific. In addition, several conditions are rare and diagnostic process and treatments are not standardized. Diagnosis may be challenging, however early diagnosis is needed for quick and appropriate interventions. Interestingly, the source of infectionin those children can be exogenous or endogenous. Indeed, mucosal damage may allow the penetrance of endogenous microbes towards the bowel wall and their translocation into the bloodstream. However, only limited knowledge of intestinal dysbiosis in oncology children is available. CONCLUSION: The diagnostic work-up requires a multimodal approach and should be implemented(also by further studies on new biomarkers) for a prompt and individualized therapy.

欧洲儿童急性胃肠炎处理循证指南（2014年版）

1991年世界卫生组织（WHO）制订了第一版儿童急性腹泻病指南，2005年WHO和联合国儿童基金会（UNICEF）制订了第二版，我国专家在参照WHO指南的基础上，结合我国国情分别于1993年、2009年制订了中国儿童急性腹泻病的专家共识；WH0指南和我国共识对中国儿童急性腹泻病的规范诊治发挥了重要的作用，收到了良好的效果。时至今日，欧洲儿科胃肠病学、肝病学和营养协会及欧洲儿科感染病协会对2008年儿童急性胃肠炎循证指南进行更新，即“2014年版”。指南中腹泻病原、低渗口服补液盐溶液使用、营养管理和常规对症治疗与我国现行共识基本一致。另首次对儿童脱水评估和疾病严重程度评分进行量化并提出通过鼻胃管补液，这是我们可以借鉴的。重度脱水休克的治疗强调了可重复3次20ml／kg0．9％氯化钠溶液，与我国危重专业观点相一致。静脉补充液体成分与我国现行共识存在差异，与指南执笔者之一意大利学者AndreaLoVecehio进行交流，其认同我国现用液体组成。细菌感染所致腹泻使用抗生素的指征与我国现行共识相同，但在抗生素选择上存在差异，建议根据我国药典和药敏结果选择合适抗生素。由于我国社会经济、文化和医学发展等与欧洲存在差异，因此指南中的观点、方法等应结合中国特点进行应用。