Presepsin as a biomarker of bacterial translocation and an indicator for the prescription of probiotics in cirrhosis

BACKGROUND The gut–liver axis and bacterial translocation are important in cirrhosis,but there is no available universal biomarker of cellular bacterial translocation,for which presepsin may be a candidate.AIM To evaluate the relationship of the blood presepsin levels with the state of the gut microbiota in cirrhosis in the absence of obvious infection.METHODS This study included 48 patients with Child–Pugh cirrhosis classes B and C and 15 healthy controls.The fecal microbiome was assessed using 16S rRNA gene sequencing.Plasma levels of presepsin were measured.A total of 22 patients received a probiotic(Saccharomyces boulardii)for 3 months.RESULTS Presepsin levels were higher in patients with cirrhosis than in healthy individuals[342(91-2875)vs 120(102-141)pg/mL;P=0.048].Patients with elevated presepsin levels accounted for 56.3%of all included patients.They had lower levels of serum albumin and higher levels of serum total bilirubin and overall severity of cirrhosis as assessed using the Child–Pugh scale.Patients with elevated presepsin levels had an increased abundance of the main taxa responsible for bacterial translocation,namely Bacilli and Proteobacteria(including the main class Gammaproteobacteria and the minor taxa Xanthobacteraceae and Stenotrophomonas),and a low abundance of bacteria from the family Lachnospiraceae(including the minor genus Fusicatenibacter),which produce short-chain fatty acids that have a positive effect on intestinal barrier function.The presepsin level directly correlated with the relative abundance of Bacilli,Proteobacteria,and inversely correlated with the abundance of Lachnospiraceae and Propionibacteriaceae.After 3 months of taking the probiotic,the severity of cirrhosis on the Child–Pugh scale decreased significantly only in the group with elevated presepsin levels[from 9(8-11)to 7(6-9);P=0.004],while there were no significant changes in the group with normal presepsin levels[from 8(7-8)to 7(6-8);P=0.123].A high level of presepsin before the prescription of the probiotic was an independent predictor of a greater decrease in Child–Pugh scores(P=0.046),as well as a higher level of the Child–Pugh scale(P=0.042),but not the C-reactive protein level(P=0.679)according to multivariate linear regression analysis.CONCLUSION The level of presepsin directly correlates with the abundance in the gut microbiota of the main taxa that are substrates of bacterial translocation in cirrhosis.This biomarker,in the absence of obvious infection,seems important for assessing the state of the gut–liver axis in cirrhosis and deciding on therapy targeted at the gut microbiota in this disease.

Sarcopenia in cirrhosis: Prospects for therapy targeted to gut microbiota

Decreased muscle mass and function,also known as sarcopenia,is common in patients with cirrhosis and is associated with a poor prognosis.Although the pathogenesis of this disorder has not been fully elucidated,a disordered gutmuscle axis probably plays an important role.Decreased barrier function of the gut and liver,gut dysbiosis,and small intestinal bacterial overgrowth(SIBO)can lead to increased blood levels of ammonia,lipopolysaccharides,pro-inflammatory mediators,and myostatin.These factors have complex negative effects on muscle mass and function.Drug interventions that target the gut microbiota(long-term use of rifaximin,lactulose,lactitol,or probiotics)positively affect most links of the compromised gut-muscle axis in patients with cirrhosis by decreasing the levels of hyperammonemia,bacterial translocation,and systemic inflammation and correcting gut dysbiosis and SIBO.However,although these drugs are promising,they have not yet been investigated in randomized controlled trials specifically for the treatment and prevention of sarcopenia in patients with cirrhosis.No data exist on the effects of fecal transplantation on most links of gut-muscle axis in cirrhosis;however,the results of animal experimental studies are promising.

Epidemiology of small intestinal bacterial overgrowth

Small intestinal bacterial overgrowth(SIBO)is defined as an increase in the bacterial content of the small intestine above normal values.The presence of SIBO is detected in 33.8%of patients with gastroenterological complaints who underwent a breath test,and is significantly associated with smoking,bloating,abdominal pain,and anemia.Proton pump inhibitor therapy is a significant risk factor for SIBO.The risk of SIBO increases with age and does not depend on gender or race.SIBO complicates the course of a number of diseases and may be of pathogenetic significance in the development of their symptoms.SIBO is significantly associated with functional dyspepsia,irritable bowel syndrome,functional abdominal bloating,functional constipation,functional diarrhea,short bowel syndrome,chronic intestinal pseudo-obstruction,lactase deficiency,diverticular and celiac diseases,ulcerative colitis,Crohn’s disease,cirrhosis,metabolic-associated fatty liver disease(MAFLD),primary biliary cholangitis,gastroparesis,pancreatitis,cystic fibrosis,gallstone disease,diabetes,hypothyroidism,hyperlipidemia,acromegaly,multiple sclerosis,autism,Parkinson’s disease,systemic sclerosis,spondylarthropathy,fibromyalgia,asthma,heart failure,and other diseases.The development of SIBO is often associated with a slowdown in orocecal transit time that decreases the normal clearance of bacteria from the small intestine.The slowdown of this transit may be due to motor dysfunction of the intestine in diseases of the gut,autonomic diabetic polyneuropathy,and portal hypertension,or a decrease in the motor-stimulating influence of thyroid hormones.In a number of diseases,including cirrhosis,MAFLD,diabetes,and pancreatitis,an association was found between disease severity and the presence of SIBO.Further work on the effect of SIBO eradication on the condition and prognosis of patients with various diseases is required.

Antibiotics,gut microbiota,and irritable bowel syndrome:What are the relations?

Irritable bowel syndrome(IBS)is a functional gastrointestinal disorder in which recurrent abdominal pain is associated with defecation or a change in bowel habits(constipation,diarrhea,or both),and it is often accompanied by symptoms of abdominal bloating and distension.IBS is an important health care issue because it negatively affects the quality of life of patients and places a considerable financial burden on health care systems.Despite extensive research,the etiology and underlying pathophysiology of IBS remain incompletely understood.Proposed mechanisms involved in its pathogenesis include increased intestinal permeability,changes in the immune system,visceral hypersensitivity,impaired gut motility,and emotional disorders.Recently,accumulating evidence has highlighted the important role of the gut microbiota in the development of IBS.Microbial dysbiosis within the gut is thought to contribute to all aspects of its multifactorial pathogenesis.The last few decades have also seen an increasing interest in the impact of antibiotics on the gut microbiota.Moreover,antibiotics have been suggested to play a role in the development of IBS.Extensive research has established that antibacterial therapy induces remarkable shifts in the bacterial community composition that are quite similar to those observed in IBS.This suggestion is further supported by data from cohort and case-control studies,indicating that antibiotic treatment is associated with an increased risk of IBS.This paper summarizes the main findings on this issue and contributes to a deeper understanding of the link between antibiotic use and the development of IBS.

Ursodeoxycholic acid as a means of preventing atherosclerosis,steatosis and liver fibrosis in patients with nonalcoholic fatty liver disease

BACKGROUND Atherosclerotic cardiovascular disease(ASCVD)is the leading cause of mortality in patients with nonalcoholic fatty liver disease(NAFLD).Weight loss is a key factor for successful NAFLD and CVD therapy.Ursodeoxycholic acid(UDCA),which is one of the first-line therapeutic agents for treatment of NAFLD,is reported to have a beneficial effect on dyslipidemia and ASCVD risk because of antioxidant properties.AIM To evaluate the effects of 6 mo of UDCA treatment on hepatic function tests,lipid profile,hepatic steatosis and fibrosis,atherogenesis,and ASCVD risk in men and women with NAFLD,as well as to assess the impact of>5%weight reduction on these parameters.METHODS An open-label,multicenter,international noncomparative trial was carried out at primary health care settings and included 174 patients with ultrasound-diagnosed NAFLD who received 15 mg/kg/d UDCA for 6 mo and were prescribed lifestyle modification with diet and exercise.The efficacy criteria were liver enzymes,lipid profile,fatty liver index(FLI),noninvasive liver fibrosis tests(nonalcoholic fatty liver disease fibrosis score and liver fibrosis index),carotid intima-media thickness(CIMT),and ASCVD risk score.To test statistical hypotheses,the Wilcoxon test,paired t-test,Fisher’s exact test,and Pearson's chi-squared test were used.RESULTS The alanine aminotransferase(ALT)level changed by-14.1 U/L(-31.0;-5.3)from baseline to 3 mo and by-6.5 U/L(-14.0;0.1)from 3 to 6 mo.The magnitude of ALT,aspartate transaminase,and glutamyltransferase decrease was greater during the first 3 mo of treatment compared to the subsequent 3 mo(P<0.001,P<0.01,P<0.001,respectively).At 6 mo,in the total sample,we observed a statistically significant decrease in body weight and levels of FLI:84.9±10.4 vs 72.3±17.6,P<0.001,total cholesterol:6.03±1.36 vs 5.76±1.21,Р<0.001,lowdensity lipoprotein:3.86±1.01 vs 3.66±0.91,Р<0.001,and triglyceride:3.18(2.00;4.29)vs 2.04(1.40;3.16),Р<0.001.No effect on nonalcoholic fatty liver disease fibrosis score or liver fibrosis index was found.The CIMT decreased significantly in the total sample(0.985±0.243 vs 0.968±0.237,P=0.013),whereas the highdensity lipoprotein(Р=0.036)and 10-year ASCVD risk(Р=0.003)improved significantly only in women.Fifty-four patients(31%)achieved>5%weight loss.At the end of the study,the FLI decreased significantly in patients with(88.3±10.2 vs 71.4±19.6,P<0.001)and without>5%weight loss(83.5±10.3 vs 72.8±16.7,P<0.001).The changes in ALT,aspartate transaminase,glutamyltransferase,total cholesterol,and low-density lipoprotein levels were similar between the subgroups.CONCLUSION UDCA normalizes liver enzymes greatly within the first 3 mo of treatment,improves lipid profile and hepatic steatosis independent of weight loss,and has a positive effect on CIMT in the total sample and 10-year ASCVD risk in women after 6 mo of treatment.

Case report of Graves' disease manifesting with odynophagia and heartburn

Graves' disease is an autoimmune disease, which can manifest with a variety of extrathyroidal clinical syndromes like ophthalmopathy, pretibial myxedema(dermopathy), acropathy, cardiomyopathy, and encephalopathy. Though quite rare, this disease can also manifest with gastrointestinal symptoms such as dysphagia, heartburn, nausea, vomiting and diarrhea. We report a clinical case of Graves' disease manifesting with dysfunction of the esophagus and heartburn in a 61-year-old man. In the muscular layer of the esophagus we found dystrophic changes led to its atony, which was documented by endoscopy and high-resolution manometry. The pathology features of esophageal symptoms were: focal proliferation of the basal cells, vascular distension, and dystrophy of the epithelial cells. Antithyroid treatment led to decrease of all clinical symptoms after 5 d of Thiamazole administration. Complete restoration of peristalsis in the esophagus, according to manometry, was observed in 1 mo after initiation of treatment.

Gut dysbiosis and small intestinal bacterial overgrowth as independent forms of gut microbiota disorders in cirrhosis

BACKGROUND Gut dysbiosis and small intestinal bacterial overgrowth(SIBO)are commonly observed in patients with cirrhosis.Despite the substantial number of articles describing the relations between disorders of gut microbiota and various manifestations of cirrhosis,dysbiosis and SIBO were always studied separately.AIM To study the relationship of gut dysbiosis and SIBO in cirrhosis.METHODS This observational study included 47 in-patients with cirrhosis.Stool microbiome was assessed using 16 S r RNA gene sequencing.SIBO was assessed using the lactulose hydrogen breath test.RESULTS SIBO was found in 24/47(51.1%)patients.Patients with SIBO had a higher abundance of Firmicutes(P=0.017)and Fusobacteria(P=0.011),and a lower abundance of Bacteroidetes(P=0.013)than patients without SIBO.This increase in the abundance of Firmicutes occurred mainly due to an increase in the abundance of bacteria from the genus Blautia(P=0.020)of the Lachnospiraceae family(P=0.047),while the abundance of other major families of this phylum[Ruminococcaceae(P=0.856),Peptostreptococcaceae(P=0.066),Clostridiaceae(P=0.463),Eubacteriaceae(P=0.463),Lactobacillaceae(P=0.413),and Veillonellaceae(P=0.632)]did not differ significantly between the patients with and without SIBO.Reduced level of Bacteroidetes in samples from patients with SIBO was a result of the decrease in bacterial numbers from all the major families of this phylum[Bacteroidaceae(P=0.014),Porphyromonadaceae(P=0.002),and Rikenellaceae(P=0.047)],with the exception of Prevotellaceae(P=0.941).There were no significant differences in the abundance of taxa that were the main biomarkers of cirrhosis-associated gut dysbiosis[Proteobacteria(P=0.790),Bacilli(P=0.573),Enterobacteriaceae(P=0.632),Streptococcaceae(P=0.170),Staphylococcaceae(P=0.450),and Enterococcaceae(P=0.873)]between patients with and without SIBO.CONCLUSION Despite the differences observed in the gut microbiome between patients with and without SIBO,gut dysbiosis and SIBO are most likely independent disorders of gut microbiota in cirrhosis.

Gut-liver axis in cirrhosis:Are hemodynamic changes a missing link?

Recent evidence suggests that the condition of the gut and its microbiota greatly influence the course of liver disease,especially cirrhosis.This introduces the concept of the gut-liver axis,which can be imagined as a chain connected by several links.Gut dysbiosis,small intestinal bacterial overgrowth,and intestinal barrier alteration lead to bacterial translocation,resulting in systemic inflammation.Systemic inflammation further causes vasodilation,arterial hypotension,and hyperdynamic circulation,leading to the aggravation of portal hypertension,which contributes to the development of complications of cirrhosis,resulting in a poorer prognosis.The majority of the data underlying this model were obtained initially from animal experiments,and most of these correlations were further reproduced in studies including patients with cirrhosis.However,despite the published data on the relationship of the disorders of the gut microbiota with the complications of cirrhosis and the proposed pathogenetic role of hemodynamic disorders in their development,the direct relations between gut dysbiosis and hemodynamic changes in this disease are poorly studied.They remain a missing link in the gut-liver axis and a challenge for future research.

Probiotics in hepatology:An update

The gut-liver axis plays an important role in the pathogenesis of various liver diseases.Probiotics are living bacteria that may be used to correct disorders of this axis.Notable progress has been made in the study of probiotic drugs for the treatment of various liver diseases in the last decade.It has been proven that probiotics are useful for hepatic encephalopathy,but their effects on other symptoms and syndromes of cirrhosis are poorly studied.Their effectiveness in the treatment of metabolic associated fatty liver disease has been shown both in experimental models and in clinical trials,but their effect on the prognosis of this disease has not been described.The beneficial effects of probiotics in alcoholic liver disease have been shown in many experimental studies,but there are very few clinical trials to support these findings.The effects of probiotics on the course of other liver diseases are either poorly studied(such as primary sclerosing cholangitis,chronic hepatitis B and C,and autoimmune hepatitis)or not studied at all(such as primary biliary cholangitis,hepatitis A and E,Wilson's disease,hemochromatosis,storage diseases,and vascular liver diseases).Thus,despite the progress in the study of probiotics in hepatology over the past decade,there are many unexplored and unclear questions surrounding this topic.

Effect of probiotics on hemodynamic changes and complications associated with cirrhosis:A pilot randomized controlled trial

BACKGROUND Bacterial translocation exacerbates the hyperdynamic circulation observed in cirrhosis and contributes to a more severe disease course.Probiotics may reduce bacterial translocation and may therefore be useful to redress the circulatory imbalance.AIM To investigate the effect of probiotics on hemodynamic parameters,systemic inflammation,and complications of cirrhosis in this randomized placebocontrolled trial.METHODS This single-blind randomized placebo-controlled study included 40 patients with Child-Pugh class B and C cirrhosis;24 patients received probiotics(Saccharomyces boulardii)for 3 mo,and 16 patients received a placebo over the same period.Liver function and the systemic hemodynamic status were evaluated pre-and postintervention.Echocardiography and simultaneous blood pressure and heart rate monitoring were performed to evaluate systemic hemodynamic indicators.Cardiac output and systemic vascular resistance were calculated.RESULTS Following a 3-mo course of probiotics in comparison to the control group,we observed amelioration of hyperdynamic circulation[a decrease in cardiac output(P=0.026)and an increase in systemic vascular resistance(P=0.026)]and systemic inflammation[a decrease in serum C-reactive protein levels(P=0.044)],with improved liver function[an increase in serum albumin(P=0.001)and a decrease in the value of Child-Pugh score(P=0.001)]as well as a reduction in the severity of ascites(P=0.022),hepatic encephalopathy(P=0.048),and cholestasis[a decrease in serum alkaline phosphatase(P=0.016)and serum gamma-glutamyl transpeptidase(P=0.039)activity]and an increase in platelet counts(P<0.001)and serum sodium level(P=0.048).CONCLUSION Probiotic administration was associated with amelioration of hyperdynamic circulation and the associated complications of cirrhosis.

Gut dysbiosis and body composition in cirrhosis

BACKGROUND Gut dysbiosis and changes in body composition(i.e.,a decrease in the proportion of muscle mass and an increase in extracellular fluid)are common in cirrhosis.AIM To study the relationship between the gut microbiota and body composition in cirrhosis.METHODS This observational study included 46 patients with cirrhosis.Stool microbiome was assessed using 16S rRNA gene sequencing.Multifrequency bioelectrical impedance analysis was performed to assess body composition in these patients.RESULTS An increase in fat mass and a decrease in body cell mass were noted in 23/46(50.0%)and 15/46(32.6%)patients,respectively.Changes in the gut microbiome were not independently associated with the fat mass percentage in cirrhosis.The abundance of Bacteroidaceae(P=0.041)and Eggerthella(P=0.001)increased,whereas that of Erysipelatoclostridiaceae(P=0.006),Catenibacterium(P=0.021),Coprococcus(P=0.033),Desulfovibrio(P=0.043),Intestinimonas(P=0.028),and Senegalimassilia(P=0.015)decreased in the gut microbiome of patients with body cell mass deficiency.The amount of extracellular fluid increased in 22/46(47.6%)patients.Proteobacteria abundance(P<0.001)increased,whereas Firmicutes(P=0.023),Actinobacteria(P=0.026),Bacilli(P=0.008),Anaerovoraceceae(P=0.027),Christensenellaceae(P=0.038),Eggerthellaceae(P=0.047),Erysipelatoclostridiaceae(P=0.015),Erysipelotrichaceae(P=0.003),Oscillospiraceae(P=0.024),Rikenellaceae(P=0.002),Collinsella(P=0.030),Hungatella(P=0.040),Peptococcaceae(P=0.023),Slackia(P=0.008),and Senegalimassilia(P=0.024)abundance decreased in these patients.Patients with clinically significant ascites(n=9)had a higher abundance of Proteobacteria(P=0.031)and a lower abundance of Actinobacteria(P=0.019)and Bacteroidetes(P=0.046)than patients without clinically significant ascites(n=37).CONCLUSION Changes in the amount of body cell mass and extracellular fluid are associated with changes in the gut microbiome in cirrhosis patients.

Immune disorders and rheumatologic manifestations of viral hepatitis

Infection with hepatotropic viruses is not limited to the liver and can lead to the development of various immunological disorders(the formation of cryoglobulins,rheumatoid factor,antinuclear antibodies,autoantibodies specific for autoimmune hepatitis and primary biliary cholangitis,and others),which can manifest as glomerulonephritis,arthritis,uveitis,vasculitis(cryoglobulinemic vasculitis,polyarteritis nodosa,Henoch-Schonlein purpura,isolated cutaneous necrotizing vasculitis),and other rheumatologic disorders,and be a trigger for the subsequent development of autoimmune hepatitis and primary biliary cholangitis.A further study of the association between autoimmune liver diseases and hepatotropic virus infection would be useful to assess the results of treatment of these associated diseases with antiviral drugs.The relationship of these immune disorders and their manifestations with hepatotropic viruses is best studied for chronic hepatitis B and C.Only isolated cases of these associations are described for hepatitis A.These links are least studied,and are often controversial for hepatitis E,possibly due to their relatively rare diagnoses.Patients with uveitis,glomerulonephritis,arthritis,vasculitis,autoimmune liver diseases should be tested for biomarkers of viral hepatitis,and if present,these patients should be treated with antiviral drugs.

Gut dysbiosis is associated with poorer long-term prognosis in cirrhosis

BACKGROUND Gut dysbiosis is common in cirrhosis.AIM To study the influence of gut dysbiosis on prognosis in cirrhosis.METHODS The case-control study included 48 in-patients with cirrhosis and 21 healthy controls.Stool microbiome was assessed using 16S ribosomal ribonucleic acid gene sequencing.We used modified dysbiosis ratio(MDR):[Bacilli(%)+Proteobacteria(%)]/[Clostridia(%)+Bacteroidetes(%)].Patients with MDR more the median made up the group with severe dysbiosis,others did the group with nonsevere dysbiosis.The follow-up period was 4 years.RESULTS The mortality rate of patients with severe dysbiosis was significantly higher than that of patients with non-severe dysbiosis(54.2%vs 12.5%;P=0.001).The presence of severe dysbiosis was independent risk factors for death[hazard ratio=8.6×(1.9-38.0);P=0.005].The abundance of Enterobacteriaceae(P=0.002),Proteobacteria(P=0.002),and Lactobacillaceae(P=0.025)was increased and the abundance of Firmicutes(P=0.025)and Clostridia(P=0.045)was decreased in the deceased patients compared with the survivors.The deceased patients had a higher MDR value than the survivors[0.131×(0.069-0.234)vs 0.034×(0.009-0.096);P=0.004].If we applied an MDR value of 0.14 as the cutoff point,then it predicted patient death within the next year with a sensitivity of 71.4%and a specificity of 82.9%[area under the curve=0.767×(0.559-0.974)].MDR was higher in patients with cirrhosis than in health controls[0.064×(0.017-0.131)vs 0.005×(0.002-0.007);P<0.001],and in patients with decompensated cirrhosis than in patients with compensated cirrhosis[0.106×(0.023-0.211)vs 0.033×(0.012-0.074);P=0.031].MDR correlated negatively with prothrombin(r=-0.295;P=0.042),cholinesterase(r=-0.466;P=0.014)and serum albumin(r=-0.449;P=0.001)level and positively with Child–Turcotte–Pugh scale value(r=0.360;P=0.012).CONCLUSION Gut dysbiosis is associated with a poorer long-term prognosis in cirrhosis.

Efficacy and safety of COVID-19 vaccination in patients with cirrhosis

BACKGROUND The clinical efficacy and safety of vaccination against novel coronavirus disease 2019(COVID-19)in patients with cirrhosis have not been evaluated yet.AIM To evaluate the clinical efficacy and safety of vaccination against COVID-19 in patients with cirrhosis.METHODS This was a retrospective cohort study of patients with cirrhosis.The first cohort included patients vaccinated with Gam-COVID-Vac(Sputnik V);the second one consisted of unvaccinated controls.RESULTS The study included 89 vaccinated patients and 148 unvaccinated ones.There were 4 cases of COVID-19 in the vaccinated group and 24 cases in the unvaccinated group(P=0.035).No severe cases of COVID-19 were revealed in the vaccinated group,while there were 12 ones in the unvaccinated group(P=0.012)with 10 deaths detected(P=0.012).The vaccine efficacy was 69.5%(95%confidence interval[CI]:18.5%-94.4%)against symptomatic cases of COVID-19,100%(95%CI:25.1%-100.0%)against severe cases,and 100%(95%CI:1.6%-100.0%)against death associated with COVID-19.The efficacy of full vaccination with revaccination against symptomatic cases of COVID-19 was 88.3%(95%CI:48.0%-99.6%).The overall mortality rate was higher in the unvaccinated group than in the vaccinated group(17.1%vs 3.0%;P=0.001).Higher Child-Turcotte-Pugh class cirrhosis(hazard ratio[HR]=4.13,95%CI:1.82-9.35)and higher age(HR=1.08,95%CI:1.04-1.15)were independent predictors of overall mortality,while vaccination had a protective effect(HR=0.09,95%CI:0.01-0.76).There was no significant difference in liver-related mortality(P=0.135)or the incidence of liver decompensation(P=0.077),bleeding esophageal varices(P=0.397),and vascular events(P=0.651)between the two groups of patients.CONCLUSION Vaccination against COVID-19 in patients with cirrhosis is effective and safe.

Lung microbiome in healthy and diseased individuals

The data on quantitative and qualitative microbial composition of the respiratory tract of healthy individuals revealed significant differences when compared with the microbiota of patients suffering from respiratory diseases. Possible etiological role of microbiota in pulmonary diseases as well as drug resistance development is of profound interest nowadays. Numerous studies have provided evidence confirming the relationship between gut microbiome and those of lungs. This relationship could explain how changes in the microbial communities in one organ may lead to pathological changes in the other. Till date, some progress has been made in the study of the biological properties of probiotic bacteria, considering their modulating effect on inflammatory immune response. The use of probiotics which exhibits an immunomodulatory potential looks promising.