Chemistry Reference
In-Depth Information
of hydrogen in the colon, producing diarrhea, abdominal cramps, and bloating. A
sucrose-free diet causes disappearance of symptoms.
8
Harms et al.
58
administered
Saccharomyces
cerevisiae
along with sucrose to treat eight children with sucrase
isomaltase deficiency. An improvement in their hydrogen breath test as well as gas-
trointestinal symptoms was observed. The investigators postulated that S.
cerevisiae
was supplying the missing isomaltase enzymes.
18.3.1.10 Lactase Deficiency
Lactose maldigestion occurs frequently and is due to insufficient activity of
lactase in the human gut and causes various degrees of abdominal discomfort, such
as cramps, bloating, diarrhea, and nausea.
59
Probiotic bacteria such as
L. acidophilus
and bifidobacteria produce β-d-galactosidase (bacterial lactase), which autodigests
lactose and improves tolerance to lactose. It was observed that in the lactase-defi-
cient people, lactose is absorbed much better from yogurt than from milk probably
due to intraluminal digestion of lactose by the lactase released from yogurt micro-
organisms.
60
Bile salts in the GIT cause the lysis of yogurt bacteria resulting in a
rapid release of lactase. Other probiotics like
L. acidophilus
may also be rich in
lactase, but are less efficient, because of their resistance to bile.
61,62
Another explana-
tion for this improved tolerance could be the slowing of the gastrointestinal transit of
yogurt compared with milk, which may facilitate prolonged contact between residual
lactase on enterocyte and lactose in the lumen.
63
Savaiano et al.
60
have demonstrated
that yogurt is superior to cultured buttermilk or pasteurized yogurt in enhancing the
digestion of lactose as pasteurization may destroy the β-galactosidase activity.
64
18.3.1.11 Inflammatory Bowel Disease (IBD)
IBD is a collective term used to describe Crohn's disease (CD), ulcerative colitis
(UC), and nonspecific colitis.
66
These diseases, although each with distinct features,
are characterized by inflammation of the GIT that can lead to pain, diarrhea, and
bleeding.
66
The exact etiology responsible for initiation and perpetuation of these
processes is unknown but it is proposed to be related to disturbance in the endog-
enous intestinal microbial flora and/or a defective mucosal barrier.
67,68
The distal
ileum and the colon are the areas with the highest luminal bacterial concentration
and represent the major sites of inflammation in IBD.
69,70
Probiotics seem to represent an effective and safe approach for the maintenance
treatment of patients with chronic CD, suggesting their potential role in IBD ther-
apy.
69
The different therapeutic modifications of gut flora, which can be useful in
IBD, are discussed in Table 18.2. A double-blind comparison of an oral probiotic
(
Saccharomyces boulardii
) preparation and mesalazine in maintaining remission of
UC showed that the probiotic treatment was as effective as mesalazine in the mainte-
nance therapy.
27,71
A combination of Balsalazide and VSL#3 (a combination of three
species of bifidobacteria, four strains of
Lactobacillus,
and one strain of
Streptococcus
salivarius
spp
. thermophilus
) was found to be a very good choice in the treatment of
active mild-to-moderate active UC versus balsalazide or mesalazine alone.
72
