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Introduction

Diarrhoea is a common condition caused by bacterial, viral, protozoal infection and certain medications.^1,2 Management of diarrhoea involves maintenance of hydration by oral or intravenous fluids, antidiarrheal drugs, probiotics etc.^3,4Saccharomyces boulardii (S. boulardii) CNCM I-745 is a probiotic which has been found to be effective in controlling pathogenic as well as antibiotic associated diarrhoea.^5,6,7 The efficacy of S boulardii CNCM I-745 was evaluated and confirmed through multiple RCTs across the globe.⁸ Though there are few real world studies from Western countries which have evaluated the effectiveness of S. boulardii CNCM I-745 in reducing duration as well as frequency of diarrhoea, such studies are scarce in the Indian population.

Aims & Methods

Aims: Primary objective was to evaluate the effectiveness of Saccharomyces boulardii (S. boulardii) CNCM I-745 in adult patients with diarrhoea. Secondary objective was to compare the effectiveness of S. boulardii CNCM I-745 and treatment modalities other than probiotics in adult patients with diarrhoea and also in subset of patients who were using concomitant antibiotics.
Methods: This is a retrospective, multicenter, comparative study analyzing electronic medical records (EMR) of 1727 adult patients with diarrhoea in India.
From the EMR database, the total number of adult patients diagnosed with diarrhoea at baseline and administered S. boulardii CNCM I-745 (test group) was 270. A control group was formed of 1457 patients who were administered any anti-diarrhoeal and /or oral rehydration therapy for managing diarrhoea excluding probiotics. Patients were enrolled at baseline with complaints of diarrhoea or loose motions with one follow up visit within 15 days. A total of 112 patients with diarrhoea at baseline in test group, and 392 patients with diarrhoea in control group, were noted to have been administered concomitant antibiotics.

Results

For the test group, the mean age was noted to be 48.54 + 16 years and for control group it was 45.84 + 16.08 years. There was female preponderance in both the control and test group (56.7% Vs 51.5%).
At follow-up, 22.2% patients in test group complained of diarrhoea Vs 84.2% in control group. Thus proportion of patients with continued diarrhoea at follow-up was significantly lower in the S Boulardii group versus the control group (p<0.05). The odds ratio for noting absence of diarrhea in test group versus control group was 18.7, with 95% confidence interval of 13.6 to 25.7.
Amongst the subset of patients who received concomitant antibiotics, 23.2% patients in test group complained of diarrhoea Vs 81.6% in control group, at follow up visit. The proportion of patients receiving concomitant antibiotics with continued diarrhoea at follow-up was significantly lower in the test group versus the control group (p<0.05). The odds ratio for noting absence of diarrhea in test group versus control group receiving concomitant antibiotics was 14.7, with 95% confidence interval of 8.8 to 24.4.

Conclusion

The effect of S. boulardii CNCM I-745 probiotic in controlling diarrhoea in Indian patients was better than anti-diarrhoeal and/or oral rehydration therapy in real-world setting, irrespective of concomitant antibiotic usage.

References

Philip NA, Ahmed N, Pitchumoni, CS. Spectrum of Drug-induced Chronic Diarrhea. Journal of Clinical Gastroenterology 2017;51(2):111–17.
Nilima, Kamath A, Shetty K, Unnikrishnan B, Kaushik S. Prevalence, patterns, and predictors of diarrhoea: a spatial-temporal comprehensive evaluation in India. BMC Public Health. 2018;18(1):1288.
Farthing M, Salam MA, Lindberg G et al. Acute diarrhoea in adults and children: a global perspective. J Clin Gastroenterol 2013;47:12–20.
Ragavan PSK, Kaur A, Kumar M, et al. Retrospective analysis of EMR database to assess the effectiveness of Saccharomyces boulardii CNCM I-745 in children with acute diarrhoea during routine clinical practice. New Microbes New Infect. 2020;38:100766.
Czerucka D, Piche T, Rampal P. Review article: Yeast as probiotics -- Saccharomyces boulardii. Aliment Pharmacol Ther. 2007;26:767–78.
Neut C, Mathieux S, Dubreuil LJ. Antibiotic susceptibility of probiotics strains: Is it reasonable to combine probiotics with antibiotics? Méd Malad infect. 2017;47:477–83.
Jones TF, McMillian MB, Scallan E, et al. A population-based estimate of the substantial burden of diarrhoeal disease in the United States; FoodNet, 1996–2003. Epidemiol Infect. 2007;135:293–301
McFarland LV, Karakan T, Karatas A. Strain-specific and outcome-specific efficacy of probiotics for the treatment of irritable bowel syndrome: A systematic review and meta-analysis. EClinicalMedicine. 2021 Nov 1;41:101154.

Disclosure

EFFECTIVENESS OF SACCHAROMYCES BOULARDII CNCM I-745 IN ADULT PATIENTS WITH DIARRHOEA – A RETROSPECTIVE, MULTICENTER, COMPARATIVE STUDY FROM INDIA

Rupali Bandagi 1, Kranthi Pebbili 2

1 Dr Reddys Laboratories Private Limited, Bangalore, India

2 Dr Reddys Laboratories Private Limited, Hyderabad, India

Conference

UEG Week Copenhagen 2023

Topics

Colorectal

Submission format

Abstract

Session

PP 06 Other lower GI disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Mistakes In Articles

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Malnutrition frequently occurs in patients who have chronic liver disease and worsens their prognosis. There are multiple causes of malnutrition in the context of cirrhosis: low dietary intake, malabsorption, metabolic alterations and modification of substrate utilisation. Sarcopenia, which is defined by loss of muscle mass and function, is a major component of malnutrition in patients with cirrhosis. Sarcopenia adversely affects the number and severity of complications, quality of life, the outcome of liver transplantation and the overall survival rate of patients with advanced liver disease. Physicians should be aware of the clinical and prognostic relevance of nutritional status, how to promptly recognise malnutrition and sarcopenia in patients with liver cirrhosis and how to appropriately manage these conditions. Here we discuss some mistakes that are frequently made regarding nutrition in chronic liver disease, and we provide evidence and experience-based approaches to avoid them.

Mistakes in nutrition in chronic liver disease and how to avoid them

Manuela Merli

Topics

Hepatobiliary Small Intestine & Nutrition

Citation

Merli M and Lapenna L. Mistakes in nutrition in chronic liver disease and how to avoid them. UEG Education 2021; 21: 23–25

Published

2021

UEG Standards and Guidelines

Consensus

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Abstract

There is a need for consensus on the recommendations for follow-up of children and adolescents with celiac disease.

Objectives

To gather the current evidence and to offer recommendations for follow-up and management.

Methods

The Special Interest Group on Celiac Diseases of the European Society of Paediatric Gastroenterology Hepatology and Nutrition formulated ten questions considered to be essential for follow-up care. A literature search (January 2010–March 2020) was performed in PubMed or Medline. Relevant publications were identified and potentially eligible studies were assessed. Statements and recommendations were developed and discussed by all coauthors. Recommendations were voted upon: joint agreement was set as at least 85%.

Results

Publications (n = 2775) were identified and 164 were included. Using evidence or expert opinion, 37 recommendations were formulated on: The need to perform follow-up, its frequency and what should be assessed, how to assess adherence to the gluten-free diet, when to expect catch-up growth, how to treat anemia, how to approach persistent high serum levels of antibodies against tissue-transglutaminase, the indication to perform biopsies, assessment of quality of life, management of children with unclear diagnosis for which a gluten-challenge is indicated, children with associated type 1 diabetes or IgA deficiency, cases of potential celiac disease, which professionals should perform follow-up, how to improve the communication to patients and their parents/caregivers and transition from pediatric to adult health care.

Conclusions

We offer recommendations to improve follow-up of children and adolescents with celiac disease and highlight gaps that should be investigated to further improve management.

ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease

M. Luisa Mearin

Publisher

European Society for Paediatric Gastroenterology, Hepatology and Nutrition

Guideline

Consensus

Topics

Paediatrics

Citation

Journal of Pediatric Gastroenterology and Nutrition, 75: 369-386

Published

2022

UEG Standards and Guidelines

Position Paper

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Abstract

The purpose of the present document is to provide detailed information on the correct and optimal use of digital media to ensure continuity of care for gastroenterological patients in everyday clinical practice, in health emergencies and/or when the patient cannot reach the hospital for other reasons.

During the recent COVID-19 pandemic, telemedicine has allowed many patients with chronic diseases to access remote care worldwide, proving to be the ideal solution to overcome restrictions and carry out non-urgent routine follow-ups on chronic patients. The COVID-19 pandemic has therefore made organizational and cultural renewal essential for the reorganization of healthcare in order to ensure greater continuity of care with a minimum risk of spreading the virus to users, practitioners and their families.

These AIGO recommendations are intended to provide Italian gastroenterologists with a tool to use this method appropriately, in compliance with current legislation, in particular the proper approach and procedures for conducting a remote examination using a video conferencing tool, the so-called televisit.

In the near future, telemedicine may contribute to a possible reorganization of healthcare systems, through innovative care models focusing on the citizen and facilitating access to services throughout the entire Country.

Keywords: Telemedicine; Telehealth; Inflammatory bowel diseases; Celiac disease; Hepatology; Endoscopy

Correct use of telemedicine in gastroenterology, hepatology, and endoscopy during and after the COVID-19 pandemic: Recommendations from the Italian association of hospital gastroenterologists and endoscopists (AIGO)

Andrea Costantino

Guideline

Position Paper

Topics

Endoscopy Hepatobiliary IBD Primary Care Small Intestine & Nutrition Stomach & H. Pylori

Citation

Digestive and Liver Disease VOLUME 53, ISSUE 10, P1221-1227

Published

2021

UEG Standards and Guidelines

Position Paper

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Abstract

Background

It is important to identify patients with monogenic IBD as management may differ from classical IBD. In this position statement we formulate recommendations for the use of genomics in evaluating potential monogenic causes of IBD across age groups.

Methods

The consensus included paediatric IBD specialists from the Paediatric IBD Porto group of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and specialists from several monogenic IBD research consortia. We defined key topics and performed a systematic literature review to cover indications, technologies (targeted panel, exome and genome sequencing), gene panel setup, cost-effectiveness of genetic screening, and requirements for the clinical care setting. We developed recommendations that were voted upon by all authors and Porto group members (32 voting specialists).

Results

We recommend next-generation DNA-sequencing technologies to diagnose monogenic causes of IBD in routine clinical practice embedded in a setting of multidisciplinary patient care. Routine genetic screening is not recommended for all IBD patients. Genetic testing should be considered depending on age of IBD-onset (infantile IBD, very early-onset IBD, paediatric or young adult IBD), and further criteria, such as family history, relevant comorbidities, and extraintestinal manifestations. Genetic testing is also recommended in advance of hematopoietic stem cell transplantation. We developed a diagnostic algorithm that includes a gene panel of 75 monogenic IBD genes. Considerations are provided also for low resource countries.

Conclusions

Genomic technologies should be considered an integral part of patient care to investigate patients at risk for monogenic forms of IBD.

Clinical Genomics for the Diagnosis of Monogenic Forms of Inflammatory Bowel Disease

Holm Uhlig

Publisher

European Society for Paediatric Gastroenterology, Hepatology and Nutrition

Guideline

Position Paper

Topics

IBD Paediatrics

Citation

Journal of Pediatric Gastroenterology and Nutrition, 72: 456-473

Published

2020

UEG Standards and Guidelines

Consensus

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ABSTRACT

Malabsorption is a complex and multifaceted condition characterised by the defective passage of nutrients into the blood and lymphatic streams. Several congenital or acquired disorders may cause either selective or global malabsorption in both children and adults, such as cystic fibrosis, exocrine pancreatic insufficiency (EPI), coeliac disease (CD) and other enteropathies, lactase deficiency, small intestinal bacterial overgrowth (SIBO), autoimmune atrophic gastritis, Crohn's disease, and gastric or small bowel resections. Early recognition of malabsorption is key for tailoring a proper diagnostic work-up for identifying the cause of malabsorption. A patient's medical and pharmacological history is essential for identifying risk factors. Several examinations such as endoscopy with small intestinal biopsies, non-invasive functional tests and radiological imaging are useful in diagnosing malabsorption. Because of its high prevalence, CD should always be looked for in cases of malabsorption with no other obvious explanations and in high-risk individuals. Nutritional support is key in the management of patients with malabsorption; different options are available, including oral supplements, enteral or parenteral nutrition. In patients with short bowel syndrome, teduglutide proved effective in reducing the need for parenteral nutrition, thus improving the quality of life of these patients. Primary care physicians play a central role in the early detection of malabsorption and should be involved in multidisciplinary teams for improving the overall management of these patients. In this European consensus, involving ten scientific societies and several experts, we have dissected all the issues around malabsorption, including the definitions and diagnostic testing (Part 1), high-risk categories and special populations, nutritional assessment and management, and primary care perspective (Part 2).

European Consensus on Malabsorption—UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN. Part 1: Definitions, Clinical Phenotypes, and Diagnostic Testing for Malabsorption

Marco Vincenzo Lenti

Publishers

European Society for Paediatric Gastroenterology, Hepatology and Nutrition, The European Society for Clinical Nutrition and Metabolism, European Association for Gastroenterology, Endoscopy and Nutrition, European Society for Primary Care Gastroenterology, Società Italiana di Gastroenterologia ed Endoscopia Digestiva

Guideline

Consensus

Topics

Endoscopy Pancreas Primary Care Small Intestine & Nutrition

Citation

United European Gastroenterol J, 13: 599-613

Published

2025

UEG Mistakes In Articles

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The relationship between nutrition and inflammatory bowel disease (IBD) has been an area of substantial interest and research for many decades now. Evidence-based nutritional strategies are being utilised as a key part of the therapeutic armamentarium in Crohn’s disease for both induction and maintenance, as primary and adjuvant treatment methods. Exclusive enteral nutrition, for instance, is well established in the treatment of paediatric IBD and adult centres are increasingly incorporating it into treatment models as an effective, drug-free alternative. The role for partial enteral nutrition and Crohn’s disease specific diets are also being more clearly elucidated. Used appropriately, and through engagement with dietetic support services, nutritional therapies can not only achieve the IBD treatment ‘targets’ but serve to optimise other vital aspects of care, such as growth, bone health, body composition and overall patient well-being. Here we discuss some of the mistakes that are frequently made in the area of nutritional management of IBD. The discussion is evidence based, with key references incorporated for further analysis beyond the scope of this article, and combines several decades of leading clinical and research experience in the area of nutrition and IBD from the authors.

Mistakes in nutrition in IBD and how to avoid them

Richard K Russell, Konstantinos Gerasimidis

Topics

Small Intestine & Nutrition

Citation

Meredith J, Russell RK and Gerasimidis K. Mistakes in nutrition in IBD and how to avoid them. UEG Education 2020; 20: 25–30.

Published

2020

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