Applied nutritional investigationEffect of the ingestion of a dietary product containing Lactobacillus johnsonii La1 on Helicobacter pylori colonization in children☆
Introduction
Probiotics are microorganisms Generally Recognized As Safe (GRAS) present in foods that survive during their transit along the digestive tract and exert health-promoting effects beneficial for the host.1, 2 One of their better described effects is the reinforcement of the gastrointestinal barrier function against pathogens and toxic substances present in the lumen.3 Several factors contribute to this protective effect: the release of antibiotic substances such as bacteriocins or H2O2, the competition with pathogens for nutrients and ecologic sites, and the stimulation of the immune system.4, 5 Studies concerning intestinal cell lines and animal models have shown that probiotics such as Lactobacillus johnsonii La1 (La1) or Lactobacillus GG exert bacteriostatic or bactericidal activities against a wide range of pathogens, including Helicobacter pylori.6, 7, 8, 9
Helicobacter pylori is a gram-negative bacteria that specifically colonizes the gastric mucosa, inducing a chronic and, in most people, asymptomatic gastritis.10 It is currently recognized as an etiologic agent of gastroduodenal ulcer and a risk factor for the development of gastric lymphoma or adenocarcinoma.11, 12 Epidemiologic observations have shown that H. pylori colonization occurs earlier, more intensely, and more frequently in individuals from developing countries who live in conditions of inadequate sanitation than in individuals from industrialized countries.13 In Chile, a 10-y epidemiologic survey indicated that approximately 35% of children 4 y of age and 60% of adolescents from the low socioeconomic stratum are colonized by H. pylori.14 Treatment with antibiotics of asymptomatic children colonized by H. pylori is currently not recommended13, 15; further, in our experience, symptomatic children living in poor sanitation areas frequently relapse when treated. Other problems related to the treatment with antibiotics are its high cost for families from low socioeconomic strata and the appearance of resistance16 not only in H. pylori but also in other species and in other loci. For these reasons, it is necessary to develop low-cost alternative solutions applicable at a large scale in at-risk populations to prevent or decrease H. pylori colonization. In this sense, the use of dietary components capable of interfering with H. pylori, including vegetables17, 18 and probiotic microorganisms,19 appears attractive. Indeed, in addition to their in vitro anti–H. pylori activities described previously, some specific strains of exogenous lactobacilli tolerant to acidic pH may transiently reside in the stomach and even adhere to the gastric mucosa,20, 21 possibly interfering with H. pylori colonization. The anti–H. pylori activity of La18 has been confirmed in colonized adult volunteers after drinking a whey-based, concentrated spent-culture supernatant of La1.22
On the basis of these findings, the principal objective of the present study was to test the capacity of two probiotic strains, Lactobacillus johnsonii La1 and L. paracasei ST11, to interfere with H. pylori colonization in a population of children from low socioeconomic strata. To determine whether the eventual antagonistic effect of the probiotic strains against H. pylori was related to the presence of the living strain or to the presence of a bacterial metabolite, products containing live bacteria were compared with the same products containing heat-killed bacteria.
Section snippets
Subjects
The protocol was approved by Ethics Committee of the Institute of Nutrition and Food Technology in Santiago. The study was done in school children from a low socioeconomic district in Santiago. Asymptomatic children without previously diagnosed gastrointestinal pathologies or a history of antibiotic, antacid, or prokinetic drug treatment were recruited. Parents received detailed information about the aims and methodologies of the study, and a written consent form was signed by those who
Results
Detection of children colonized by H. pylori was carried out by 13C-UBT at the beginning of the study; 326 children were screened and H. pylori was detected in 252 of them (77.3%), with DOB1 values of 56.3 ± 27.7‰. No differences in colonization rates were observed between males and females (78.5% and 76.2%, respectively; χ2 = 0.24). When evaluated by age group (Fig. 1), the colonization rate increased significantly from 51.9% in the 6-y-old children to approximately 90% in children older than
Discussion
During recent decades, the incidence of intestinal infections has decreased drastically in Chile as a result of a combination of rapid economic growth and improved sanitation and nutrition.23 Because the route of transmission of H. pylori is likely to be similar to other enteric pathogens,24 we believed that H. pylori infection also was decreasing in the Chilean population and that a prevalence lower than that described 10 y ago by Hopkins et al. was going to be observed.14 These investigators
Acknowledgements
The authors thank M. Figueroa for help in measureing 13C-UBT in children, A. Anziani for breath sample processing, and Dr. O. Brunser for helpful discussions and for revising the manuscript.
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This study was supported by Nestlé-Chile SA.