Immune response and intestinal permeability in children with acute
gastroenteritis treated with Lactobacillus rhamnosus GG: a randomized,
double-blind, placebo-controlled trial.
Author(s): Sindhu KN(1), Sowmyanarayanan TV, Paul A, Babji S, Ajjampur SS, Priyadarshini S,
Sarkar R, Balasubramanian KA, Wanke CA, Ward HD, Kang G.
Affiliation(s): Author information:
(1)Division of Gastrointestinal Sciences, Christian Medical College, Vellore,
Tamil Nadu, India.
Publication date & source: 2014, Clin Infect Dis. , 58(8):1107-15
BACKGROUND: Probiotics have a possible role in the treatment of pediatric acute
gastroenteritis. We report the effect of the probiotic Lactobacillus rhamnosus GG
(LGG) on intestinal function, immune response, and clinical outcomes in Indian
children with cryptosporidial or rotavirus diarrhea.
METHODS: Children with gastroenteritis aged 6 months to 5 years, testing positive
for either rotavirus or Cryptosporidium species in stool (coinfections were
excluded), were randomized to LGG (ATCC 53103) or placebo, once daily for 4
weeks. Baseline demographic and clinical details were obtained. Sera were tested
for immunoglobulin G (IgG) and immunoglobulin A (IgA) antibodies to
Cryptosporidium and rotavirus, and the lactulose to mannitol ratio for intestinal
permeability was determined at baseline and at the end of follow-up.
RESULTS: Of the 124 children enrolled, 82 and 42 had rotavirus and
cryptosporidial diarrhea, respectively. Median diarrheal duration was 4 days;
one-third of the children had severe diarrhea. Baseline and clinical parameters
were comparable between children receiving LGG and placebo. At the end of
follow-up, fewer children with rotavirus diarrhea on LGG had repeated diarrheal
episodes (25% vs 46%; P = .048) and impaired intestinal function (48% vs 72%; P =
.027). Significant increase in IgG levels postintervention (456 vs 2215 EU; P =
.003) was observed in children with rotavirus diarrhea receiving LGG. Among
children with cryptosporidial diarrhea, those receiving LGG showed significant
improvement in intestinal permeability.
CONCLUSIONS: LGG has a positive immunomodulatory effect and may be useful in
decreasing repeated episodes of rotavirus diarrhea. Improvement in intestinal
function in children with rotavirus and cryptosporidial gastroenteritis
emphasizes the role of probiotics in treating intestinal impairment after
infection.
CLINICAL TRIALS REGISTRATION: CTRI/2010/091/000339.
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