Gut microbiota, probiotics

and immunity contribute for

our digestive health
Ari Fahrial Syam
Division of Gastroenterology,
Department of Internal Medicine,
Faculty of Medicine, University of Indonesia-Cipto
Mangunkusumo Hospital

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Gastrointestinal Tract

Gaster
Liver

Colon

Small
intestine

Anus 5
 Gut microbiota
• 1014 microorganisms, weighing
over 1 kg, are colonized in the
gastrointestinal tract
(mostly in the large intestine).

Harmful effects and pathogens Health promoting factors

• About 1000 different

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Ps.aeruginosa

Proteus

species live in the Pathogens

(toxins)
Staphylococci
Clostridium 4

gut (99% of the

Colonization
Veillonellae resistance
Enterococci
Immune

bacteria come from

E.coli modulatory
Production of
carcinogens 8 Lactobacilli functions

Streptococci

30~40 species).
Absorption and
Intestinal Eubacteria digestive
putrefaction functions
Bifidobacteria
Bacteroides
Synthesis of
vitamins
Roberfroid et al, 1995 11 (log bacteria/g feces)
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 Human adult intestine
The gut is the largest and most
Length --- 7 m unique immune system organ

villi
Surface area
Lumen
--- 300m2, equal to the
area of a tennis court
Cross-section view Intestinal villi

Sixty % of total immune cells and antibodies

exist in intestine.
Unique dendritic cells, T cells, B cells and
antibodies (IgA) are found there.
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The World Health Organization,2001

Live microorganisms administered in

adequate amounts which confer a
beneficial health effect on the host

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Characterization of Probiotic

No pathogenicity islands
No transmissible drug resistance sites
Survives transit through the GI tract
Acid and bile resistant
Antibiotic sensitivity defined

Quigley EMM, DDW 2017

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 Characterization of EPS

Altmann et al.,
Plos One
2016;10:1371

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Exopolysaccharide (EPS) will influence the host immune response
Mode of Actions of Probiotic?

Compete with and exclude Pathogen

Anti-bacterial effects:
Produce bacteriocins
Denature toxins
Enhance gut barrier function
Modulate motility and sensation

Quigley EMM, DDW 2017

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Mode of Actions of Probiotic?

Enhance host immunity

Immune modulation
Cytokine modulation
IgA production
Metabolic functions
Caloric salvage
Produce valuable metabolites
Drug metabolism

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Quigley EMM, DDW 2017
A live microbial food ingredient which is beneficial
to health

A mixture of probiotics and prebiotics which

beneficially affects the host by improving the
survival and implantation of live microbial dietary
supplements in the gastrointestinal tract, and thus
improving host health and wellbeing

A non-digestible food ingredient which beneficially

affects the host by selectively stimulating the
growth and/or activity of one or a limited number
of bacteria in the colon having the potential to
improve host health
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Pobiotik dan flora normal berinteraksi dalam aktifitas metabolisme
untuk memproduksi berbagai zat termasuk untuk meningkatkan 16

imunitas
Probiotic criteria
1. It should be isolated from the same species as
its intended host
2. It should have a demonstrable beneficial effect
on the host
3. It should be non-pathogenic
4. It should be able to survive transit through the
gastrointestinal tract
5. On storage, large number of viable bacteria
must be able to survive prolonged periods.
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THE AVAILABILITY OF PROBIOTICS

PROBIOTICS AVAILABLE IN THE FORM OF:

DRUGS.
FOOD SUPPLEMENTS
FUNCTIONAL FOOD
PRODUCTS

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 Antibiotic Associated Diarrhea
Gastroenteritis
Lactose Intolerance
To prevent overgrowth bacteri
Traveler's diarrhea
Inflammatory Bowel Disease (IBD)
Irritable bowel syndrome (IBS)

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IBS-C management:

• Treating abdominal pain and cofactors…

• Antidepressant agents
• Psychological therapies
• Antispasmodic agents
• … treating constipation
• Dietary fiber, bulking agents, laxatives
• Probiotics
• 5HT4 receptor agonists
• Secretagogues
Treating constipation: probiotics

Probiotics Carbohydrate fermentation

Bile salt metabolism
Mucus degradation
Production of colonic gas
Gut Microbiota Stool consistency
modulation Mucus secretion increase
Anti-inflammatory effects

Modulation of symptoms
Eamonn et al Gastroenterol Clin N Am 2012
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 Colonoscopy findings from Constipation patients

Haemorrhoid
36.39
Non-specific
Infection
Normal

Adenoma

Other
% 15.42
Carcinoma
12.05
9.888.92 IBD
7.95
Diverticular Disease
4.82
3.61
Radiation Colitis
0.480.48
TB colitis

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Murdani, et al, 2006
Some studies show that probiotic use was
associated with improvement in global IBS
symptoms compared to placebo
contradictory results
Until now no curative treatments are
available, therapy for IBS is palliative and
supportive, targeting specific symptoms,
but is notoriously unsatisfactory.

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 Patients and methods

A retrospective study was conducted in 20 adult patients

(12F, 8M; mean age 36.2+/- 13.7) with functional
constipation who performed a H2/CH4 lactulose breath test
(LBT) at the Gastroenterology Unit of Catholic University,
Policlinico Gemelli, Rome, with methane production

(>5 ppm) and without small intestinal bacterial overgrowth

(SIBO).

Ojetti et al, 2017

Mean H2 and CH4 production during LBT at enrolment and
4 weeks after the administration of L reuteri twice a day

* p< 0.0001
The significantly decrease of CH4 AUC at enrolment and 4 weeks
after the administration of L reuteri twice a day
 Conclusion
Crosstalk of microbiota, probiotics with gut immune system
① Crosstalks down-regulate inflammatoric reaction such as allergy.
② On the other hand, crosstalks develop immune response (IgA
production, etc).
③ Crosstalks contribute to maintenance of gut homeostasis and symbiosis.

These events are believed to contribute to the suppression of

hypersensitive immune reactions such as allergy, inflammatory
bowl disease and other diseases and to the prevention of infectious
diseases. Microbiota Gut Systemic
Probiotics immune system immune system
(Lactobacillus,
Bifidobacterium)
Maintain gut
homeostasis
crosstalk
Protect from
infectious disease,
allergy and auto-
immune diseases
and cancer 34
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