Advertisement

Digestive Diseases and Sciences

, 52:2082 | Cite as

Lactobacillus plantarum 299v Enhances the Concentrations of Fecal Short-Chain Fatty Acids in Patients with Recurrent Clostridium difficile-Associated Diarrhea

  • Marlene Wullt
  • Marie-Louise Johansson Hagslätt
  • Inga Odenholt
  • Anna Berggren
Article

Abstract

Our objective was to document how intake of Lactobacillus plantarum 299v affects the concentrations of fecal organic acids during and after metronidazole treatment in 19 patients with recurrent Clostridium difficile-associated diarrhea. Fecal samples were analyzed by gas-liquid chromatography. After intake of metronidazole a significant decrease in total short-chain fatty acids was seen in the placebo group (from 77.1 to 45.5 μmol/g; P=0.028) but not in the Lactobacillus group (79.8–60.4 μmol/g). In addition, a statistically significant difference between treatment groups was noted for butyrate (5.6–1.2 μmol/g in the placebo group vs. 7.6–5.6 μmol/g in the Lactobacillus group; P=0.047). At the end of the study and after cessation of placebo or Lactobacillus, the total short-chain fatty acids rose to the same levels as before antibiotic treatment in the placebo group. Both treatment groups showed a significant decrease in concentrations of succinate at the end of the study in comparison to the time when metronidazole intake was stopped (6.3–1.5 μmol/g in the placebo group versus 9.3–0.9 μmol/g in the Lactobacillus group; P=0.028). The present study of fecal samples from a clinical trial is the first to demonstrate that administration of Lactobacillus plantarum 299v reduces the negative effects of an antibiotic on colonic fermentation. The intake of this probiotic strain may thereby provide an additional benefit for patients with recurrent Clostridium difficile-associated diarrhea.

Keywords

Short-chain fatty acids Recurrent Clostridium difficile-associated diarrhea Lactobacillus plantarum 299v, Probiotic bacteria Colonic microflora Treatment 

Notes

Acknowledgements

This study was supported by a grant from the county of Skåne. Probi AB Ltd. (Sweden) provided active preparations of Lactobacillus plantarum 299v and placebo. Anna Berggren is employed at Probi AB. The other authors have no financial interest in the company.

References

  1. 1.
    Fekety R, McFarland LV, Surawicz CM, Greenberg RN, Elmer GW, Mulligan ME (1997) Recurrent Clostridium difficile diarrhea: characteristics of and risk factors for patients enrolled in a prospective, randomized, double-blinded trial. Clin Infect Dis 24:324–333PubMedGoogle Scholar
  2. 2.
    Vollaard EJ, Clasener HA (1994) Colonization resistance. Antimicrob Agents Chemother 38:409–414PubMedGoogle Scholar
  3. 3.
    May T, Mackie RI, Fahey C, Cremin C, Garleb KA (1994) Effect of fiber source on short-chain fatty acid production and the growth and toxin production by Clostridium difficile. Scand J Gastroenterol 29:916–922PubMedGoogle Scholar
  4. 4.
    Hogenauer C, Hammer HF, Krejs GJ, Reisinger EC (1998) Mechanisms and management of antibiotic-associated diarrhea. Clin Infect Dis 27:702–710PubMedGoogle Scholar
  5. 5.
    Hove H, Tvede M, Mortensen PB (1996) Antibiotic-associated diarrhea, Clostridium difficile, and short-chain fatty acids. Scand J Gastroenterol 31:688–693PubMedGoogle Scholar
  6. 6.
    Naaber P, Mikelsaar M (2004) Interactions between lactobacilli and antibiotic-associated diarrhea. Adv Appl Microbiol 54:231–260PubMedCrossRefGoogle Scholar
  7. 7.
    McFarland LV, Surawicz CM, Greenberg RN, Fekety R, Elmer GW, Moyer KA, Melcher SA, Bowen KE, Cox JL, Noorani Z (1994) A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. JAMA 24:1913–1918CrossRefGoogle Scholar
  8. 8.
    Surawicz CM, McFarland LV, Greenberg RN, Rubin M, Fekety R, Mulligan ME, Garcia RJ, Brandmarker S, Bowen K, Borjal D, Elmer GW (2000) The search for a better treatment for recurrent Clostridium difficile diasease: use of high-dose vancomycin combined with Saccharomyces boulardii. Clin Infect Dis 31:1012–1017PubMedCrossRefGoogle Scholar
  9. 9.
    Wullt M, Johansson Hagslätt M-L, Odenholt I (2003) Lactobacillus plantarum 299v for the treatment of recurrent Clostridium difficile-associated diarrhea: a double-blind, placebo-controlled trial. Scand J Infect Dis 35:365–367PubMedCrossRefGoogle Scholar
  10. 10.
    Salminen S, Ouwehand AC, Isolauri E (1998) Clinical applications of probiotic bacteria. Int Dairy J 8:563–572CrossRefGoogle Scholar
  11. 11.
    Sartor RB (2005) Probiotic therapy of intestinal inflammation and infection. Curr Opin Gastroenterol 21:44–50PubMedGoogle Scholar
  12. 12.
    Ahrne S, Nobaek S, Jeppsson B, Adlerberth I, Wold AE, Molin G (1998) The normal Lactobacillus flora of healthy human rectal and oral mucosa. J Appl Microbiol 85:88–94PubMedCrossRefGoogle Scholar
  13. 13.
    Naaber P, Smidt I, Stsepetova, Brilene T, Annuk H, Mikelsaar M (2004) Inhibition of Clostridium difficile strains by intestinal Lactobacillus species. J Med Microbiol 53:551–554PubMedCrossRefGoogle Scholar
  14. 14.
    Johansson ML, Molin G, Jeppsson B, Nobaek S, Ahrne S, Bengmark S (1993) Administration of different Lactobacillus strains in fermented oatmeal soup: in vivo colonization of human intestinal mucosa and effect on the indigenous flora. Appl Environ Microbiol 59:15–20PubMedGoogle Scholar
  15. 15.
    Adlerberth I, Ahrné S, Johansson M-L, Molin G, Hanson LA, Wold AE (1996) A mannose-specific adherence mechanism in Lactobacillus plantarum conferring binding to the human colonic cell line HT-29. Appl Environ Microbiol 62:2244–2251PubMedGoogle Scholar
  16. 16.
    Mortensen FV, Moller JK, Hessov I (1999) Effects of short-chain fatty acids on in vitro bacterial growth of Bacteroides fragilis and Escherichia coli. APMIS 107:240–244PubMedCrossRefGoogle Scholar
  17. 17.
    Rabbani GH, Albert MJ, Hamidur Rahman AS, Chowdhury AK (1999) Short-chain fatty acids improve clinical, pathologic, and microbiologic features of experimental shigellosis. J Infect Dis 179:390–397PubMedCrossRefGoogle Scholar
  18. 18.
    Roediger WE (1980) Role of anaerobic bacteria in the metabolic welfare of the colonic mucosa in man. Gut 21:793–798PubMedGoogle Scholar
  19. 19.
    Scheppach W (1994) Effects of short chain fatty acids on gut morphology and function. Gut 35(Suppl):35S–8SGoogle Scholar
  20. 20.
    Mortensen PB, Clausen MR (1996) Short-chain fatty acids in the human colon: relation to gastrointestinal health and disease. Scand J Gastroenterol 216 (Suppl):132S–48SGoogle Scholar
  21. 21.
    Johansson ML, Nobaek S, Berggren A, Nyman M, Bjorck I, Ahrne S, Jeppsson B, Molin G (1998) Survival of Lactobacillus plantarum DSM 9843 (299v), and effect on the short-chain fatty acid content of feces after ingestion of a rose-hip drink with fermented oats. Int J Food Microbiol 30:29–38CrossRefGoogle Scholar
  22. 22.
    Johansson M-L, Quednau M, Molin G, Ahrne S (1995) Randomly amplified polymorphic DNA (RAPD) for rapid typing of Lactobacillus plantarum strains. Lett Appl Microbiol 21:155–159PubMedGoogle Scholar
  23. 23.
    Richardson AJ, Calder AG, Stewart CS (1989) Simultaneous determination of volatile and non-volatile acidic fermentation products of anaerobes by capillary gas-chromatography. Lett Appl Microbiol 9:5–8Google Scholar
  24. 24.
    Berggren A (1996) Formation, pattern and physiological effects of short-chain fatty acids. Doctoral thesis. Lund Institute of Technology, Lund University, Lund, SwedenGoogle Scholar
  25. 25.
    Meijer-Severs GJ, Van Santen E, Meijer BC (1990) Short-chain fatty acid and organic acid concentrations in feces of healthy human volunteers and their correlations with anaerobe cultural counts during systemic ceftriaxone administration. Scand J Gastroenterol 25:698–704PubMedGoogle Scholar
  26. 26.
    Mellon AF, Deshpande SA, Mathers JC, Bartlett K (2000) Effect of oral antibiotics on intestinal production of propionic acid. Arch Dis Child 82:169–172PubMedCrossRefGoogle Scholar
  27. 27.
    Bender A, Breves G, Stein J, Leonhard-Marek S, Schroder B, Winckler C (2001) Colonic fermentation as affected by antibiotics and acidic PH: Application of an in vitro model. Z Gastroenterol 39:911–918PubMedCrossRefGoogle Scholar
  28. 28.
    Breuer RI, Buto SK, Christ ML, Bean J, Vernia P, Paoluzi P, Di Paolo MC, Caprilli R (1991) Rectal irrigation with short-chain fatty acids for distal ulcerative colitis. Preliminary report. Dig Dis Sci 36:185–187PubMedCrossRefGoogle Scholar
  29. 29.
    Macfarlane S, Macfarlane GT (2003) Regulation of short-chain fatty acid production. Proc Nutr Soc 62:67–72PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Marlene Wullt
    • 1
  • Marie-Louise Johansson Hagslätt
    • 2
  • Inga Odenholt
    • 1
  • Anna Berggren
    • 3
  1. 1.Infectious Diseases Research Unit, Department of Clinical Sciences, Lund UniversityMalmöSweden
  2. 2.Laboratory of Food Hygiene, Department of Food Technology, Lund UniversityMalmoSweden
  3. 3.Probi ABLundSweden

Personalised recommendations