A systematic review of the efficacy and safety of Saccharomyces boulardii in the treatment of acute gastroenteritis in the pediatric population

Padayachee, Morgambal (2016-12)

Thesis (MNutr)--Stellenbosch University, 2016.

Thesis

ENGLISH SUMMARY : Background: The yeast Saccharomyces boulardii has been classed a probiotic because it is a live microorganism known to confer a health benefit to its host, with one such benefit being in the management of gastrointestinal disturbances like gastroenteritis. Gastroenteritis is known to be the second leading cause of death in the world’s most vulnerable populations, with Rotavirus being the most common causative agent, responsible for 215,000 global child deaths during 2013. Together with a few other probiotics, Saccharomyces boulardii has been considered a potentially viable treatment option having been associated with a decreased duration of diarrhea, decreased number of days to the first formed stool, and decreased duration of hospital stay in individual studies. This systematic review was therefore designed to specifically investigate the effects of Saccharomyces boulardii on acute gastroenteritis caused by Rotavirus in the pediatric hospitalized patient. Objectives: To assess the efficacy and safety of Saccharomyces boulardii in the treatment of acute gastroenteritis in the pediatric population. Secondary objectives of cost-effectiveness in terms of length of hospital stay; optimal dosing and administration routes were also investigated. Methods: Data sources included Medline, CINAHL, Scopus and The Cochrane Library up to and including August 2015. Only randomized controlled trials in a hospital setting and involving subjects less than 16 years were included. Two reviewers independently evaluated studies for eligibility, quality and extracted the data. Data were analyzed using Review Manager 5 (RevMan 2008) software. A random effects model of meta-analysis was used due to the presence of heterogeneity of treatment effects between studies. Results: Out of a pool of 190 articles, 10 studies were selected for final inclusion and analysis. A meta-analysis involving five of the ten included studies showed that Saccharomyces boulardii significantly shortened the duration of diarrhea (in days), compared to the control/placebo group (MD -0.57, 95%CI: -0.83 to -0.30, P < 0.0001). Also, participants were passing solid stools in the Saccharomyces boulardii group compared to the control group on Day 2 (RR 3.00; 95% CI: 0.32 to 27.87), Day 3 (RR 3.17; 95% CI: 1.89 to 5.31), Day 4 (RR 1.63; 95% CI: 1.30 to 2.06) and Day 5 (RR 1.25; 95% CI: 1.08 to 1.44), (P = 0.06). Other outcomes like number of participants having less than three stools per day during the intervention and duration of hospital stay did not produce any statistically significant results. No studies reported on any significant adverse effects associated with the use of Saccharomyces boulardii. Conclusion: The results of the current systematic review appear to indicate there’s a potential benefit with using Saccharomyces boulardii to treat acute gastroenteritis in the pediatric patient. Offering this unique yeast probiotic at a dose of 250mg once to twice per day for up to five days has shown some benefit and appears to be safe. However, larger and more rigorous controlled trials are needed to further investigate the efficacy and safety of individual probiotics, like Saccharomyces boulardii, in order to offer specific treatment guidelines.

AFRIKAANSE OPSOMMING : Agtergrond: Die gis Saccharomyces boulardii word beskou as ‘n probiotika aangesien dit ‘n lewendige mikroorganisme is wat gesondheidsvoordele inhou vir die gasheer. Een van die voordele is in die behandeling van gastrointestinale afwykings soos gastroenteritis. Alhoewel gastroenteritis slegs ‘n simptoom is van ‘n toestand, is dit bekend om die tweede mees algemene oorsaak van sterfte te wees onder vatbare populasies in die wêreld. Rotavirus, die mees algemene oorsaak van gastroenteritis, was verantwoordelik vir 215,000 kindersterftes wêreldwyd tydens 2013. Tesame met ‘n paar ander probiotika word Saccharomyces boulardii beskou as ‘n potensiële lewensvatbare behandelingsopsie. Hierdie gis probiotika word in individuele studies geassosieer met ‘n verkorte duurte van diaree, verminderde aantal dae tot die eerste gevormde stoelgang en ‘n verkorte duurte van hospitaal verblyf. Hierdie sistematiese literatuuroorsaak was dus beplan om die effek van Saccharomyces boulardii op akute gastroenteritis veroorsaak deur Rotavirus in pediatriese gehospitaliseerde pasiënte te ondersoek. Doelwitte: Om die effektiwiteit en veiligheid van Saccharomyces boulardii in die behandeling van akute gastroenteritis in die pediatrie populasie te bepaal. Sekondêre doelwitte was om die koste-effektiwiteit in terme van duurte van hospital verblyf, optimale dosering en administrasie roetes te ondersoek. Metodes: Data bronne het Medline, CINAHL, Scopus en die Cochrane Biblioteek tot en met Augustus 2015 ingesluit. Slegs verewekansigde gekontrolleerde proewe in ‘n hospitaal omgewing gedoen op persone jonger as 16 jaar is ingesluit. Twee evalueerders het die studies onafhanklik evalueer vir geskiktheid, kwaliteit en was betrokke by data ekstraksie. Data was ge-analiseer deur gebruik te maak van Review Manager 5 (RevMan 2008) sagteware. Die stogastiese-effekte model van meta-analise was gebruik as gevolg van die teenwoodigheid van heterogeniteit van behandelings-effekte tussen studies. Resultate: Uit ‘n poel van 190 potensiële artikels is 10 studies geselekteer vir finale insluiting en analise. ‘n Meta-analise op vyf van die tien studies het getoon dat Saccharomyces boulardii verantwoordelik was vir ‘n beduidende verkorte duurte van diaree (in dae), vergeleke met die kontrole of plasebo groepe (MD -0.57, 95%CI: -0.83 to -0.30, P < 0.0001). Resultate het ook gedui dat meer deelnemers in die Saccharomyces boulardii groep soliede stoelgane gehad het vergeleke met die kontrole groep op Dag 2 (RR 3.00; 95% CI: 0.32 to 27.87), Dag 3 (RR 3.17; 95% CI: 1.89 to 5.31), Dag 4 (RR 1.63; 95% CI: 1.30 to 2.06) en Dag 5 (RR 1.25; 95% CI: 1.08 to 1.44), (P = 0.06). Ander uitkomste soos die aantal deelnemers met minder as drie stoelgange per dag gedurende intervensie en duurte van hospital verblyf het nie beduidende resultate gelewer nie. Geen studies het enige newe-effekte geassosieer met die gebruik van Saccharomyces boulardii gerapporteer nie. Gevolgtrekking: Die resultate van die huidige sistematiese literatuuroorsig dui op ‘n potensiële voordeel met die gebruik van Saccharomyces boulardii vir die behandeling van akute gastroenteritis in die pediatriese groep. Die inname van hierdie unieke gis probiotika teen ‘n dosis van 250mg een tot twee maal per dag vir tot vyf dae het op sommige voordele gewys en blyk om veilig te wees. Groter en strenger gekontrolleerde proewe word egter aanbeveel om die effektiwiteit en veiligheid van individuele probiotika soos Saccharomyces boulardii verder te ondersoek ten einde spesifieke behandelingsriglyne te kan voorstel.

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