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Saccharomyces boulardii: Supporting gastrointestinal health

 
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As we continue to learn more about the implications of gastrointestinal inflammation on the immune response, digestive health and longer-term health risks, the need to expand our natural medicine toolkit to support a reduction of inflammation, or inflammation causing pathologies, is critical.

In 1920 during a cholera outbreak1, microbiologist, Henri Boulard, first documented the benefit of Saccharomyces boulardii (S. boulardii) in Indonesia after observing the use of a tea made of lychee skins and mangosteen fruits for the prevention of diarrhoea.2 One hundred years later, S. boulardii, continues to be a mainstay in the prevention and treatment of diarrhoea.1

Commonly associated with gut inflammation, diarrhoea continues to be one of the leading causes of morbidity and hospitalisation worldwide alongside meaningful economic burden.2 This continued prevalence emphasises the demand for alternative therapies from the standard protocol of hydration and electrolyte therapy, both ineffective at reducing stool volume, frequency and duration of diarrhoea.2

An impressive safety profile

S. boulardii has an excellent safety profile with minimal adverse reactions.3

The presence of translocated fungus or yeasts within the blood from the gut, is known as fungemia.4 A retrospective study identified the use of S. boulardii as a risk factor for the development of fungemia and recommends extreme caution when administering S. boulardii to the elderly patient more susceptible to translocation due to altered gut permeability.4 Furthermore, S. boulardii is contraindicated in intensive care, those hospitalised with a central venous catheter, immunocompromised or critically ill patients.4

A means to reduce gastrointestinal inflammation

Intestinal permeability controls the transport of substances across the gastrointestinal epithelium and into circulation.5 Altered intestinal permeability results in increased inflammation, pathogen translocation, and potential disease progression, including Crohn’s disease.5 Translocation of lipopolysaccharides promotes inflammation through the release of IL-6 and TNF-a, a process counteracted by S. boulardii through the enhancement of IL-10 levels, a known anti-inflammatory.6

S. boulardii limits inflammation by production of the protein phosphatase 63 kDa, capable of reducing the toxicity of lipopolysaccharides, and reducing inflammation.6 Within the cell, S. boulardii functions to inhibit the production of the proinflammatory cytokine IL-8 by inhibiting the NF-kB and MAPK signalling pathways.6 Further studies have demonstrated that a preexposure to S. boulardii reduces inflammation by stimulating the production of immunoglobulins and cytokines, to support the immune response to future infection.6

The best use of S. boulardii

Due to its favourable role in gastrointestinal health, the therapeutic benefits of S. boulardii focus on the reduction of diarrhoea and inflammation and microbiome restoration.

Diarrhoea treatment

Well-regarded for its role in reducing diarrhoea, S. boulardii influences short chain fatty acid (SCFA) production, involved in water and electrolyte absorption.7

Acute paediatric diarrhoea

Of 24 randomised control trials looking at the efficacy of S. boulardii to treat paediatric diarrhoea, 83% also found S. boulardii beneficial in reducing acute diarrhoea by up to one day, with no adverse events identified.1 Typically, the treatment period for these trials was seven days with doses ranging from 1 x 1010 CFU/day to 500 mg/day.1 A meta-analysis found a reduction in the stool frequency from day 2 of treatment with S. boulardii2 suggesting benefits to recovery also.

Antibiotics and S. boulardii – the perfect match

Often prescribed alongside the use of antibiotics for the reduction and prevention of antibiotic-associated diarrhoea (AAD), studies looking at AAD in the treatment of Clostridium difficile demonstrated both a preventative and curative effect of S. boulardii.7 Studies involving the use of antibiotics known to reduce SCFA levels in conjunction with S. boulardii have demonstrated S. boulardii’s ability to maintain SCFA levels during antibiotic therapy.7 Early administration of S. boulardii at the commencement of antibiotic therapy has been shown to offer greatest benefit.7

Unlike most probiotics, S. boulardii is resistant to antibiotics2 and does not contribute to antibiotic resistance due to its fungal nature2 supporting its concomitant use with antibiotic therapy.

Helicobacter pylori infection

Involving 1-2 antibiotics and a proton pump inhibitor for the treatment of Helicobacter pylori infection, studies have identified that the additional treatment of S. boulardii reduced the incidence of antibiotic associated diarrhoea in 93% of the treatment groups.1


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References

1. Mcfarland, L. V. (2017). The Microbiota in Gastrointestinal Pathophysiology Common Organisms and Probiotics: Saccharomyces boulardii. In The Microbiota in Gastrointestinal Pathophysiology. https://doi.org/10.1016/B978-0-12-804024-9/00018-5

2. Dinleyici, E. C., Eren, M., Ozen, M., Yargic, Z. A., & Vandenplas, Y. (2012). Effectiveness and safety of Saccharomyces boulardii for acute infectious diarrhea. In Expert Opinion on Biological Therapy (Vol.12, Issue 4, pp. 395–410). https://doi.org/10.1517/14712598.2012.664129

3. Pais, P., Almeida, V., Yılmaz, M., & Teixeira, M. C. (2020). Saccharomyces boulardii: What makes it tick as successful probiotic? In Journal of Fungi (Vol. 6, Issue 2, pp. 1–15). MDPI AG. https://doi.org/10.3390/jof6020078

4. Poncelet, A., Ruelle, L., Konopnicki, D., Miendje Deyi, V. Y., & Dauby, N. (2021). Saccharomyces cerevisiae fungemia: Risk factors, outcome and links with S. boulardii-containing probiotic administration. Infectious Diseases Now, 51(3), 293–295. https://doi.org/10.1016/j.idnow.2020.12.003

5. Odenwald, M. A., & Turner, J. R. (2013). Intestinal Permeability Defects: Is It Time to Treat? Clinical Gastroenterology and Hepatology, 11(9), 1075–1083. https://doi.org/10.1016/j.cgh.2013.07.001

6. Stier, H., & Bischoff, S. C. (2016). Influence of saccharomyces boulardii CNCM I-745 on the gut-associated immune system. In Clinical and Experimental Gastroenterology (Vol. 9, pp. 269–279). Dove Medical Press Ltd. https://doi.org/10.2147/CEG.S111003

7. Czerucka, D., & Rampal, P. (2019). Diversity of Saccharomyces boulardii CNCM I-745 mechanisms of action against intestinal infections. World Journal of Gastroenterology, 25(18), 2188–2203. https://doi.org/10.3748/wjg.v25.i18.2188

8. McFarland, L. v., & Goh, S. (2019). Are probiotics and prebiotics effective in the prevention of travellers’ diarrhea: A systematic review and meta-analysis. Travel Medicine and Infectious Disease, 27, 11–19. https://doi.org/10.1016/j.tmaid.2018.09.007

9. McFarland LV. Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World J Gastroenterol 2010;16(18):2202-2222.

10. Abbas Z, Yakoob J, Jafri W, et al. Cytokine and clinical response to Saccharomyces boulardii therapy in diarrhea-dominant irritable bowel syndrome: A randomized trial. Eur J Gastroenterol Hepatol 2014;26(6):630-639.

11. McFarland LV, Goh S. Are probiotics and prebiotics effective in the prevention of travellers’ diarrhea: A systematic review and meta-analysis. Travel Med Infect Dis 2019;27:11-19.

12. Szajewska H, Kolodziej M. Systematic review with meta-analysis: Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea. Aliment Pharmacol Ther 2015;42(7):793-801.

13. Carstensen JW, Chehri M, Schønning K, et al. Use of prophylactic Saccharomyces boulardii to prevent Clostridium difficile infection in hospitalized patients: A controlled prospective intervention study. Eur J Clin Microbiol Infect Dis 2018;37(8):1431-1439.

14. Dinleyici EC, Kara A, Ozen M, et al. Saccharomyces boulardii CNCM I-745 in different clinical conditions. Expert Opin Biol Ther 2014;14(11):1593-1609

15. Kaźmierczak-Siedlecka, K., Ruszkowski, J., Fic, M., Folwarski, M., & Makarewicz, W. (2020). Saccharomyces boulardii CNCM I-745: A Non-bacterial Microorganism Used as Probiotic Agent in Supporting Treatment of Selected Diseases. In Current Microbiology (Vol. 77, Issue 9, pp. 1987–1996). Springer. https://doi.org/10.1007/s00284-020-02053-9

16. Villar-Garcia J, Hernandez JJ, Guerri-Fernandez R, et al. Effect of probiotics (Saccharomyces boulardii) on microbial translocation and inflammation in HIV-treated patients: A double-blind, randomized, placebo-controlled trial. J Acquir Immune Defic Syndr 2015;68(3):256-263.

17. García-Collinot G, Madrigal-Santillán EO, Martínez-Bencomo MA, et al. Effectiveness of Saccharomyces boulardii and metronidazole for small intestinal bacterial overgrowth in systemic sclerosis. Dig Dis Sci 2020;65(4):1134-1143.

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