pengaruh sinbiotik pada tgi anakmei12.ppt

7/23/2019 Pengaruh sinbiotik pada TGI AnakMei12.ppt

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PENGARUH SINBIOTIK PADAPENGARUH SINBIOTIK PADA

TRAKTUS GASTRONTESTINALTRAKTUS GASTRONTESTINAL

ANAKANAK

Dr. Eva J. Soelaeman SpA (K)Dr. Eva J. Soelaeman SpA (K)RSAB Harapan KitaRSAB Harapan Kita


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Defnisi ProbiotikDefnisi Probiotik

Organisme hidup yang ilaOrganisme hidup yang ila

di!onsumsi se"ara oral dapatdi!onsumsi se"ara oral dapat

memnatu !esehatan tuuhmemnatu !esehatan tuuh


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Mikroora UsusMikroora Usus

# $%% spesies# $%% spesies

&'&$ !g&'&$ !g

&%%%%%%%%%%%%%% sel&%%%%%%%%%%%%%% sel ada *etus normal saluran "ernanyaada *etus normal saluran "ernanya

sterilsteril

Kolonisasi a!teriKolonisasi a!teriBifdobacteriaBifdobacteria

+e!anisme pertahanan tuuh+e!anisme pertahanan tuuh


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Probiotik PrebiotikProbiotik Prebiotik

SinbiotikSinbiotik


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Properties of Probiotic (1)Properties of Probiotic (1)

Human originHuman origin

Acid and bile stabilityAcid and bile stability

Adherence to human intestinal cellAdherence to human intestinal cell Colonization of human intestinal tractColonization of human intestinal tract

Production of antimicrobialProduction of antimicrobial

substancessubstances


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Properties of Probiotic (2)Properties of Probiotic (2)

Antagonism against pathogenicAntagonism against pathogenic

bacteriabacteria

Safety in food and clinical useSafety in food and clinical use

Clinically validated and documentedClinically validated and documented

health eects (evidence basehealth eects (evidence base

medicine)medicine)

Technologic propertiesTechnologic properties


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Probiotic AgentsProbiotic Agents

Lactobacillus GGLactobacillus GG

Lactobacillus acidophilusLactobacillus acidophilus

Bifdobacterium bifdumBifdobacterium bifdum

Enterococcus aeciumEnterococcus aecium

Bifdobacterium longumBifdobacterium longum

Lactobacillus plantarumLactobacillus plantarum

Streptococcus thermophilusStreptococcus thermophilus

Saccharomyces boulardiiSaccharomyces boulardii


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Latobai!!usLatobai!!us

ai"o#$i!usai"o#$i!us +enghasil!an ,at pemunuh !uman+enghasil!an ,at pemunuh !uman

alami - a"to"idin / a"idophillinalami - a"to"idin / a"idophillin

menghamat S. *ae"alismenghamat S. *ae"alis +ening!at!an !e!ealan mela0an+ening!at!an !e!ealan mela0an

1amur / a!teri 1ahat1amur / a!teri 1ahat

+enempel dengan ai! pada dinding+enempel dengan ai! pada dinding

usus atau saluran reprodu!siusus atau saluran reprodu!si men"egah in*e!si / peradanganmen"egah in*e!si / peradangan


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Bif"obateriu% LatisBif"obateriu% Latis

+erangsang sistem !e!ealan tuuh+erangsang sistem !e!ealan tuuh

+enga!ti*!an sel 2 (sel pemunuh+enga!ti*!an sel 2 (sel pemunuhpenya!it se"ara alami)penya!it se"ara alami)

+ening!at!an sel imun untu!+ening!at!an sel imun untu!*agositosis*agositosis

Si*at antimi!roa terhadap 3lostridiumSi*at antimi!roa terhadap 3lostridium


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LactobacillusBakteri penghasil asam laktat (LAB=lactic acid bacteria),Gram positif, anaerobBentuk batang sampai bentuk coccobacil

Tumbuh optimum : pH 5,5 - 5,!"ermentasi: meme#ah $at makanan %ang ti&ak&i#ernaasam laktat, hidrogen peroksida,untukperkembangan &an hi&up bakteri tersebut sertamenghambat bakteri patogen &an 'amur!


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Eksklusi KompetitifEksklusi Kompetitif

Tempat AdesiTempat Adesi


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Kompetitif EksklusiKompetitif Eksklusi

NutrientNutrient


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Respon Imun pada DindingRespon Imun pada Dinding

UsusUsus


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h%si#al *emo+alh%si#al *emo+alBakteri atogenBakteri atogen

&ari sus&ari sus


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Latose Into!eraneLatose Into!erane S. thermophilus, L. bulgaricum andS. thermophilus, L. bulgaricum and

Lactobacilli : increase lactase enzymeLactobacilli : increase lactase enzyme

Increase quantity, availability, digestion ofIncrease quantity, availability, digestion of

nutrient I.e Folic acid, niacin,riboflavin, B !nutrient I.e Folic acid, niacin,riboflavin, B !


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Lactobacillus acidophilus

"lora normal &i G.T, mulut / +agina!0empro&uksi metabolit:La#tase, 1-gala#tosi&ase laktosa sebagai sumber karbon utama

&alam pro&uksi energi2it 3 / substansi antimikroba:ba#terio#inacidolin, lactocidin,acidolphilin.

Lactobacillus rhamnosus4timulasi pro&uksi antibo&i /mengoptimalkan fagositosis!


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Anti-ba#terial

agents

!

aeruginosa

!#oli nteroba#ter

3lebsiellaspp

roteusspp

4taph%!aureus

4tap!pi&ermi

&is

1haemol%ti#

4trepto#o#

4

(677 8)

4

(677 8)

4

(677 8)

4

(95 8)

4

(677 8)

4

(677 8)

4

(677 8)

4

(677 8)

Efek Lactobacillus acidophilusterhadap pertumbuhan

bakteri patogen(N.Am.J.ed.!ci 2"1" 2(12)

esimpulan!"actobacillus acidophilus ( #$#%&cells'm") memilii ativitasyang tinggi dalam menghambat bateri patogen ram*positive +ram*negative


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Studi aca tersamar ganda, pada &% ana , usia rerata #%bulan dengan diare -on rotavirus./osis " acidophilus 0 #1#%23'hari selama 45 6am

arameter L.acidophilus-*4

(n=;urasi &iare

(?am)

@,567,5 ,;6;,@ C7,76

>iare stop

DaETi&ak

E


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BifidobacteriumBifidobacterium

LAB, homofermentatifLAB, homofermentatif

Gram positif anaerob, ti&ak aktif bergerak,Gram positif anaerob, ti&ak aktif bergerak,ti&ak membentuk spora!ti&ak membentuk spora!

0erupakan mikroflora pertama %ang a&a0erupakan mikroflora pertama %ang a&a

&i &alam saluran pen#ernaan ba%i!&i &alam saluran pen#ernaan ba%i!


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Bifidobacterium longum

0o&ulasi sistem imun, antinflamasi &an antikanker4intesis en$im pen#ernaan seperti fosfatase kasein atau

liso$im!

Anti-rota+irus!

Bifdobacterium bifdum

0en#egah perkembangbiakan E. coli, Salmonella &an

Clostridium!

ro&uksi asam laktat &an asam asetat %ang menurunkan

pH usus &an men#egah pertumbuhan patogen!

:iosci :iotechnol :iochem. 5%%;#?1perimental :iology and @edicine5%## 5=;!&5==#Borld Academy of Science, ?ngineering and Technology >2 5%%2

L Acidophilus L rhamnosus Bifidobacterium


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L.Acidophilus

FMetabolit:latase!

"#galatosidase!menerna $AKT%SA

FSubstansi antimikroba:

&AKTERI%SIN: acidolin,lactocidin, acidolphilin

L.rhamnosus

FStimulasi produksiantibodi

F%ptimalkanfagositosis'

Bifidobacteriumlongum

FModulasi sistem imun!antinflamasi!antikanker

FSintesis en(impenernaan

FAnti#rota)irus'

Bifdobacterium

bifdum

FAnti E. coli,Salmonella danClostridium'

FMerangsang

pen*erapan:besi! kalsium!magnesium! dan seng

Streptococcus

thermophilus

FMenerna proteinsusu +kasein,'

FSedikit gen *angterdiri dari protein

permukaan!F-ega. transformasinitrat nitrit'

/%S

FPrebiotik

meningkatkan akti)itasdan pertumbu.anprobiotik

FPen*erapan kalsium

dan magnesium'


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MEN0APA MU$TI SPE-IES1MEN0APA MU$TI SPE-IES1

6!0eningkatkan sur+i+al probiotik

;!0en#iptakan pH %ang lebih optimal

5, ro&uksi metabolit lebih optimal

.nternational ?ournal of "oo& 0i#robiolog% @ (


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:ateriosin

@enghambattransport asam amino

@erusamembran sitoplasma

patogen

Tahara and anatani, #22;

6!6! 0empro&uksi substansi-substansi penghambat :0empro&uksi substansi-substansi penghambat :BA3T*.4.BA3T*.4.menghambat pertumbuhan bakterimenghambat pertumbuhan bakteriGram positif / negatifGram positif / negatifbakteriosinbakteriosinmenghambatmenghambatbakteri / pro&uksi toksin!bakteri / pro&uksi toksin!

&akteriosin&akteriosina&alah suatu toksin (protein) %anga&alah suatu toksin (protein) %ang&ipro&uksi sebagai metabolit &ari probiotik %ang&ipro&uksi sebagai metabolit &ari probiotik %ang&igunakan untuk menghambat pertumbuhan patogen!&igunakan untuk menghambat pertumbuhan patogen!

E#AN$!E #E%JAE#AN$!E #E%JA

!$N&$'$#!$N&$'$#


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SIN&I%TIK PADA DIARE AKUTSIN&I%TIK PADA DIARE AKUTInternational 2ournal of Probiotis and Prebiotis 3ol' 4! No' 4! pp' 56#75! 8995International 2ournal of Probiotis and Prebiotis 3ol' 4! No' 4! pp' 56#75! 8995

Anak (usia -6< bln) &engan &iare akut %ang &iberikanAnak (usia -6< bln) &engan &iare akut %ang &iberikan

terapi sinbiotik (4!thermophilus I L!a#i&ophilus IB!la#tisterapi sinbiotik (4!thermophilus I L!a#i&ophilus IB!la#tis

I"4 77 mg),n= +s plasebo (n=


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ANAA !$N&$'$#ANAA !$N&$'$#

0emperbaiki keseimbangan mikroflora (bakteri0emperbaiki keseimbangan mikroflora (bakteribaik) tubuh!baik) tubuh! 0en'aga kesehatan saluran #erna0en'aga kesehatan saluran #erna 0embantu pembentukan en$im pen#ernaan!0embantu pembentukan en$im pen#ernaan!

0enekan pertumbuhan ATG &i saluran0enekan pertumbuhan ATG &i saluran#erna!#erna!

0eningkatkan pen%erapan mineral (Ja, 0g, "e,0eningkatkan pen%erapan mineral (Ja, 0g, "e,&an Kin#)&an Kin#)


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!

"

#


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-$INI-A$ TRIA$-$INI-A$ TRIA$


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Pre*ention of $nfantilePre*ention of $nfantile

+iarrhea+iarrhea

infants aged *5> months hospitalized infants aged *5> months hospitalized

for non*D diseasesfor non*D diseases

Eormula ! :i7dobacteria vs controlEormula ! :i7dobacteria vs control 8bserve for 4 months8bserve for 4 months

/iarrhea episode decreased (4F vs =#F)/iarrhea episode decreased (4F vs =#F)

9otavirus infection decreased (#%F vs9otavirus infection decreased (#%F vs=2F)=2F)

Saavedra, #222Saavedra, #222


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Pre*ention Antibiotic,Pre*ention Antibiotic,

associated +iarrheaassociated +iarrhea

#5% children#5% children

Probiotic vs PlaceboProbiotic vs Placebo 4%F n4%F no &iarrhea +s 8 no &iarrheao &iarrhea +s 8 no &iarrhea

re&u#e& the number of &a%s an& &urationre&u#e& the number of &a%s an& &uration

of e+ents &iarrheaof e+ents &iarrhea"a 9osa, @inerva Pediatr, 5%%="a 9osa, @inerva Pediatr, 5%%=


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Acute +iarrheaAcute +iarrhea

;2 children;2 children

Probiotic vs PlaceboProbiotic vs Placebo >iarrheal phase re&u#e& b% iarrheal phase re&u#e& b%


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Acute +iarrheaAcute +iarrhea

arti"ipants 0ere "hildren aged & ' 45 months 0hoarti"ipants 0ere "hildren aged & ' 45 months 0ho0ere randomly assigned to re"eive one o* three0ere randomly assigned to re"eive one o* threetreatments -treatments -

Oral rehydration therapy plus pla"eo6Oral rehydration therapy plus pla"eo6

Oral rehydration solution plusOral rehydration solution plus SaccharomycesSaccharomycesboulardiiboulardii66

Oral rehydration solution plus a "ompound "ontainingOral rehydration solution plus a "ompound "ontainingLactobacillus acidophilusLactobacillus acidophilus Lactobacillus rhamnosusLactobacillus rhamnosusBifdobacterium longumBifdobacterium longumandand Saccharomyces boulardiiSaccharomyces boulardii..

Sample si,e 0as 4% per group and the out"omes 0ereSample si,e 0as 4% per group and the out"omes 0ereduration o* diarrhoea o* *ever o* vomiting and o*duration o* diarrhoea o* *ever o* vomiting and o*hospitali,ation.hospitali,ation.


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$mmune %esponse$mmune %esponse

After %ota*irus -accinationAfter %ota*irus -accination

># children># children

"actobacillus 5 1 #%"actobacillus 5 1 #%22

CE3CE3 Dncrease level of DgA rotavirusDncrease level of DgA rotavirus


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Eect of Lactobacillus rhamnosus inEect of Lactobacillus rhamnosus in

%educing +uration of Acute $nfantile%educing +uration of Acute $nfantile+iarrhea/ A +ouble &lind %andomi0ed+iarrhea/ A +ouble &lind %andomi0ed

linical rial in $ndonesialinical rial in $ndonesia

Eormula contains prebiotic dan probioticEormula contains prebiotic dan probiotic

Accelerate rehydration (>,2 vs =,2= hours)Accelerate rehydration (>,2 vs =,2= hours)

Shorten duration of diarrhea (#,;= vs 5,>Shorten duration of diarrhea (#,;= vs 5,>

days)days) Shorten hospitalization days (=,#2 vs =,4% dayShorten hospitalization days (=,#2 vs =,4% day

/ecrease stool output (#,5 vs #,;% gram)/ecrease stool output (#,5 vs #,;% gram)


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!afet of Probiotic!afet of Probiotic

&acteria&acteria 66 infants : 9!7 IE-

a loMer freNuen#% of reporte& #oli# ora loMer freNuen#% of reporte& #oli# or

irritabilit% ( C 7!776) an& a loMerirritabilit% ( C 7!776) an& a loMerfreNuen#% of antibioti# use ( C 7!776)freNuen#% of antibioti# use ( C 7!776)

Long-term #onsumption : Mell tolerate&Long-term #onsumption : Mell tolerate&

an& safean& safe 4aa+e&ra, Am ? Jlin utr,


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!afet of Probiotic!afet of Probiotic

&acteria&acteria

A recent revieG of #>= human clinicalA recent revieG of #>= human clinical

trials of probiotics betGeen #2;# andtrials of probiotics betGeen #2;# and

#22& involving more than 4%%#22& involving more than 4%%

sub6ects found no adverse events.sub6ects found no adverse events.


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ructooligosaccharide andructooligosaccharide and

+iarrhea+iarrhea E8S in children diarrheaE8S in children diarrhea

/uration of /iarrhea is shortened/uration of /iarrhea is shortened E8S vs Placebo (5.;5 vs >.5> days)E8S vs Placebo (5.;5 vs >.5> days)

@. urie, 9evieG,@. urie, 9evieG,

:ioscience @icroIora, 5%%5:ioscience @icroIora, 5%%5


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Probiotik "an in&eksiProbiotik "an in&eksi

$emberian probioti% pada bayi baru lahir bisa$emberian probioti% pada bayi baru lahir bisa

mengurangi %e&adian '() dan sepsismengurangi %e&adian '() dan sepsis $ada pasien on%ologi: bisa mengurangi$ada pasien on%ologi: bisa mengurangi

episode demam dan pema%aian antibioti%episode demam dan pema%aian antibioti%

*+amashiro, !-*+amashiro, !-


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