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Inflammatory bowel diseases (IBDs) are chronic inflammatory disorders that include Crohn disease (CD), ulcerative colitis (UC), and chronic pouchitis. Crohn disease can affect the entire gastrointestinal tract anywhere from mouth to anus. The chronic inflammation is not limited to the lining of the bowel but affects the entire bowel wall, sometimes resulting in intra-abdominal abscesses and fistula (abnormal connections between the lumen of the bowel, other organs, or the surface of the skin) and intestinal obstruction. Patients typically experience symptoms of mild diarrhea, right lower quadrant pain, and low-grade fever. Ulcerative colitis is limited to the colon, and patients experience rectal bleeding, abdominal pain, and diarrhea. The inflammation in UC is confined to the upper layer of the colonic wall and the mucosa. Patients with CD and those with UC both experience periods of remission and relapses. Chronic pouchitis is a chronic inflammation of the ileoanal pouch. An ileoanal pouch is an internal reservoir, constructed for patients with UC who have had their large intestine surgically removed mostly because of severe inflammation refractory to medical treatment. Patients with pouchitis typically present with bloody diarrhea, urgency in passing stools, or discomfort while passing stools. Rarely, pain occurs with pouchitis. Inflammatory bowel disease is caused by multiple factors that disturb intestinal homeostasis. An abnormal immune response to commensal bacteria or dietary factors in genetically susceptible hosts plays a major role in the pathogenesis. Environmental factors including psychological stress, use of nonsteroidal anti-inflammatory drugs, and cigarette smoking can also contribute to IBD. The current treatment of IBD mainly consists of drugs directed against the overactive adaptive immune response, Nutrition Today Page 1
The concept that ingestion of certain bacteria may promote health is not new. Fermented milk products have been consumed by human beings for thousands of years with the belief that they provide health benefits. For example, according to Persian tradition, Abraham of the Old Testament owed his longevity to sour milk. In the early 20th century, the Russian immunologist, Elie Metchnikoff, proposed that ingestion of lactic acid bacteria promoted health and longevity of life. He based his theory on the observation that Bulgarians who consumed large quantities of fermented milk lived longer than those who did not. Around the same time, the first attempt to treat disease with bacteria was made by Dr Henry Tissier, a French pediatrician, who discovered Y-shaped or "bifid" bacteria (now known as Bifidobacterium) and recommended administration of isolated bifid cultures to infants with diarrhea to help restore a healthy gut flora. Metchnikoff and Tissier are largely credited for being the first individuals to make scientific suggestions about probiotic bacteria, although the term probiotic was not coined until 1965. The term probiotic, which literally means "for life," was first introduced by Lilly and Stillwell in 1965 to describe "substances produced by one microorganism which stimulate the growth of another." Since that time, the definition has undergone many revisions. In an attempt to provide an agreed upon definition, a joint Food and Agricultural Organization/World Health Organization Expert Consultation Nutrition Today Page 2
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Because the viability of probiotics in some food products and during transit through the gastrointestinal tract is variable, the prebiotic concept has been developed. Prebiotics are nondigestible short-chain carbohydrates, originally defined as selectively fermented ingredients that allow specific changes, both in the composition and/or activity in the gastrointestinal microflora that confer benefits upon host's well-being and health. Substances are considered prebiotics according to the following conditions: (1) when they are not broken down nor absorbed by enzymes in the upper part of the mammalian gastrointestinal tract, (2) when they are selectively fermented by one or a limited number of potentially beneficial bacteria in the intestine, and (3) when they are able to alter the colonic microflora toward a healthier composition. Prebiotics have become very popular food ingredients. The most commonly used prebiotics, inulin and oligofructose, are natural food ingredients or dietary fibers present in plants as storage carbohydrates. Wheat, chicory, bananas, onions, leeks, Jerusalem artichokes, asparagus, and garlic contain prebiotics. Most commercially used prebiotics are synthesized from sucrose or extracted from chicory roots. They are used in, for example, confectioneries, bakery products, fruit juices, desserts, Nutrition Today Page 5
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