The role of Probiotics in Management of Acute Non ... - equistro.dk

The role of Probiotics in Management of Acute Non-specific Diarrhoea
GI disorders are one of the most common reasons a dog is brought to the vet.
With clinical signs ranging from diarrhoea, vomiting, abdominal cramps, inappetance and weight loss, it
can be as distressing for the owner as it is for the dog.
Healthy Gut - Function and Nutrition
Not only is the gut the organ of digestion and absorption, it is also the largest immune organ in the body
– being the point of entry for infectious diseases and allergy sensitising proteins. The health of the gut is
therefore critical to the health of the dog in maintaining a strong immune system.
The gut is the only body tissue that uses both systemic and luminal nutrition source of energy. 1
The large intestine mucosal cells rely primarily on short chain fatty acids as their luminal energy
source. Butyrate is the major SCFA energy source for colonocytes enabling them to function effectively. 3
Fibre is fermented into SCFA by microflora resident in the gastrointestinal tract. 4
The small intestine utilises nutrients such as glutamine and other amino acids as energy sources for
the enterocytes. As the enterocytes are replaced every 3-5 days, starving the gut for periods of time may
have negative consequences on the integrity of the mucosal barrier and make the gut vulnerable. 2

The Microflora
The normal gut contains microflora – trillions of beneficial bacteria (10 14 ) of 400 different species 5 –
required to help activate the digestive process. These microflora also play an active role in host defence
whereby colonisation resistance affords protection against pathogens. 6 They form a symbiotic relationship
with the host which also enhances the immune system.
At birth the puppies gut is relatively sterile but becomes inoculated by different bacteria from its
environment. These bacteria are collectively known as the microflora. The microflora is made up of
beneficial and pathogenic bacteria, the pathogens being suppressed to low levels when the intestine is
healthy.
The Disturbed Gut - Unpleasant Symptoms
The symptoms of a disturbed gut – particularly an acute case – can be hard for dog owners to ignore,
and frequently results in a visit to the vet. Diarrhoea and/or vomiting are common signs, but the dog may
also show other signs suggestive of GI tract disease. Behavioural changes may indicate abdominal
cramps and tenderness, or there may be excessive gas production (flatulence and borborygmi), weight or
failure to gain weight, and frequently inappetance.
Causes
Disturbance to gut function can be influenced by a range of factors, all of which may affect the microbial
balance in the GI tract, causing some degree of dysbiosis:
Changes in diet
Scavenging and/or dietary indiscretion
Gastrointestinal disease such as parasites
Antibiotic or other drug therapy
Stress – i.e. through travel, kennelling, post-surgery or weaning.
In most acute cases in dogs, multiple mechanisms may contribute to the diarrhoea 7 :
Passive secretion through osmosis. This is a common cause in diet changes, dietary indiscretion
or ‘garbage intoxication’
Active secretion
Increased permeability of mucosa
Abnormal intestinal motility
Management of acute diarrhoea
The management of acute diarrhoea cases will vary between vets and cases, but it is generally accepted
that we should consider the fundamentals of diarrhoea management when treating our cases. That is:
maintaining hydration; protecting the mucosal integrity; stabilising gut microflora; and modifying toxic
effects.
Five main areas of management are:
1. Fluid therapy: The most beneficial & indeed life saving component of management for acute
diarrhoea is fluid therapy. Intravenous fluid therapy and hospitalisation are indicated if the animal
is dehydrated or vomiting significantly. Oral rehydration therapy can be implemented with fluids
and/or electrolytes if the animal is able to drink.
2. Dietary modification: Provide a diet that is highly digestible protein and carbohydrate is
appropriate for most acute intestinal diarrhoeas. A high biologically active protein source is ideal
to assist repair of damaged tissue and replace the natural turnover of the enterocytes. Diets low
in fibre and moderate in fat to ensure it is highly digestible –maximising nutritional absorption
and reducing strain on the digestive system, while providing adequate energy. Short term dietary
modification is recommended to be introduced to the dog in small, frequent meals. 8

3. Antibiotics and other Prescription only medication (POM): Historically antibiotics have used in the
treatment of diarrhoea. Evidence now shows that in the majority of cases they are not indicated
or beneficial in both human and veterinary fields. The World Health Organisation (WHO)
recommends antibiotics should not be used routinely, only being used for specific bacterial
infections, after appropriate identification. 9 Other POMs may be indicated depending on the
presentation of acute diarrhoea patient.
4. Anti-diarrhoeals: Anti-diarrhoeals such as Kaolin and Pectin can be important in the management
of acute diarrhoeas. Kaolin is a naturally occurring clay. It is recognised for its adsorbent abilities
and acts as a natural binding agent. It has recently been shown to decrease the bioavailability of
intestinal insults 10 . Pectin, from the skin of fruits, has a soothing affect on the gut and is
considered to have anti inflammatory properties. 11 Together they have been used for many years
as part of diarrhoea management.
5. Probiotics & Prebiotics: Probiotics and Prebiotics together can be utilized to manipulate the
microflora into more favourable balance after gut disturbances and in the management of acute
diarrhoea. The beneficial bacteria can become depleted during GI disruption, compromising the
ability of the gut to function effectively. Probiotics provide an influx of beneficial bacteria to the
unbalanced gut. We will consider these in more detail.
Probiotics and Prebiotics
Probiotics are described as: “A live microbial” “which beneficially affects the host animal by improving its
intestinal microbial balance”. 12
Probiotics exert their beneficial effects by 3 main mechanisms:
The first mechanism is that of competitive exclusion. Competitive exclusion works by a process of
competition between the Probiotic and pathogenic bacteria for adhesion or colonisation sites on the
gastrointestinal wall, and also by competition for nutrients within the gut. 13
The second mechanism is through the production of lactic acid by the Probiotic microorganisms. Lactic
acid is produced as a means of optimising the immediate environment of the Probiotic bacteria. Lactic
acid production encourages growth of lactic acid bacteria whilst inhibiting the growth of pathogenic
bacteria such as E. coli and Salmonella. Under stress conditions the animals gut becomes more alkaline
and more prone to illness as the gut conditions become more suitable for the growth of pathogenic
bacteria. 14
A third mechanism is to enhance and regulate the immune system. The immune system is stimulated by
Probiotics in several ways. Probiotics have been shown to increase cytokine production; phagocytic
activity of the innate immune system; and antibody production via the adaptive immune system. 15,16
Prebiotics are non-digestible food ingredients that provide a source of nutrition for the bacteria – can help
increase the growth and viability of the beneficial bacteria in the gut. 17 Prebiotics are the food source
preferentially chosen by Lactobacillus and Bifidobacterium spp which reside in the distal small intestine
and the large intestine. They are fermented in the colon by the microflora into SCFA which is known as
the bifidogenic process. 18 Prebiotics need to have a low hygroscopicity, as water will affect the viability of
the Probiotics. 19 Providing dual source prebiotics will benefit good bacterial strains covering a larger area
of gut.
A synergistic effect has long been identified between Prebiotics and Probiotic microorganisms, more
recently in dogs, suggesting it is more beneficial to the gut health than Probiotics alone. 20 This is what is
commonly referred to as a Synbiotic formulation.

Ideal Probiotics Features
When considering the use of probiotics in companion animals with acute non-specific diarrhoea, one
needs to identify the ideal features of probiotics and how to avoid use of inappropriate products.
Unfortunately, there is currently poor regulation of probiotics in the veterinary industry. This was
identified in a recent study from Canada 21 and highlights the importance of identifying a quality
manufacturer for source of appropriate probiotics, capable of exerting a beneficial effect in the species for
which it is dispensed.
1. Probiotics need to be safe, non-pathogenic and non-toxic microorganisms. In the EU, the only
strains registered for use are Enterococcus faecium and Lactobacillus acidophilus. 22 These strains
themselves can vary and not all strains of E.faecium should be assumed are registered for use in
dogs in the EU. The NCIMB (National Collection of Industrial, Marine and food Bacteria) collection
bank plays an important role in retaining an original source of the stored strains for culture. This
ensures that there is no genetic drift of the strain over time, so we can ensure it is always non-
pathogenic & non-toxic.
2. Colony forming units (CFU) refer to the number of live, viable cells present. A product should
contain large numbers to have a beneficial effect. Studies in humans suggest a minimum
therapeutic dose of 1x10 8 CFU/ day to exert a beneficial effect. 23 Low levels of Probiotic bacteria
(providing they are appropriate for the species) will do no harm but are unlikely to produce a
beneficial effect. Quality products will ensure they meet label claim at the end of the shelf life of
the product.
3. Probiotics should be capable of surviving low pH of stomach and bile acids. Microencapsulation of
the probiotics with cryoprotectants is recommended. This affords the probiotics an additional
protection barrier during the production process as well as additional protection from the
stomach acid and bile. Probiotic strains should also be selected based on their ability to survive
these conditions. Strains that have been approved for use in companion animals have been
proven in studies to survive the stomach pH and bile as well as other attributes. 24
Acid stability of microencapsulated Enterococcus faecium 10415 EC No.E1707 In vitro unbuffered
growth for 2 hours contact time.
When held at a pH of 2.0 and pH 1.5 for a 2 hour period there is no significant loss in viability / concentration of
the bacterial strain. This in vitro study mimics the stomach acid conditions. The contact time is extreme – a two
hour contact time period without any buffering effect of e.g. food or water, before plating out. 14

4. Lastly, the Probiotics should remain stable for long periods under normal storage conditions. This
may be facilitated by freeze-drying or similar during the final stages of manufacture. This
additional process helps give the Probiotics their 2 year shelf life seen in some of the quality
products available to the veterinary market. 19
Probiotics in use
It is exciting to see much more research in recent years, into Probiotics in companion animals, as the
benefits have been seen in humans and food production animals.
Strompfova in 2004 assessed various attributes of a good probiotic in the canine. 24 Strains were evaluated
for acid and bile tolerance; production of antimicrobial substances (bacteriocins) directly against other
pathogenic bacterial strains; and capacity of adherence to the canine intestinal mucous. Both the survival
of the Probiotics in the GI tract and ability to attach to the mucous are important because Probiotics need
to be viable and able to attach and colonise to exert their beneficial effect. This attachment ability varies
between the Probiotic bacterial strains in the different host species. Findings in the dog were favourable
for particular strains of E. faecium.
Other research by various authors has also shown that the administration Enterococcus faecium reduces
Clostridium spp. Staphlococcus & Pseudomonas in the canine. 25,26
Specific immune studies have looked supplementing Probiotic E. Faecium and stimulation of immune
function in dogs as well as immune response to Giardia infection in mice. 27,28 Both yield exciting
information for continued research in these areas.
Key Points of Probiotics
o The importance of normal intestinal microflora is paramount to the resistance of pathogenic
microorganisms
o Antibiotic therapy, stress and dietary changes can induce a disturbance in the gut microflora
o Probiotics can be beneficial in the prevention of significant dysbiosis and therapeutically to reestablish
the microflora and help maintain gut function
o A quality source of appropriate probiotics and a thorough understanding of how to evaluate the
various products are important.
Written by: Jane McNae BVSc, MACVSc (Surg), MRCVS. International Technical Manager for Probiotics
International Ltd.

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