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Celiac Disease: Efficacy of Probiotics in Children

Celiac Disease: Efficacy of Probiotics in Children. Short Title: Probiotics and Celiac By Dr. Nagina Shahzadi , Dr. Muhammad Almas Hashmi, Dr. Sadida Bahawal. Discussion Outline. Background Information Purpose & Hypothesis Research Methods Results

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Celiac Disease: Efficacy of Probiotics in Children

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  1. Celiac Disease: Efficacy of Probiotics in Children Short Title: Probiotics and Celiac By Dr. NaginaShahzadi, Dr. Muhammad Almas Hashmi, Dr. SadidaBahawal

  2. Discussion Outline • Background Information • Purpose & Hypothesis • Research Methods • Results • Implications for Clinical Practice and Public Health • Study Findings and Evidence Based Practice Guideline • Value of the Study • References

  3. Celiac Disease The current knowledge

  4. The Current Knowledge • Autoimmune disorder causing damage to the small intestines with exposure to gluten, a storage protein found in wheat, rye, and barley • Consuming gluten causes an immune response in which the body attacks the small intestine, leading to damaged villi • Results in malabsorption of nutrients

  5. The Current Knowledge • 1 in 100 People Affected World-Wide • Hereditary • Two Types- Classical and Non-Classical • Currently no cure • Only known treatment is a life-long, gluten-free diet

  6. Probiotics • Naturally occurring microorganisms with possible beneficial health effects: • Aid in digestion • Reduction of inflammation • Inhibit disease-causing bacteria within the intestine

  7. The research Hypothesis The purpose of this study

  8. The Purpose of the Study & The Hypothesis The Purpose: “To determine the efficacy of probiotic along with gluten free diet in reducing diarrhea frequency in newly diagnosed patients with Celiac Disease and compare it with gluten free diet alone.” The Hypothesis: “Probiotic along with gluten free diet is effective in reducing diarrhea in patients of celiac disease as compared gluten free diet alone.”

  9. Research Methods The research design, controlling threats to internal validity, measuring the variables

  10. The Research Methods • Randomized Controlled Trial • Located at the Department of Pediatrics, DHQ Allied Hospital, Faisalabad • Duration of the trial lasted one year, from November 1, 2011 to October 31st, 2012 • Sample Size calculated using WHO Sample Size Calculator with a 5% level of significance • 58 patients in each group –Total 116 patients • Consecutive non-probability sampling for sample collection

  11. The Research methods

  12. The Research methods Group A: Given Gutcare sachet 500 mg (Clostridium butyricum and Bifidobacterium) diluted in 75-100 ml of boiled water twice a day + Gluten free diet Group B; Gluten free diet only

  13. The Research Methods • “Thorough history and physical examination” • Number of stools per day recorded at time of entry • Each group took the probiotics and/or followed the gluten free diet for 28 days • Stool frequency recorded again • Efficacy of treatment: “Reduction in stool frequency to more than half after a treatment of 28 days”

  14. Results What did this study find?

  15. Results • Mean number of stools decreased by more than half in 86% of patients in Group A • Mean number of stools decreased by more than half in 62% of patients in Group B • Treatment deemed effective for 50/58 patients in group A • Treatment deemed effective for 36/58 patients in group B

  16. Implications for Clinical Practice and Public Health Does this research have an impact on improving treatment for celiac disease patients?

  17. Implications for Clinical Practice and Public Health • Study by De Palma G found gluten free diet to decrease colonization of healthy bacteria and increase harmful bacteria • Polysaccharides in wheat grain essential for healthy bacteria colonization • Probiotic use, along with the gluten free diet, may be a solution to this issue • The complete exclusion of gluten for an entire lifetime is almost impossible

  18. Evidence Based Practice Guidelines The Significance of Study Findings

  19. Evidence Analysis Library CD: Gluten-Free Dietary Pattern “The registered dietitian (RD) should advise and educate individuals with celiac disease to be compliant with a gluten-free dietary pattern. Research on individuals with celiac disease reports that long-term compliance with a gluten-free dietary pattern improves outcomes related to bone density, iron deficiency anemia, villous atrophy, gastrointestinal and neurological symptoms, pregnancy outcomes and quality of life. ” • Strong • Imperative CD: Monitoring and Evaluation of Factors Affecting Quality of Life “The registered dietitian (RD), at every encounter,  should monitor and evaluate the factors affecting the quality of life of individuals with celiac disease, reviewing changes in client status, which includes medical status (e.g., gastrointestinal, immune, neurological and psychological) and social status (e.g., socioeconomic factors, religion, social and medical support and daily stress level). Individuals with celiac disease may not attain the same level of quality of life as the general population, due to social inconveniences of following a gluten-free dietary pattern.” • Strong • Imperative

  20. Value of the Study

  21. Value of the Study

  22. Value of the Study

  23. Value of the Study

  24. References Pictures Used: • https://www.giantmicrobes.com/us/products/celiac-disease.html • https://celiac.org/wp/wp-content/uploads/2009/11/Child-stomachache-Tom-Le-Goff.jpg • http://summercommunications.com/index.php/2017/09/12/can-pregnancy-trigger-celiac-disease/ • https://shop.ubiome.com/pages/probiotics-guide • https://www.pinterest.com/pin/39195459236100824/ • http://www.greenlife.my/ • http://www.essentialprobiotics.com/the-world-inside-us-the-human-microbiome/ • https://www.livewell.pk/gutcare-powder-sachet-10-sachets/ • http://www.rewildthyself.com/poop-like-caveman/ • http://occoquanbayperformance.com/2015/12/prebiotics-and-probiotics-are-they-right-for-you/ • https://www.pinterest.com/mediamed/doctors-visit-cartoons/?lp=true • https://www.stockunlimited.com/vector-illustration/boy-having-a-stomachache_1957045.html • http://www.eatrightstore.org/product/0F87E78B-4F5F-4F27-BDBD-0803429FC63E • http://www.andeal.org • https://4.bp.blogspot.com/-OjzZ96XcROI/V9ThIZmyY5I/AAAAAAAABH8/FX1WZRF-vM8MsMcxo8VsAVBgU8DN2IP0ACLcB/s1600/Weather-study-quality-small.jpg

  25. References Shahzadi N, Hashmi M, Bahawal S. Celiac Disease; Efficacy of Probiotics in Children. Professional Med J. 2016;23(7): 807-81. DOI: 10.17957/ TPMJ/16.3327 What is Celiac Disease. Celiac Disease Foundation. https://celiac.org/celiac-disease/understanding-celiac-disease-2/what-is-celiac-disease/. Accessed November 1, 2017 Celiac Disease Symptoms. Celiac Disease Foundation. https://celiac.org/celiac-disease/understanding-celiac-disease-2/celiacdiseasesymptoms/. Accessed November 1, 2017. Evidence Analysis Library. Academy of Nutrition and Dietetics. https://www.andeal.org/template.cfm?template=guide_summary&key=2420. Accessed November 1, 2017.

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