CURRICULUM VITAE

Name

: Hery Djagat Purnomo, Dr, dr., Sp.PD-KGEH,

Education background
1984-1991 : Medical Doctor, University of Brawijaya
1997-2002 : Internist specialist, Faculty of medicine University
of Diponegoro, Semarang)
2003-2008 : Gastroentero-hepatology consultant
2013
: Doctor (PhD), Faculty of medicine University of
Diponegoro
Fellowship:
2005
2006
2009

YCP World Congres Gastro, Montreal, Canada

Observer Gastroenterology,Santo Thomas
Hospital, Manila
Training of Advanced Endoscopic Therapeutic, AIG,
Hyderabad, India

Work experiences
1992-1995 : Head of Puskesmas Ropang- Moyohulu,
Sumbawa NTB
1995-1996 : Medical Doctor in Jombang hospital
1997-2002 : Internist in Dr.Kariadi Hospital, Semarang
2012-now : Head of Gastroentero hepatology division. Internal
medicine department, Dr.Kariadi hospital, Faculty of
medicine University of Diponegoro
2009-now : Secretary Internist Sp-2 Program
2014
: Secretary of Medical committee Dr Kariadi Hospital
Organization
1997-now
: Member of IDI in Semarang
2002-now
: Member of PAPDI in Semarang
2004-2007,2013-now: Secretary of PAPDI in Semarang

Peran Probiotik-Prebiotik
pada gastrointestinal
DR.dr.Hery Djagat Purnomo,SpPD
KGEH,FINASIM
Divisi Gastroentero-hepatologi
Departemen Ilmu Penyakit Dalam
RSUP Dr Kariadi-FKUNDIP Semarang
KALBE AKADEMIA , ASTON HOTEL JEMBER, 7
Feb 2015

J Glausiusz. Discover June 2007

BodySite
?
Nasal
No
se

bacteria/mlor
gram
103-104

Oral

Oral
1010total
Saliva
Gingival crevice
Toothsurface

#species

>700
108-1010
1012
1011

Gastrointestinal
Gastrointestinal
Tract
1014total
Stomach
100-104
Small intestines
104-107

>1000

Colon (feses)1011-1012

Skin

Skin
1012total
Surface

?
105

Urogenital

Urogenital
1012total?
Vagina

Humancells
1013total

?
109

Human Microbiota
Our human body sites are
colonized by an enormous number
of microorganisms, of which the
majority is bacterial species, and
they form complex communities
called the human microbiota.
The total number of these bacterial
cells is estimated to be more than
1014, accounting for 10 times more
than the total number of eukaryotic
cells that compose a human
individual .
Among them, the gut microbiota
is the largest and most complex,
and is composed of more than
1,000 different intestinal microbes.

Gut Microbiota
1014 microorganism, weigh > 1 kg,
colonized in gastrointestinal tract
(most are in colon)

About 1000 different

species live in the gut
(99% of the bacteria
come from 30~40
species).

Harmful effects and

pathogens

Health promoting factors

Ps.aeruginosa
Proteus
Pathogens
(toxins)

Staphylococci
Clostridium

4
Colonization
resistance

Veillonellae
Enterococci
Production of
carcinogens

E.coli
8

Lactobacilli

Streptococci
Intestinal
putrefaction

Roberfroid et al, 1995

Eubacteria
Bifidobacteri
a
Bacteroides
11 (log bacteria/g feces)

Immune
modulatory
functions
Absorption
and digestive
functions
Synthesis of
vitamins

Adult Gut
Length - 7 m

The gut is the largest and

most unique immune
system organ
villi

Mucosal surface area - 300m 2,

equal to tennis court

60 % of total immune cells

Lumen

Cross-section
view

and antibodies exist in intestine.

Unique dendritic cells, T cells, B cells

and
antibodies (IgA) are found there.

Intestinal
villi

Probiotic

Definition of probiotic (FAO/WHO) : probiotics are Live

microorganisms which when administrated in adequate
amounts confer a health benefit on the host.

Lactic acid bacteria (LAB) like Lactobacillus and

bifidobacteria are the most common types microbes used
as probiotics.

In 1989 Roy Fuller suggested a definition of probiotics

which has been widely used: "A live microbial feed
supplement which beneficially affects the host animal by
improving its intestinal microbial balance.

It has been so far technologically difficult to quantitatively

and comprehensively measure the microbial composition
alteration. (Metagenomic data ?)

History of Probiotic

Louis Pasteur (1822-1895)

Observed antagonistic interaction
between bacterial strains
Suggested that non-pathogenic
bacteria should be used to control
pathogenic bacteria
Metchnikoff (1875-1916)
Observed that lactic fermentation of milk arrested putrefaction
Suggested that consumption of fermented products would offer
the same benefit to humans
Felt that longevity in Bulgarian peasants was due to ingestion
of soured milks
Ferdinand Vergin (1950s)
Publishes article discussing effects of antibiotics on beneficial
intestinal bacteria
Fuller (1980s)
Establishes first definition of probiotics

Lactobacillus acidophillus 5
milyar CFU, Bifidobacterium
longum 5 milyar CFU,
Fructooligosaccharides (FOS)
15%

Objectives of stakeholders in
the probiotic field

Definisi
Probiotics :
Live microorganisms that, when administered in adequate
amounts, confer a health benefi t on the host.

Prebiotics :
Nondigestable substances that provide a beneficial
physiological effect for the host by selectively stimulating the
favorable growth or activity of a limited numberof indigenous
bacteria

Synbiotics
Products that contain both probiotics and prebiotics

Functions of the
intestinal microbiota
Number : resident gut microbial population is estimated 100 trillion,
at least 500 different species.
A number of lines of evidence point to an important role for intestinal
microbes in maintaining normal gastrointestinal

function
Example :
1) Antibiotics --- Clostridium difficile diarrhea, colitis , Post infectious
IBS
2) IBD remains in remission when the gut microbiota are diverted but
recurs when the gut is reconnected, permitting exposure to gut
microbiota again.
3) Alterations in the intestinal microbiota (e.g., following infection or
use of antibiotics or probiotics) can affect intestinal functions
including
immunologic, motility, and sensation

Possible distribution of
mechanisms among probiotics

Factors determined clinical

efficacy of a probiotic product

Specific microbial species

Dosage
Formulation
Viability of the probiotics both on the shelf and within
the intestine
Residence time in the gut or in various segments there
of
Method of dosing, a report of clinical efficacy for one
probiotic product or strain cannot be simply assumed
for another probiotic.
It is difficult to be an informed health-care provider or a consumer of
probiotic products when these factors are rarely tested before a probiotic
product is marketed

Potential Mechanisms of Action

Using probiotics to treat gastrointestinal

diseases:
scientific rationale

Probiotics have intestinal barrier,

immunologic, antibacterial, and motility
and sensation effects that may contribute
to their efficacy in various indications.
Probiotics have been shown to affect the
intestinal mucosa in numerous ways.

Yehuda Ringel. Am J Gastroenterol Suppl 2012; 1:34 40;

Probiotics have been shown to affect the

intestinal mucosa in numerous ways :
1. Direct effects on the epithelial barrier, including
increasing mucin expression / secretion, production
of antimicrobial peptides, including defensin.
2. Influence mucosal immunity by increasing levels of
IgA-producing cells.
3. Influence cytokine expression and suppress
mucosal infl ammation, potentially through Toll-like
receptor signaling.
4. Have a number of functional effects on the
gastrointestinal tract ; repair intestinal dysmotility
and visceral hypersensitivity.
5. Potential to have a direct antimicrobial effect ;
bacteriocins, simply adhering to epithelial cells.

Probiotic and prebiotic modulation of intestinal

barrier and immune responses

Nutrients 2013, 5, 1869-1912

Probiotic strains differentially modulate T cell differentiation

and
effector cytokines

Overview of studies documenting the probiotic strain-specific effects on Th1

cytokines (IFN and IL-12) associated with cell-mediated immunity, Th17
cytokines (IL-23 and IL-17) associated with pro-inflammatory anti-pathogen
responses, Th2 cytokines (IL-4 and IL-5)humoral immunity and Treg (TGF)
associated with immune tolerisation/suppression

Interaction of the gut microbiome, probiotics

and prebiotics on the brain gut axis.

Gut Microbes 4:1, 1727; January/February 2013

Clinical evidence supporting the use of

probiotics in
gastrointestinal diseases
Prevention of acute diarrhea
Treatment of infectious diarrhea
Prevention of c. difficile associated
diarrhea
Prevention of antibiotic-associated
diarrhea
Prophylaxis of traveler s diarrhea
Recommendation : On balance, the evidence
supports the use of probiotics in the prevention and
treatment of infectious diarrhea. However, more research is
needed to guide the use of particular probiotic regimens in
specifi c patient groups.

 Inflammatory bowel disease

Recommendation : The best evidence exists for VSL#3
(a probiotic mixture ), at a dosage of 4.5 10 11 CFU twice daily, for
the maintenance of remission in patients with pouchitis.

In ulcerative colitis, E. coli Nissle 1917 (at a dosage of 200 mg

once daily) has been shown to be as eff ective as mesalamine 500 mg
three times daily in a well-designed, double-blind, double-dummy trial.
However, there is insufficient evidence at this time on the efficacy of
other probiotic preparations and more studies are clearly needed. Little
evidence suggests that probiotics have any eff ect in Crohn s disease

Irritable bowel syndrome

Recommendation :
Have concluded that some probiotics are
beneficial in improving symptoms and
reducing the risk of persistent symptoms in
some patients with IBS, although the overall
effect is modest.
There is little evidence for harm associated
with probiotics in fact, suggesting that the
potential benefit may outweigh any risks
associated with these products

Formal guideline exist in management

IBS with probiotic :
American Gastroenterological Society
Konsensus penatalaksanaan IBSkonstipasi di Indonesia

Algoritma Penatalaksanaan Konstipasi

dengan Waktu Transit Normal (NTC)
Normal Ttransit Constipation (NTC)
Serat + Probiotik
Milk of magnesia / bisacodyl / laktulosa / PEG
Perbaikan
Lanjutkan terapi

Tidak ada perbaikan

Serat+probiotik+bisacodyl+laktulosa/
MOM/PEG

Perbaikan
Lanjutkan terapi

Tidak ada perbaikan

Serat+probiotik+bisacodyl+laktulosa+PEG
Perbaikan
Lanjutkan terapi

Tidak ada perbaikan

Sesuaikan terapi

Algoritma Penatalaksanaan Konstipasi

Waktu Transit Lambat (STC)
Slow transit constipation
Serat +probiotik+ MOM+bisakodil/ prokinetik
Tidak ada perbaikan

Perbaikan
Lanjutkan terapi

Tambahan laktulosa / PEG

Perbaikan

Lanjutka terapi

Tidak ada perbaikan

Pertimbangkan operasi

Algoritma Penatalaksanaan
untuk Disfungsi Anorektal
Disfungsi Anorektal

Serat + Probiotik, Supositoria, Enema

Biofeedback + Serat + Probiotik

Perbaikan

Tak ada Perbaikan

Follow up

Investigasi Ulang

Mechanism exhibited by probiotics, prebiotics and

synbiotics against prevention of colorectal cancer

Maya Raman,Gut Microbes 4:3, 181192; May/June 2013

Probiotics, synbiotics, prebiotics mechanism

of actions (CRC)

Desmutagenic potential of probiotics in preventing cancer. Interaction of probiotics

with immature dendritic cells (DC) leading to activation of cascade and NK cell
activation, proliferation and cytotoxic activity.

PLoS ONE 7(4) 2012 : e34938. doi:10.1371/

journal.pone.0034938

Conclusions/Significance:
Probiotics are generally beneficial in treatment and prevention of gastrointestinal
diseases.
Efficacy was not observed for Travelers Diarrhea or Necrotizing Enterocolitis or
for the probiotic species L. acidophilus, L. plantarum, and B. infantis.
When choosing to use probiotics in the treatment or prevention of
gastrointestinal disease, the type of disease and probiotic species (strain)
are the most important factors to take into consideration

Candidates of Probiotic
Lactobacillus
~ Acidophilus, reuteri, casei, planatarum,
rhamnosus GG

Bifidobacteria
~ Bifidum, breve, infantis, longum

Streptococcus
~ Thermophilus

Saccharomyces
Several combinations

Bifidobacteria : physiology effect

and clinical usage
1. To improve colonic transit time (esp.for slow transit
time).
2. To improve colon fermentation, B12 vitamin synthesis
3. To produce inhibitor factor, to inhibit adhesion site
and to stimulate immunity
4. Improvement in colon immunity system
5. Effects on various gastrointestinal disease ; acute
diarrhea infection, rotavirus infection, AAD, pauchitis
and IBD, IBS, colon tumour.
6. Effect on deconjugation/bile acid hydrolisis
7. Effect on cell proliferation
C Picard et al. Aliment Pharmacol Ther 2005.
22, 495512

Probiotics - Constipation and Transit Time

17 studies on constipation/transit time, with

yoghurt, yoghurt enriched with probiotics,
fermented milks or probiotic tablets
12 studies showed some benefits for
constipation or shortened TT
Probiotic-enriched yoghurts appeared more
effective
Effects on TT more apparent in subjects with
long TT

Probiotics - Constipation and Transit Time

Healthy elderly subjects

Gp 1 TT
Gp 2 TT

24.61.7h,
n=50
64.113.3 h n=50

Randomized study no placebo

B. animalis DN173010 ferm milk (108/g) 2 or 3/d
2 weeks treatment, Oro-faecal TT before & after

Results:
Gp1 (rapid TT) 10%
Gp2 (slow TT) 40%
(Meance et al Microb Ecol Health Dis
13 217 2001)

Alimentary Pharmacology & Therapeutics 2008, 29 ; 104114

Conclusions

This probiotic resulted in improvements in

objectively measured abdominal
girth and gastrointestinal transit, as well as
reduced symptomatology.

These data support the concept that

accelerating transit is a useful strategy for
treating distension.

Mechanism

Probiotics Improve Gut Motility

in IBS

Germ free

ctobacilli acidophilus

Bifidobacterium bifidum

Mechanism

Probiotics Modulate Bowel Flora

in IBS

Open label trial N=85

Bifido, Lactobacillus and Enterococcus, 4 weeks

Fecal Flora Change after Treatment (CFU/g)

*P<0.05
**P<0.01
Fan et al. J Zhejiang Univ SCIENCE B, 2006, 7(12):987-991 987

The Intervention Study of One

Probiotics Yogurt Containing
Bifidobacterium Lactis DN-173 010
on Constipation-Predominant
Irritable Bowel Syndrome

Chen Sheng-liang, MD PhD

Renji Hospital, School of Medicine
Shanghai Jiaotong University

Dec. 3, 2010 Tokyo

Aims
To investigate the efficacy of one probiotics Yogurt
containing ND 173 010 on Chinese IBS-C patients :
1 Symptoms (abdominal discomfort, etc)
2 Defecation habits and stool consistency
3 Colonic transit time of all sected colon
4 Micro-flora in IBS-C patients and healthy volunteers
5) Safety and compliance of two test products

Methods

Subjects

Rating of abdominal symptom

Bristol standard of stool characteristics

IBS-C subjects (Rome III criteria) 40, aged 18-75

Healthy volunteers : without IBS-C or constipation symptoms
Severity = severity*frequency
Symptoms abdominal pain, abdominal distension,
defecation
difficulty
Grades: 0 = none; 1 = awareness from doctors 2 = mild
but not
affect work or life 3 = affect work or life

0 Bristol 4-7 1 Bristol 3 2 Bristol 2 3 Bristol 1

o CTT (Radiology Procedure , meaasure w/Arhan Method)

Study Protocol
Probiotics yogurt consumption
IBS-C Washout

Non-probiotics yogurt
consumption
Probiotics yogurt consumption

Controls

-1 week

Non-probiotics yogurt
consumption
0 week
2 week

4 week

Run
in
Symptoms score, Colonic transit time, and Bowel movements
evaluation

The sore of difficult defecation

The Effect of Probiotics Yogurt on

Individual Abdominal Symptoms in IBS-C
Patients
P<0.01

20

P<0.01

P<0.01
15
10

Fig 5. The defecation difficulty score

decreased significantly after probiotics
yogurt consumption both in 2 weeks and 4
weeks than those after non-probiotics
yogurt consumption (P<0.01)

5
0

n=20

Probiotics yogurt
Average bowel movements/week

Before consumption
2 Weeks
4 Weeks

10

n=20
Non-Probiotics yogurt

P<0.01

Before consumption
2 Weeks
4 Weeks

8
6
4
2
0

n=20
Probiotics yogurt

n=20
Non-Probiotics yogurt

Fig 6. The bowel movements increased

significantly after probiotics yogurt
consumption in both 2 weeks and 4 weeks
than those after non-probiotics yogurt
consumption (P<0.01)

The Effects on Colonic Transit Time

CTT=1.2ni

40

Right colon
Left colon
Rectosigmoid colon

30

P<0.01

20

Fig 7. The baseline difference of colonic

transit time in each section between IBS-C
patients and healthy controls.

10
0

20

CTT=1.2ni

15

P<0.05

Before consumption
2 Weeks
4 Weeks

10
5

Fig 8. After probiotics yogurt consumption

2 weeks and 4 weeks, colonic transit time
were decreased in healthy controls with
significant change in left colon (P<0.05).

CTT=1.2ni

20
15
10
5
0

Before consumption
2 Weeks
4 Weeks

Fig 9. After non-probiotics yogurt

consumption 2 weeks and 4 weeks, The
colonic transit time were not significant
changed in healthy controls .

The Effects on Colonic Transit

Time
CTT=1.2ni

40
30

P<0.01
P<0.01

20

Fig 10. After probiotics yogurt

consumption 2 weeks and 4 weeks, The
colonic transit time in each section were
decreased in IBS-C patients (P<0.01).

10
0

CTT=1.2ni

40
30
20
10
0

P<0.01

Before consumption
2 Weeks
4 Weeks

P<0.05

Before consumption
2 Weeks
4 Weeks

Fig 11. After non-probiotics yogurt

consumption 2 weeks and 4 weeks, Only the
right colonic transit time were decreased
in IBS-C patients (P<0.01).

World J Gastroenterol 2008 October 28; 14 (40): 62376243

Study Protocol
Methods :
RCT 135 female subjects with constipation,
observed for 2 weeks with therapy of 100 g of
fermented milk containing Bifidobacterium lactis
DN-173010 Activia (case group) or 100 g non
probiotic milk (control group).
Parameter Outcome : stool frequency, defecation
condition score, stool consistency, food intake and
Activia is fermented milk product containing
safety.
probiotic B.lactis DN-173010 (1.25 x 1010 cfu/pot) and
yoghurt as L.bulgaricus and S thermophilus (1.2 x
109 cfu/pot)

Summary

Probiotic (B lactis DN -173010)

Activia
has useful effects after 1-2 weeks
consumption on stool frequency,
defecation condition score, stool
consistency in female patients with
constipation

Summary
First study shows effect of B.lactis

DN-173010 in different etnic

population with different diet pattern
from Europe population
First study, study which proves
positive effect of B.lactis DN 173010
on contipation patients

Summary
Most of constipation in population:
functional constipation
Lifestyle modification and supportive
therapy (probiotic) are important basic
therapy
Pharmacological therapy that can be
given are laxative/non laxative agent
Need more study in Indonesia
probiotic role in constipation

Effects of probiotic treatment in 7 randomized

controlled trials in surgical patients with a high risk
of post operative bacterial infections

Gut Microbes 1:3, 164-185; May/June 2010

Clinical Implications and

Conclusions
Current evidence supports the role of probiotics
in a broad range of gastrointestinal conditions.
Sufficient evidence exists to indicate that
probiotics are effective in the prevention and
treatment of diarrhea, although the precise
strains (or combinations), formulations that
provide the greatest efficacy, and patient groups
that derive the greatest benefit remain unclear

 Initial evidence is also supportive of a role for

probiotics in pouchitis and, perhaps, ulcerative
colitis, although the data are relatively limited for the
later indication.
Finally, probiotics appear to be efficacious in IBS, but
again the magnitude of benefit is uncertain, available
clinical data are largely derived from inadequately
designed studies, and the most effective species and
strains remain uncertain.
Across all indications, the long-term effects and
safety of probiotic use remain uncertain. Clearly, larger,
well-designed, confirmatory clinical trials are needed to
evaluate the efficacy of probiotics across indications

Trend of changes in psychometric hepatic encephalopathy

scores from baseline to 10th week among the three groups.
PHES, psychometric hepatic encephalopathy score

Conclusions

This probiotic resulted in improvements in

objectively measured abdominal
girth and gastrointestinal transit, as well as
reduced symptomatology.

These data support the concept that

accelerating transit is a useful strategy for
treating distension.

Mechanism

Probiotics Improve Gut Motility

in IBS

Germ free

ctobacilli acidophilus

Bifidobacterium bifidum

Mechanism

Probiotics Modulate Bowel Flora

in IBS

Open label trial N=85

Bifido, Lactobacillus and Enterococcus, 4 weeks

Fecal Flora Change after Treatment (CFU/g)

*P<0.05
**P<0.01
Fan et al. J Zhejiang Univ SCIENCE B, 2006, 7(12):987-991 987

The Intervention Study of One

Probiotics Yogurt Containing
Bifidobacterium Lactis DN-173 010
on Constipation-Predominant
Irritable Bowel Syndrome

Chen Sheng-liang, MD PhD

Renji Hospital, School of Medicine
Shanghai Jiaotong University

Dec. 3, 2010 Tokyo

Aims
To investigate the efficacy of one probiotics Yogurt
containing ND 173 010 on Chinese IBS-C patients :
1 Symptoms (abdominal discomfort, etc)
2 Defecation habits and stool consistency
3 Colonic transit time of all sected colon
4 Micro-flora in IBS-C patients and healthy volunteers
5) Safety and compliance of two test products

Methods

Subjects

Rating of abdominal symptom

Bristol standard of stool characteristics

IBS-C subjects (Rome III criteria) 40, aged 18-75

Healthy volunteers : without IBS-C or constipation symptoms
Severity = severity*frequency
Symptoms abdominal pain, abdominal distension,
defecation
difficulty
Grades: 0 = none; 1 = awareness from doctors 2 = mild
but not
affect work or life 3 = affect work or life

0 Bristol 4-7 1 Bristol 3 2 Bristol 2 3 Bristol 1

o CTT (Radiology Procedure , meaasure w/Arhan Method)

Study Protocol
Probiotics yogurt consumption
IBS-C Washout

Non-probiotics yogurt
consumption
Probiotics yogurt consumption

Controls

-1 week

Non-probiotics yogurt
consumption
0 week
2 week

4 week

Run
in
Symptoms score, Colonic transit time, and Bowel movements
evaluation

The sore of difficult defecation

The Effect of Probiotics Yogurt on

Individual Abdominal Symptoms in IBS-C
Patients
P<0.01

20

P<0.01

P<0.01
15
10

Fig 5. The defecation difficulty score

decreased significantly after probiotics
yogurt consumption both in 2 weeks and 4
weeks than those after non-probiotics
yogurt consumption (P<0.01)

5
0

n=20

Probiotics yogurt
Average bowel movements/week

Before consumption
2 Weeks
4 Weeks

10

n=20
Non-Probiotics yogurt

P<0.01

Before consumption
2 Weeks
4 Weeks

8
6
4
2
0

n=20
Probiotics yogurt

n=20
Non-Probiotics yogurt

Fig 6. The bowel movements increased

significantly after probiotics yogurt
consumption in both 2 weeks and 4 weeks
than those after non-probiotics yogurt
consumption (P<0.01)

The Effects on Colonic Transit Time

CTT=1.2ni

40

Right colon
Left colon
Rectosigmoid colon

30

P<0.01

20

Fig 7. The baseline difference of colonic

transit time in each section between IBS-C
patients and healthy controls.

10
0

20

CTT=1.2ni

15

P<0.05

Before consumption
2 Weeks
4 Weeks

10
5

Fig 8. After probiotics yogurt consumption

2 weeks and 4 weeks, colonic transit time
were decreased in healthy controls with
significant change in left colon (P<0.05).

CTT=1.2ni

20
15
10
5
0

Before consumption
2 Weeks
4 Weeks

Fig 9. After non-probiotics yogurt

consumption 2 weeks and 4 weeks, The
colonic transit time were not significant
changed in healthy controls .

The Effects on Colonic Transit

Time
CTT=1.2ni

40
30

P<0.01
P<0.01

20

Fig 10. After probiotics yogurt

consumption 2 weeks and 4 weeks, The
colonic transit time in each section were
decreased in IBS-C patients (P<0.01).

10
0

CTT=1.2ni

40
30
20
10
0

P<0.01

Before consumption
2 Weeks
4 Weeks

P<0.05

Before consumption
2 Weeks
4 Weeks

Fig 11. After non-probiotics yogurt

consumption 2 weeks and 4 weeks, Only the
right colonic transit time were decreased
in IBS-C patients (P<0.01).

Study flowchart demonstrating patient

flow throughout the study procedures

World J Gastroenterol 2008 October 28; 14 (40): 62376243

Study Protocol
Methods :
RCT 135 female subjects with constipation,
observed for 2 weeks with therapy of 100 g of
fermented milk containing Bifidobacterium lactis
DN-173010 Activia (case group) or 100 g non
probiotic milk (control group).
Parameter Outcome : stool frequency, defecation
condition score, stool consistency, food intake and
Activia is fermented milk product containing
safety.
probiotic B.lactis DN-173010 (1.25 x 1010 cfu/pot) and
yoghurt as L.bulgaricus and S thermophilus (1.2 x
109 cfu/pot)

Summary

Probiotic (B lactis DN -173010)

Activia
has useful effects after 1-2 weeks
consumption on stool frequency,
defecation condition score, stool
consistency in female patients with
constipation

Summary
First study shows effect of B.lactis

DN-173010 in different etnic

population with different diet pattern
from Europe population
First study, study which proves
positive effect of B.lactis DN 173010
on contipation patients

Summary
Most of constipation in population:
functional constipation
Lifestyle modification and supportive
therapy (probiotic) are important basic
therapy
Pharmacological therapy that can be
given are laxative/non laxative agent
Need more study in Indonesia
probiotic role in constipation