Exploring the use of Bimuno® GOS on traveller’s diarrhoea
Prevalence, causes
and risk factors
Traveller’s diarrhoea (TD) is the most common cause of gastrointestinal (GI) issues encountered by those travelling in high-risk geographical areas (NICE., 2023). Whilst the prevalence of TD is dependent on the season of travel and destination, it is thought to affect up to 70% of traveller’s, particularly those visiting low or middle-income countries (NICE., 2023).
TD can be defined as passing 3 or more stools in a 24-hours period accompanied by one additional GI symptom that occurs during or within 10-days of travel (NICE., 2023). The cause is infectious in nature, with bacteria, such as E. coli and Campylobacter, responsible for up to 90% of cases (NICE., 2023). Generally, TD arises because of poor sanitation and hygiene standards in lesser-developed countries, and certain demographics, such as infants and children, are at a higher risk of acquiring such infections (Adler et al., 2021; Turunen et al., 2020).
Enteric immunity and competitive exclusion
The gut microbiome plays an important role in immunity and supports the gut barrier, a physical and chemical lining where also the mucosal immune system resides (Shi et al., 2017). Microbial metabolites, namely short chain fatty acids (SCFAs), are essential nutrients for intestinal epithelial cells and can facilitate crosstalk with the mucosal immune system, resulting in immuno-modulatory benefits such as promoting an anti-inflammatory response through the release of cytokines such as interleukin-10 and increasing natural killer cell activity (Gonçalves et al., 2018; Hasle et al., 2017).
Commensal gut microbes, such as bifidobacteria, can also restrict the growth of potential pathogenic microbes from colonising by competing for available nutrients, in what is referred to as competitive exclusion (Horrocks et al., 2023). This mechanism of outcompeting pathogens and limiting the nutrients available to them can prevent their adhesion in the GI tract and prevent the onset of infection, such as that seen in TD (Woo and Ahn., 2013).
TD and Bimuno® GOS
In two larger, independent, parallel, double-blind, placebo-controlled trials, the efficacy of Bimuno® GOS in preventing and reducing the impact of TD in healthy adults travelling to geographical areas of risk was assessed (Drakoularakou et al., 2009; Hasle et al., 2017).
In one study, participants were randomly assigned to placebo or intervention groups (Hasle et al., 2017). The intervention group consumed 2.75g/day active Bimuno® GOS for 5-days prior to departure and throughout their travel period lasting between 7 and 15 days (Hasle et al., 2017. Each day, participants kept a diarrhoea log, where diarrhoea was defined as greater than 3 loose stools per day. The results showed that Bimuno® GOS significantly lowered the incidence of TD and prevented 1-day, self-limiting diarrhoea in the 334 participants adhering strictly to the protocol (Hasle et al., 2017).
Similarly, Drakoularakou and colleagues (2009) recruited healthy volunteers intending to travel to countries with low or high risk for TD for between a total of 14 and 60 days. A total of 159 volunteers were assigned to either the placebo or intervention groups, where they consumed 2.75g/day of either maltodextrin or Bimuno® GOS. 31% of the individuals recruited reported experiencing acute diarrhoea, however, the incidence was significantly lower in those consuming Bimuno® GOS (38%) compared to the placebo group (62%). Diarrhoeal duration was also shorter in the group consuming Bimuno® GOS, lasting on average 2.4-days vs the placebo group who experienced 4.6-days of diarrhoea. Along with a lower incidence and duration of TD, Bimuno® GOS also reduced accompanying abdominal pain. Post-travel, participants completed the World Health Organization Quality of Life (QoL)-BREF which revealed an overall better quality of life (QoL) in those who experienced TD whilst consuming Bimuno® GOS.
The takeaway
Collectively, these results are suggestive that prebiotics could be an effective way to prevent and reduce the incidence and duration of TD, as well as accompanying abdominal pain, whilst also improving QoL.
Read the full open-access articles here
References
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Drakoularakou, A., Tzortzis, G., Rastall, R.A. and Gibson, G.R. (2009). A double-blind, placebo-controlled, randomized human study assessing the capacity of a novel galacto-oligosaccharide mixture in reducing travellers’ diarrhoea. European Journal of Clinical Nutrition, [online] 64(2), pp.146–152. Available at: https://www.nature.com/articles/ejcn2009120 [Accessed 5 Sep. 2023].
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