Effect ofLactobacillusingestion on the gastrointestinal mucosal barrier alterations induced by indometacin in humans

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Abstract
Background: Chronic nonsteroidal anti‐inflammatory drug (NSAID) ingestion strongly affects the gastrointestinal mucosa as a first stage before ulceration. SomeLactobacillusstrains may stabilize the mucosal barrier by increasing mucin expression, reducing bacterial overgrowth, stimulating mucosal immunity and synthetizing antioxidant substances; these events are altered in NSAID‐associated gastroenteropathy.Aim: To determine whether ingestion of the probioticLactobacillusGG (LGG) protects the gastrointestinal mucosa against indometacin‐induced alterations of permeability.Subjects and methods: Four gastrointestinal permeability tests were carried out in random order in 16 healthy volunteers: (i) basal; (ii) after indometacin; (iii) after 5 days of living LGG ingestion before indometacin administration; (iv) after 5 days of heat‐killed LGG ingestion before indometacin administration.Results: Indometacin significantly increased basal sucrose urinary excretion (29.6 mg [17.1–42.1] vs. 108.5 mg [68.2–148.7],P=0.0030) (means [95% CI]) and lactulose/mannitol urinary excretion (1.03% [0.73–1.32] vs. 2.93% [1.96–3.90],P=0.00012). Heat‐killed LGG did not modify the indometacin‐induced increase of gastrointestinal permeability, while live bacteria significantly reduced the alteration of gastric (47.8 mg [31.1–64.6],P=0.012) but not intestinal permeability induced by NSAID.Conclusions: Regular ingestion of LGG protects the integrity of the gastric mucosal barrier against indometacin, but has no effect at the intestinal level.