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Intestinal microflora has metabolic, trophic and protective functions, and can be modified in pathological conditions and by the exogenous administration of probiotics. Probiotics are defined as living microorganisms which resist gastric, bile, and pancreatic secretions, attach to epithelial cells and colonize the human intestine. In the last twenty years research has been focused on the identification of the role of planktonic flora and adhesive bacteria in health and disease, and on the requisite of bacterial strains to become probiotic product which can be marketed. Probiotics can be commercialized either as nutritional supplements, pharmaceuticals or foods, but the marketing as a pharmaceutical product requires significant time, complex and costly research, and the demonstration of a well-defined therapeutic target. This review examines the sequential steps of research which, from the identification of a possible probiotic strain, lead to its production and marketing, summarizing the whole process existing behind its development, through its growth in laboratory, the studies performed to test its resistance to human secretions and stability, microencapsulation technologies, and safety tests.

The primary claim of probiotics is their beneficial influence on the intestinal ecosystem, which, in turn, may provide protection against gastro-intestinal infections. The positive actions on human health include antagonistic activity against pathogens, anti-allergic effects and other effects on the immune system. In recent years, the concept of probiotics evolved from food with beneficial, even if not clearly established, effects on well-being, to the new area of the nutraceuticals or functional foods. This concept was developed further into the biotherapeutics, which are the clinical applications of probiotic microorganisms originally selected for food use. Whereas several of these health claims remain controversial, well-planned clinical trials increasingly support the claims for some carefully selected probiotic strains. Aim of this review is to provide a first attempt to evaluate these two areas of use of probiotics and to draw a borderline between them. Only a more in-depth knowledge of the mechanisms underlying the probiotic effects will allow a clear discrimination between the food use and the clinical use.

reversed 2 months later. Post-operative follow-up (1-3-6 months) included a clinical, nutritional haematological and biochemical examination. Results: Pre-operatively 1 patient was asymptomatic; 1 patient presented with hematochezia; 1 patient suffered abdominal pain. All patients had hundreds of colonic adenomatous polyps with mild dysplasia; 2 patients had gastric polyps; 1 patient ileal polyps; 1 patient had echo-structural thyroid abnormalities remaining euthyroid. No intra-operative or early post-operative complications occurred. Fifteen days post-operatively, 1 patient had partial small bowel obstruction caused by intestinal infection. After closure of ileostomies, all patients had voluntary bowel movements (mean: 4 movements/day) and no soiling, improving with diet and psyllium. A gradual weight increase was observed in 2 patients. Conclusions: Laparoscopic total colectomy with transanal rectal mucosectomy assures a low rate of complications, good functional outcome and excellent cosmetic results.