Use of probiotics
Treatment with strains of living beneficial bacteria was long considered the safest and most sustainable approach against IBD. Although some of them seem effective to treat UC, studies regarding their use against CD are still inconclusive.
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Probiotics are living microorganisms which, when ingested in adequate quantities, provide health benefits. Several mechanisms of action might underlie the beneficial effects of probiotics in IBD: inducing changes in the gut microbiota composition thus reducing gut dysbiosis; regulating metabolic activity of the gut microbiota; eliminating pro-inflammatory processes; and immunomodulation12.
Contrasted results depending on the disease
In UC, the efficacy of probiotics containing one and only strain (from the E. coli Nissle 1917 species), as well as milk fermented with Bifidobacterium, in inducing disease remission was comparable to that of standard anti-inflammatory treatments (mesalazine)12. Different combinations of bacterial strains were also tested, but with no effect on disease remission, with one exception: a cocktail of 8 different strains15 induced a significant reduction in UC symptoms13,16,(rectal bleeding and stool frequency) and a study proved its efficacy in maintaining remission. This same cocktail also seems to be efficient in patients with pouchitis: it prevents inflammatory flares arising from coloproctectomy and maintains remission17,18, However, probiotics have not shown to be useful in CD so far. Results from the rare studies performed are weak and inconclusive, including with strains that have proven to be efficient against UC and pouchitis12,15
Heterogeneity of non-clinical and clinical results could be at least partially attributed to factors related to the host (age, gender, diet, disease location, severity, family history of IBD) and the probiotic preparations that were used (type of strain, concentration, mode of administration, potential colonization, and strain survival rate). Other factors, such as dose and duration of probiotics administration, are also supposed to play a primary role in the success of this therapeutic approach, whose adverse effects are minimal, or even nonexistent12.
15 Lactobacillus paracasei, L. plantarum, L. acidophilus, L. delbrueckii, Bifidobacterium longum, B. breve, B. infantis, Streptococcus thermophilus.
16 Derwa Y, Gracie DJ, Hamlin PJ, et al. Systematic review with meta-analysis: the efficacy of probiotics in inflammatory bowel disease. Aliment Pharmacol Ther. 2017;46(4):389-400.
17 Shen J, Zuo ZX, Mao AP. Effect of probiotics on inducing remission and maintaining therapy in ulcerative colitis, Crohn's disease, and pouchitis: meta-analysis of randomized controlled trials. Inflamm Bowel Dis. 2014;20(1):21-35.
18 Dong J, Teng G, Wei T, et al. Methodological Quality Assessment of Meta-Analyses and Systematic Reviews of Probiotics in Inflammatory Bowel Disease and Pouchitis. PLoS One. 2016;11(12):e0168785.