Effectiveness of probiotic therapy for the prevention of relapse in patients with inactive ulcerative colitis

Summary Background Ulcerative colitis (UC) and Crohn's disease (CD) are inflammatory bowel diseases (IBD). Evidence implicates disturbances of the gastrointestinal microbiota in their pathogenesis. Aim To perform a systematic review and meta‐analysis to examine the efficacy of probiotics in IBD. Methods MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (until November 2016). Eligible randomised controlled trials (RCTs) recruited adults with UC or CD, and compared probiotics with 5‐aminosalicylates (5‐ASAs) or placebo. Dichotomous symptom data were pooled to obtain a relative risk (RR) of failure to achieve remission in active IBD, or RR of relapse of disease activity in quiescent IBD, with 95% confidence intervals (CIs). Results The search identified 12 253 citations. Twenty‐two RCTs were eligible. There was no benefit of probiotics over placebo in inducing remission in active UC (RR of failure to achieve remission=0.86; 95% CI=0.68‐1.08). However, when only trials of VSL#3 were considered there appeared to be a benefit (RR=0.74; 95% CI=0.63‐0.87). Probiotics appeared equivalent to 5‐ASAs in preventing UC relapse (RR=1.02; 95% CI=0.85‐1.23). There was no benefit of probiotics in inducing remission of active CD, in preventing relapse of quiescent CD, or in preventing relapse of CD after surgically induced remission. Conclusions VSL#3 may be effective in inducing remission in active UC. Probiotics may be as effective as 5‐ASAs in preventing relapse of quiescent UC. The efficacy of probiotics in CD remains uncertain, and more evidence from RCTs is required before their utility is known.

show abstract

“…Three of the six RCTs compared probiotics with 5‐ASA, and three compared probiotics with placebo . No trials were at low risk of bias.…”

Section: Resultsmentioning

confidence: 99%

Systematic review with meta‐analysis: the efficacy of probiotics in inflammatory bowel disease

Derwa

Gracie

Hamlin

et al. 2017

Aliment Pharmacol Ther

296

217

View full text Add to dashboard Cite

show abstract

“…Probiotics, live microorganisms that confer a health benefit on the host when administered clinically to inhabit inflammatory reactions, abrogate disorders of the intestinal flora (8), prevent and treat diarrhea and allergy (9) and alleviate symptoms of patients with ulcerative colitis (10). However, different species or even different strains of the same species may have different functions in the regulation of intestinal flora and development of the intestinal immune system (11).…”

Section: Introductionmentioning

confidence: 99%

Effect of Clostridiumï¿½butyricum supplementation on the development of intestinal flora and the immune system of neonatal mice

et al. 2017

View full text Add to dashboard Cite

Abstract. The objective of the present study was to examine whether Clostridium butyricum supplementation has a role in the regulation of the intestinal flora and the development of the immune system of neonatal mice. A total of 30 pregnant BALB/c mice, including their offspring, were randomly divided into three groups: In the maternal intervention group (Ba), maternal mice were treated with Clostridium butyricum from birth until weaning at postnatal day 21 (PD21) followed by administration of saline to the offspring at PD21-28; in the offspring intervention group (Ab), breast-feeding maternal mice were supplemented with saline and offspring were directly supplemented with Clostridium butyricum from PD21-28; in the both maternal and offspring intervention group (Bb), both maternal mice and offspring were supplemented with Clostridium butyricum at PD 0-21 and at PD21-28. While mice in the control group were given the same volume of normal saline. Stool samples from the offspring were collected at PD14, -21 and -28 to observe the intestinal flora by colony counts of Enterococcus spp., Enterobacter spp., Bifidobacterium spp. and Lactobacillus spp. Detection of intestinal secreted immunoglobulin A (sIgA) levels and serum cytokine (interferon-γ, and interleukin-12, -4 and -10) levels in offspring was performed to evaluate the effect on their immune system. The results revealed that compared with the control group, offspring in the Ba group displayed significantly decreased stool colony counts of Enterococcus spp. (t=3.123, P<0.01) at PD14 and significantly decreased counts of Enterobacter spp. at P<0.05 and t=2.292, P<0.05, respectively). Compared with the control group, the stool colony counts of Bifidobacterium spp. and Lactobacillus spp. were significantly increased in the Ba group at PD21 (t=3.085, P<0.01 and t=2.8508, P<0.05, respectively). The Ab group had significantly higher stool colony counts of Bifidobacterium spp. and Lactobacillus spp. at PD28, compared with the control group (Q=7.679, P<0.01 and Q=6.149, P<0.01, respectively). There were no significant differences identified in the sIgA levels of the intestinal fluid and serum cytokine levels between the control group and the intervention groups. In conclusion, Clostridium butyricum administered to breast-feeding maternal mice was able to regulate the intestinal flora balance in their offspring. However, due to insignificant effects on sIgA level and the associated cytokines, Clostridium butyricum had a limited influence on the balance of type 1 vs. type 2 T-helper cells. However, using Clostridium butyricum as an invention may be a safe method for improving the balance of intestinal flora and associated processes in offspring.

show abstract

“…microbiological studies have detected a significant reduction of Bifidobacteria and lactobacilli and an overgrowth of specific pathogenic strains, such as deltaproteobacteria and Bilophila wadsworthia. The use of probiotics in combination with the standard treatment, improves patients' quality of life and life expectancy, reducing significantly clinical symptoms and minimizing side effects [21][22][23][24][25] . The results of our study confirm the beneficial effects of probiotics on Uc activity, partly by improving patient's response to anti-inflammatory treatment.…”

Section: Discussionmentioning

confidence: 99%

The long-term effects of probiotics in the therapy of ulcerative colitis: A clinical study

Palumbo¹,

Romeo²,

Gammazza³

et al. 2016

BIOMED PAP

View full text Add to dashboard Cite

Aim.Intestinal dysbiosis seems to be the leading cause of inflammatory bowel diseases, and probiotics seems to represent the proper support against their occurrence. Actually, probiotic blends and anti-inflammatory drugs represent a weapon against inflammatory bowel diseases. The present study evaluates the long-term (2 years) effects of combination therapy (mesalazine plus a probiotic blend of Lactobacillus salivarius, Lactobacillus acidophilus and Bifidobacterium bifidus strain BGN4) on ulcerative colitis activity. Method. Sixty patients with moderate-to-severe ulcerative colitis were enrolled: 30 of them were treated with a single daily oral administration of mesalazine 1200 mg; 30 patients received a single daily oral administration of mesalazine 1200 mg and a double daily administration of a probiotic blend of Lactobacillus salivarius, Lactobacillus acidophilus and Bifidobacterium bifidus strain BGN4. The treatment was carried out for two years and the clinical response evaluated according to the Modified Mayo Disease Activity Index. Results. All patients treated with combination therapy showed better improvement compared to the controls. In particular, the beneficial effects of probiotics were evident even after two years of treatment. Conclusions. A long-term treatment modality of anti-inflammatory drugs and probiotics is viable and could be an alternative to corticosteroids in mild-to moderate ulcerative colitis.

show abstract

Effectiveness of probiotic therapy for the prevention of relapse in patients with inactive ulcerative colitis

Abstract: Probiotics may be effective for maintaining clinical remission in patients with quiescent UC, especially those who belong to cluster I on fecal bacterial analysis.

Cited by 104 publications

References 54 publications

Systematic review with meta‐analysis: the efficacy of probiotics in inflammatory bowel disease

Systematic review with meta‐analysis: the efficacy of probiotics in inflammatory bowel disease

Effect of Clostridiumï¿½butyricum supplementation on the development of intestinal flora and the immune system of neonatal mice

The long-term effects of probiotics in the therapy of ulcerative colitis: A clinical study

Contact Info

Product

Resources

About