Gut Microbiota and Inflammatory Bowel Disease

Abstract

Bacteria play an important role in the pathogenesis of inflammatory bowel disease (IBD), its complications and its symptoms. Antibiotics can decrease tissue invasion and eliminate aggressive bacterial species. They are used in IBD to treat infective complications and for altering bacterial flora, which may result in specific anti-inflammatory effects. In addition, suppression of bacterial metabolic activities or direct effects of antibiotics on intestinal structures and functions may result in symptoms which cannot be differentiated from symptoms caused by inflammation. Although current clinical trials do not fulfill criteria of evidence-based treatment, a few placebo- or standard treatment-controlled studies suggest that metronidazole and ciprofloxacin are effective in Crohn’s colitis and ileocolitis, perianal fistulae and pouchitis. Administration of probiotics, prebiotics and synbiotics can restore a predominance of beneficial species. However, beneficial effects of probiotics in IBD are modest, strain-specific and limited to certain manifestations of disease and duration of use of the probiotic. For probiotics there is reasonable evidence of efficacy in relapse prevention in chronic pouchitis and ulcerative colitis, and suggestive evidence for postoperative prevention in pouchitis. Therapeutic manipulation of the intestinal flora offers considerable promise for treating IBD, but must be supported by large controlled therapeutic trials before widespread clinical acceptance. These agents may become a component of treating IBD in combination with traditional anti-inflammatory and immunosuppressive agents. Probiotic strategies, based on metagenomic or metabonomic analyses, and new classes of probiotics might play an important role in the future management of IBD.

Prolonged antibiotic use induces intestinal injury in mice that is repaired after removing antibiotic pressure: implications for empiric antibiotic therapy

“…Empiric antibiotic therapy is prescribed for many human conditions including urinary tract infections (Aypak et al 2009), inflammatory bowel disease (Balfour Sartor 2004; Shanahan and Bernstein 2004; Perencevich and Burafkoff 2006; Hammer 2011) organ transplants (Hamandi et al 2009), lyme disease (Klempner et al 2001; Marques 2008; Wright et al 2012), cancer patients with febrile neutropenia caused by chemotherapy Kern et al 2013) and nursing home acquired infections in elderly patients (Xie et al 2012). Prolonged broad-spectrum empiric antibiotics are also prescribed for serious bacterial infections such as bacteremia, sepsis and pneumonia (Kollef 2008; Iapichino et al 2008; Siddiqui and Razzak 2012).…”

Probiotics as a promising treatment for inflammatory bowel disease

“…Recently, the applications of probiotics that selectively manipulate the gut microflora have gained great interest due to the feasibility of their administration and their safety as well [23]. These agents may become a component of treating IBD in combination with traditional anti-inflammatory and immunosuppressive agents [24].…”

Probiotics Applications in Autoimmune Diseases

“…In addition, the relative load of some species of colon-associated bacteria such as Bifidobacteria shows little presence in the gut of IBD patients indicating less bacterial-synchronization and disturbed quorum sensing processes in such patients. Interestingly, antibiotics are used in IBD to treat infective complications and to improve symptoms through altering the gut microfloral composition [32].…”