Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis

Abstract

Background: Ten to 15% of patients with pouchitis experience refractory or recurrent disease. The aim of this study was to evaluate the effectiveness of a single daily high dose probiotic preparation (VSL#3) in maintaining antibiotic induced remission, and quality of life (QOL), for one year in such patients. Methods: Patients with pouchitis at least twice in the previous year or requiring continuous antibiotics, associated with a pouchitis disease activity index (PDAI) >7 (0 = perfect; 18 = worst), in whom remission was induced by four weeks of combined metronidazole and ciprofloxacin, were randomised to receive VSL#3 6 g or placebo once daily for one year or until relapse. Symptomatic, endoscopic, and histological evaluations were made before, and two and 12 months after randomisation or at the time of relapse. Remission was defined as a clinical PDAI (2 and endoscopic PDAI (1. Relapse was defined as an increased clinical PDAI score >2 and increased endoscopic PDAI score >3. QOL was assessed using the inflammatory bowel disease questionnaire (IBDQ). Results: Thirty six patients were randomised: 20 to VSL#3 and 16 to placebo. Remission was maintained at one year in 17 patients (85%) on VSL#3 and in one patient (6%) on placebo (p,0.0001). The IBDQ score remained high in the VSL#3 group (p = 0.3) but deteriorated in the placebo group (p = 0.0005). Conclusion: The once daily high dose probiotic VSL#3 is effective in maintaining antibiotic introduced remission for at least a year in patients with recurrent or refractory pouchitis. This is associated with a high level of quality of life.

Enhanced antiinflammatory capacity of a Lactobacillus plantarum mutant synthesizing modified teichoic acids

“…Their positive effects have been studied in the treatment and prevention of various intestinal disorders, including colitis in animal models and IBD in humans (14)(15)(16)(17)(18)(19). However, the mechanisms underlying these effects and especially the role of bacterial cell-wall components are currently not well understood.…”

“…Notably, their successful use in the prevention of inflammatory bowel disease (IBD) has been described (13). Recent studies have reported the positive effects of probiotics not only in the prevention of colitis in animal models (14)(15)(16) but also in the maintenance of remission after surgery in IBD (17)(18)(19). We established that the in vivo protective effect of LAB in a murine 2,4,6-trinitrobenzenesulfonic acid (TNBS)-induced model of colitis is strain-specific (20,21).…”

Quantitative Risk–Benefit Analysis of Probiotic Use for Irritable Bowel Syndrome and Inflammatory Bowel Disease

“…It is simply unknown if there is a sub-population of IBD patients with substantial immunosuppressant-related risk. In situations where efficacy is more convincingly established (pouchitis prophylaxis with VSL#3 in patients with a colectomy, for instance (63,64)), this unknown risk may be worth it, but in immunosuppressed IBD patients in general, for whom the efficacy confidence interval is broad and marginally significant, the potential severity of risk may not be worth it.…”

Probiotics – do they have a role in the pig industry?

“…Where studies have been carefully carried out, the commercial claims for many probiotics are difficult to substantiate. However, in humans, a number of gastrointestinal tract conditions appear to be alleviated by treatment with various lactic acid bacteria (LAB); for example, various types of inflammatory bowel disease have been shown to respond well to treatment with LAB (Mimura et al, 2004;Bibiloni et al, 2005). Similarly, there appears to be some benefit in prophylactic and reactive treatment with probiotics in traveller's diarrhoea (usually caused by enterotoxigenic E. coli ), rotaviral diarrhoea in infants using L. rhamnosus GG and dirrhoea related to antibiotic use (Sazawal et al, 2006;Henker et al, 2008).…”