Probiotics for maintenance of remission in ulcerative colitis

Iheozor‐Ejiofor, Zipporah; Kaur, Lakhbir; Gordon, Morris; Baines, Patricia Anne; Sinopoulou, Vassiliki; Akobeng, Anthony K

doi:10.1002/14651858.cd007443.pub3

Cited by 79 publications

(36 citation statements)

References 57 publications

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“…Seven studies focused on a single bacterial strain and five studies on multiple strains. The conclusion was that at present, it is not possible to state if probiotics are able to maintain clinical remission in any of the associations studied (148).…”

Section: Inflammatory Bowel Diseasesmentioning

confidence: 85%

Anti-Inflammatory and Immunomodulatory Effects of Probiotics in Gut Inflammation: A Door to the Body

et al. 2021

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Hosting millions of microorganisms, the digestive tract is the primary and most important part of bacterial colonization. On one side, in cases of opportunistic invasion, the abundant bacterial population inside intestinal tissues may face potential health problems such as inflammation and infections. Therefore, the immune system has evolved to sustain the host–microbiota symbiotic relationship. On the other hand, to maintain host immune homeostasis, the intestinal microflora often exerts an immunoregulatory function that cannot be ignored. A field of great interest is the association of either microbiota or probiotics with the immune system concerning clinical uses. This microbial community regulates some of the host’s metabolic and physiological functions and drives early-life immune system maturation, contributing to their homeostasis throughout life. Changes in gut microbiota can occur through modification in function, composition (dysbiosis), or microbiota–host interplays. Studies on animals and humans show that probiotics can have a pivotal effect on the modulation of immune and inflammatory mechanisms; however, the precise mechanisms have not yet been well defined. Diet, age, BMI (body mass index), medications, and stress may confound the benefits of probiotic intake. In addition to host gut functions (permeability and physiology), all these agents have profound implications for the gut microbiome composition. The use of probiotics could improve the gut microbial population, increase mucus-secretion, and prevent the destruction of tight junction proteins by decreasing the number of lipopolysaccharides (LPSs). When LPS binds endothelial cells to toll-like receptors (TLR 2, 4), dendritic cells and macrophage cells are activated, and inflammatory markers are increased. Furthermore, a decrease in gut dysbiosis and intestinal leakage after probiotic therapy may minimize the development of inflammatory biomarkers and blunt unnecessary activation of the immune system. In turn, probiotics improve the differentiation of T-cells against Th2 and development of Th2 cytokines such as IL-4 and IL-10. The present narrative review explores the interactions between gut microflora/probiotics and the immune system starting from the general perspective of a biological plausibility to get to the in vitro and in vivo demonstrations of a probiotic-based approach up to the possible uses for novel therapeutic strategies.

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Section: Inflammatory Bowel Diseasesmentioning

confidence: 85%

Anti-Inflammatory and Immunomodulatory Effects of Probiotics in Gut Inflammation: A Door to the Body

et al. 2021

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“…Certain probiotic strains have discrete effects on mucosal immune function, such as that seen with Lactobacillus plantarum TIFN1010 which modulates gene transcription pathways related to cell-cell adhesion and mucosal healing processes (238). However, robust clinical data to support their use remains limited, with systematic reviews in IBD (246)(247)(248), Irritable bowel syndrome (IBS) (249) and C. difficile-associated diarrhoea (CDAD) (250) showing neutral or only qualified evidence for use. Similarly, practice guidelines do not recommend the routine use of probiotics (233), partly due to uncertainty regarding species or strain-dependent effects (251,252).…”

Section: Probioticsmentioning

confidence: 99%

The role of the microbiome in gastrointestinal inflammation

et al. 2021

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The microbiome plays an important role in maintaining human health. Despite multiple factors being attributed to the shaping of the human microbiome, extrinsic factors such diet and use of medications including antibiotics appear to dominate. Mucosal surfaces, particularly in the gut, are highly adapted to be able to tolerate a large population of microorganisms while still being able to produce a rapid and effective immune response against infection. The intestinal microbiome is not functionally independent from the host mucosa and can, through presentation of microbe-associated molecular patterns and generation of microbial-derived metabolites, fundamentally influence mucosal barrier integrity and modulate host immunity. In a healthy gut there is an abundance of beneficial bacteria that help to preserve intestinal homeostasis, promote protective immune responses and limit excessive inflammation. The importance of the microbiome is further highlighted during dysbiosis where a loss of this finely-balanced microbial population can lead to mucosal barrier dysfunction, aberrant immune responses, and chronic inflammation that increases the risk of disease development. Improvements in our understanding of the microbiome are providing opportunities to harness members of a healthy microbiome to help reverse dysbiosis, reduced inflammation and ultimately prevent disease progression.

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“…18 In contrast, the Cochrane Collaboration review that included 12 studies (n = 1,473 participants) showed that the effectiveness of probiotics in the management of UC patients remains uncertain. 19 The review revealed no statistical differ-ence in the clinical relapse (RR, 1.01; 95% CI, 0.84-1.22) and maintenance of remission (RR, 1.06; 95% CI, 0.90-1.25) between probiotics and mesalazine. 19 This could be due to the small sample size used for clinical trials that limit the number of data.…”

Section: Probioticsmentioning

confidence: 93%

“…19 The review revealed no statistical differ-ence in the clinical relapse (RR, 1.01; 95% CI, 0.84-1.22) and maintenance of remission (RR, 1.06; 95% CI, 0.90-1.25) between probiotics and mesalazine. 19 This could be due to the small sample size used for clinical trials that limit the number of data. Thus, no firm conclusion can be drawn on the efficacy of probiotics in maintaining remission of UC.…”

Section: Probioticsmentioning

confidence: 93%

Anti-inflammatory diet and inflammatory bowel disease: what clinicians and patients should know?

et al. 2021

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Current treatment for inflammatory bowel disease (IBD) includes the application of anti-inflammatory agents for the induction and remission of IBD. However, prolonged use of anti-inflammatory agents can exert adverse effects on patients. Recently, formulated dietary approach in treating IBD patients is utilized to improve clinical activity scores. An alteration of gastrointestinal microbiota through dietary therapy was found to reduce IBD and is recognized as a promising therapeutic strategy for IBD. One of the recommended formulated diets is an anti-inflammatory diet (AID) that restricts the intake of carbohydrates with modified fatty acids. This diet also contains probiotics and prebiotics that can promote balanced intestinal microbiota composition. However, scientific evidences are limited to support this specific dietary regime in maintaining the remission and prevention relapse of IBD. Therefore, this review aimed to summarize available data from various studies to evaluate the AID diet effectiveness which will be useful for clinicians to manage their IBD patients by application of improved dietary therapy.

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Probiotics for maintenance of remission in ulcerative colitis

Abstract: Trusted evidence. Informed decisions. Better health.

Cited by 79 publications

References 57 publications

Anti-Inflammatory and Immunomodulatory Effects of Probiotics in Gut Inflammation: A Door to the Body

Anti-Inflammatory and Immunomodulatory Effects of Probiotics in Gut Inflammation: A Door to the Body

The role of the microbiome in gastrointestinal inflammation

Anti-inflammatory diet and inflammatory bowel disease: what clinicians and patients should know?

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