The Efficacy of Probiotics, Prebiotic Inulin-Type Fructans, and Synbiotics in Human Ulcerative Colitis: A Systematic Review and Meta-Analysis

Abstract

Studies of probiotics, fructan-type prebiotics, and synbiotics in patients with ulcerative colitis (UC) show significant heterogeneity in methodology and results. Here, we study the efficacy of such interventions and the reasons for the heterogeneity of their results. Eligible random controlled trials were collected from the PUBMED and SCOPUS databases. A total of 18 placebo-controlled and active treatment-controlled (i.e., mesalazine) studies were selected with a Jadad score ≥ 3, including 1491 patients with UC. Data for prebiotics and synbiotics were sparse and consequently these studies were excluded from the meta-analysis. The UC remission efficacy of probiotics was measured in terms of relative risk (RR) and odds ratio (OR). Significant effects were observed in patients with active UC whenever probiotics containing bifidobacteria were used, or when adopting the US Food and Drug Administration (FDA)-recommended scales (UC Disease Activity Index and Disease Activity Index). By the FDA recommended scales, the RR was 1.55 (CI95%: 1.13–2.15, p-value = 0.007, I2 = 29%); for bifidobacteria-containing probiotics, the RR was 1.73 (CI95%: 1.23–2.43, p-value = 0.002, I2 = 35%). No significant effects were observed on the maintenance of remission for placebo-controlled or mesalazine-controlled studies. We conclude that a validated scale is necessary to determine the state of patients with UC. However, probiotics containing bifidobacteria are promising for the treatment of active UC.

Mechanisms of Action of Prebiotics and Their Effects on Gastro-Intestinal Disorders in Adults

“…The second study of the same research group evaluated a 10 g administration of fructans to 67 subjects affected by mild IBD for 4 weeks, and they had no effects on F. prausnitzii and B. adolecentis, while Rhamnococcus gnavus and B. longum increased, with a significant improvement of disease symptoms [107]. Furthermore, two studies included in a recent metanalysis-one focused on prebiotics in an adult population and the other in children and young individuals-reported that the response to mesalazine is positively influenced by prebiotics through a mitigation of intestinal inflammation [141].…”

Protective Effect of Bruguiera gymnorrhiza (L.) Lam. Fruit on Dextran Sulfate Sodium-Induced Ulcerative Colitis in Mice: Role of Keap1/Nrf2 Pathway and Gut Microbiota

“…When intestinal flora is out of balance, harmful bacteria grow excessively, which leads to the occurrence of colon diseases. It has been revealed that probiotics are closely related to human health, especially the intestinal barrier (Asto et al, 2019). Therefore, the regulation of intestinal microecology is conducive to the control of development of UC.…”

Enteral Nutrition Supplemented with Transforming Growth Factor-β, Colostrum, Probiotics, and Other Nutritional Compounds in the Treatment of Patients with Inflammatory Bowel Disease

“…There were six metanalyses published during the last two years [13,[69][70][71][72][73], the results of which are summarized in Table 4. The conclusions that we can draw from these metaanalyses could be the following: The administration of probiotics either alone or in combination with mesalazine could increase the rate of clinical remission of patients with UC.…”