The Role of Pre- and Probiotics in the Treatment of Inflammatory Bowel Disease

Abstract

Many patients with inflammatory bowel disease use alteranative therapy, mainly probiotics and synbiotics, to manage this intestinal condition. Despite widespread use of these natural therapies by patients, health care providers may be unfamiliar with probiotics as a treatment modality. This review describes the rationale for use of probiotics in patients with active or inactive inflammatory bowel disease, their mechanism(s) of action, and recent controlled clinical studies in which efficacy of probiotics, prebiotics and synbiotics in patients with active or inactive inflammatory bowel disease has been explored. Certain probiotics, particularly E. coli Nissle 1917 and a multi-agent mixture VSL#3, may be benefit patients with UC or pouchitis, while LactoBacillus rhamnosus GG appears less useful. In general, probiotics show potential for therapeutic application mainly in pouchitis and to a lesser degree in UC, while their effects in maintenance therapy for CD have been much less promising. While there is suggestion of benefit when patients with ulcerative colitis use bacterial therapies small sample sizes and methodological weeknesses in study designs necessitate that additional studies must be conducted before probiotics and or synbiotics can be routinely recommended in clinical practice.

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

“…Probiotics exert their beneficial effect through multiple mechanisms, including stimulation of anti-inflammatory and inhibition of pro-inflammatory cytokines, restoration of the intestinal mucosal barrier, antagonistic action on many pathogens, and many others [68] (Table 3). Such mechanisms have been investigated in animal models.…”