The use of probiotics in inflammatory bowel disease

Abstract

A body of evidence from clinical and experimental observations indicates a role for intestinal microflora in the pathogenesis of inflammatory bowel disease (IBD). Probiotics are defined as ‘living organisms, which upon ingestion in certain numbers, exert health benefits beyond inherent basic nutrition’. Recent evidence supports the potential role of probiotics in IBD therapy.

Our own experience was recently focused on the use of a new probiotic preparation (VSL#3) containing 300 billion/g of viable lyophilized bacteria of four strains of lactobacilli, three strains of bifidobacteria, and one strain of Streptococcus salivarius subsp. thermophilus.

First a pilot study using VSL#3 as maintenance treatment in patients allergic or intolerant to SASP or 5-aminosalicylic acid (5-ASA) was carried out. Twenty patients received 6 g a day of VSL#3 for 12 months and were periodically assessed. Microbiological determination showed a significant increase in concentration of lactobacilli, bifidobacteria and Streptococcus salivarius subsp. thermophilus,faecal pH was significantly reduced, and the great majority of patients (75%) remained in remission. Subsequently efficacy of this new oral probiotic preparation was tested versus placebo in the maintenance treatment of chronic relapsing pouchitis. Forty patients who obtained clinical and endoscopic remission after 1 month antibiotic treatment were randomized to receive VSL#3 6 g daily or an identical-appearing placebo for 9 months. Of the 20 patients who received the placebo, all relapsed, whereas 17 of the 20 patients treated with VSL#3 were still in remission after 9 months. All these 17 patients, after suspension of the treatment, had a relapse within 4 months. Faecal concentration of lactobacilli, bifidobacteria and Streptococcus salivarius supsp. thermophilus significantly increased. A controlled study evaluating the efficacy of treatment with antibiotics and probiotics vs mesalazine in the prevention of postoperative recurrence in patients with Crohn’s disease is now in progress.

These findings suggest that probiotics may be of therapeutic benefit in maintenance treatment of IBD.

We have carried out a pilot study to evaluate the efficacy of 3 months treatment with rifaximin (1.8 g/day) a non-absorbable rifamicyn derivative with a wide antibacterial spectrum, followed by 9 months treatment with VSL#3 6 g/day, in prophylaxis of postoperative recurrence of CD. Patients were assessed endoscopically and histologically after 3 and 12 months, and clinically every 3 months for 1 year. Only one patient had a severe endoscopic recurrence at 3 months. At 12 months one of 10 had a clinical relapse, together with a severe endoscopic recurrence. These preliminary results suggest that the combination of antibiotics and probiotics may be of benefit in prevention of postoperative recurrence of CD; a controlled trial vs mesalazine is now in progress.