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in the treatment of Inflammatory Bowel Disease (IBD)
There are more microbe cells (bacteria, fungi, or protozoa) in our body than human cells. These microbes are essential in functions such as digestion of food and our defenses against harmful microbes. One theory about IBD is that there is a change in the balance of healthy and unhealthy microbes in the gut that triggers abnormal inflammation. This is an area of much research interest but there is not yet enough information to draw clear conclusions. The interest in probiotics relates to the importance of microbes in the function of the gastrointestinal system.
Probiotics are microorganisms (bacteria or yeasts) that are believed to provide health benefits when consumed. They may be taken as a pill, capsule, or powder and are also occasionally added to foods such as yogurt. Preparations may contain one microorganism or a mixture.
Some people have suggested that taking certain probiotics can have a positive influence on the balance of healthy and unhealthy microbes in the gut. There has been limited scientific evaluation of the effect of probiotics in IBD and other health conditions.
There is continuing interest in research on probiotics. When there is more understanding of the helpful and unhelpful microbes that may be involved in IBD, there may be more clear evidence on whether some probiotics may be helpful and how they can be used.
There have been several studies assessing probiotics in Crohn’s disease and there is no evidence that probiotics are useful in Crohn’s disease
There is some evidence that certain probiotics may be useful in ulcerative colitis
Common probiotics: The most common probiotics available in the community are Lactobacilli and Bifidobacteria. These can be bought in health food stores or supermarkets. Sometimes probiotics are sold by companies using product names that do not identify the species included (for instance, Align or Tuzen). LactobacillI are commonly found in yogurt. There is no evidence that these probiotics work in treating Crohn’s disease or ulcerative colitis.
Probiotics in food: There are probiotics in some foods. For example, yogurt contains lactobacillus and sometimes other probiotic species as part of the natural process used in preparing yogurt. Some types are marketed that have added probiotic -- this should be described in the ingredient list. Lactobacillus produces some lactase that may help people with lactose intolerance in digesting the milk protein in the yogurt. Yogurts are marketed to have beneficial effects in health and disease but there have been no studies assessing the benefit of any yogurt in IBD.
Crohn’s disease: Several studies have explored the use of different probiotics in maintaining remission (once it has been achieved) and do not provide evidence that probiotics are of benefit in treating Crohn’s disease.
Ulcerative colitis: A probiotic VSL#3 (made up of 8 different species) has been shown to have some benefit when used together with 5-ASA in settling active disease. The probiotic E coli Nissle 1917 (available in Europe but not North America) has been shown to settle active disease with similar efficacy as low dose 5-ASA.
Pouchitis is inflammation in the ileal pouch created after the colon is removed for colitis. The probiotic VSL#3 has been shown to reduce symptoms of pouchitis and also to prevent the development of pouchitis.
There are few side effects from taking most probiotics. However, in patients who are very ill they should not be assumed to be safe. For instance, in a patient with a very inflamed bowel using a probiotic might cause problems with the probiotic leaking into the blood causing a serious infection.
Bernstein CN. Treatment of IBD: Where we are and where we are going. American Journal of Gastroenterology 2015; 110:114-126.
Gionchetti P, Rizello F, Venturi A, Brigidi P et al. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: A double-blind, placebo-controlled trial. Gastroenterology 2000; 119: 305-9.
Hempel S, Newberry S, Ruelaz A, Wang Z, Miles JN, Suttorp MJ, Johnsen B, Shanman R, Slusser W, Fu N, Smith A, Roth B, Polak J, Motala A, Perry T, Shekelle PG. Safety of probiotics used to reduce risk and prevent or treat disease. Evidence Reports/Technology Assessment (Full Rep). 2011 Apr; (200):1-645.
Jonkers D, Penders J, Masclee A, Pierik M. Probiotics in the management of inflammatory bowel disease: a systematic review of intervention studies in adult patients. Drugs 2012;72(6):803-823.
Last reviewed: March 2020
For more information and fact sheets about IBD and its treatment please visit: http://www.crohnsandcolitis.ca
Disclaimer: This information is provided for educational purposes only. Always consult a qualified health care professional for your specific care.
Source: This summary provides scientifically accurate information. It was prepared in a research review by researchers with the IBD Clinical and Research Centre, University of Manitoba with assistance from colleagues in Canada and internationally.
Acknowledgement: Preparation of this material was supported by funding from the Canadian Institutes of Health Research.
©2016 Charles N. Bernstein, John R. Walker on behalf of Manitoba IBD Clinical and Research Centre. This work is licensed under a Creative Commons Attribution-nonCommercial-NoDerivs 2.5 Canada License. You are free to copy and distribute this material in its entirety as long as: 1) this material is not used in any way that suggests we endorse you or your use of the material, 2) this material is not used for commercial purposes, 3) this material is not altered in any way (no derivative works). View full license at http://creativecommons.org/licenses/by-nc-nd/2.5/ca/.