Supplemental therapy

PROBIOTICS

Probiotics are bacteria found in supplements or food products, such as some yogurts, that may benefit health by improving the balance of bacteria in the gut.

There has always been a lot of interest into whether bacteria can be used as a way of treating IBD. In particular, there has been a lot of research into probiotics – these are a mixture of live ‘friendly’ (beneficial) bacteria which can be taken by mouth. The aim of taking probiotics is to increase the number of beneficial bacteria in the bowel.

VSL#3 is a probiotic frequently prescribed for IBD patients. It is a mixture of 4 lactobacilli strains (Lactobacillus plantarum, Lactobacillus casei, Lactobacillus acidophilus, Lactobacillus delbrueckii ssp. bulgaricus), 3 bifidobacteria strains (Bifidobacterium infantis, Bifidobacterium breve, Bifidobacterium longum), and 1 strain of Streptococcus salivarius ssp. Thermophiles.

It has been examined in UC, CD, and pouchitis patients. Some research demonstrated the efficacy of this probiotic mix in maintenance of remission in patients with chronic pouchitis.

The effect of VSL#3 on maintenance of remission in UC patients was evaluated in 20 patients in remission who were treated for 12 months. At the end of the trial 15 of 20 patients (75%) remained in remission. In a study the efficacy of VSL#3 combined with antibiotic treatment on the postoperative recurrence of CD was compared with treatment with 5-ASA alone. At the end of the trial 20% of the patients had recurrent CD in the probiotic/antibiotic group, whereas 40% of patients in the 5-ASA group relapsed.

Although the trials summarized above are promising, the current consensus is that a number of larger controlled trials are necessary before the use of probiotics as a routine medical treatment is warranted.

References