Probiotics in Inflammatory Bowel Disease

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Key points

  • A substantial body of evidence points to key role for microbiome-host interactions in the pathogenesis of inflammatory bowel disease (IBD).

  • Data from animal models support potent antiinflammatory effects for several specific commensal/probiotic strains.

  • Well-designed studies of probiotics in IBD in humans remain scanty.

  • Available evidence supports a role for probiotics in pouchitis and mild/moderate ulcerative colitis but not in Crohn disease.

  • Novel approaches to the modulation of the microbiota in

Probiotics: definition

Probiotics are defined as live microbial food ingredients that, when ingested in adequate amounts, alter the microflora and confer a health benefit to the host.12, 13, 14 For now the definition of a probiotic demands that the organisms included in the preparation be live and assumes that any biological or clinical effects depend on bacterial viability; studies showing (albeit in in vitro or animal models) that dead organisms or bioactive molecules produced by bacteria, such as proteins,

Probiotics: mechanisms of action relevant to inflammatory bowel disease

Many probiotics are derived from the commensal microbiota in the healthy human gut; their properties, understandably, mimic those of the homeostatic effects of the intact microbiota, and several are relevant to IBD.

First and foremost, a substantial literature attests to the antiinflammatory effects of probiotics which, in turn, reflect the immune tolerance that exists between the host and its microbiota. Studies show that probiotics alter the mucosal immune system through a process mediated by

Probiotics in the management of inflammatory bowel disease

The impact of probiotics on UC, Crohn disease, and pouchitis has been the subject of several systematic reviews and meta-analyses.59, 60, 61, 62, 63, 64, 65, 66, 67, 68 Before discussing the conclusions of these studies, several issues need to be addressed. First, combining diverse species and strains in a single analysis suggests that they are homogeneous, which they are not; second, populations of patients with UC or Crohn disease are remarkably heterogeneous; and, third, when critically

Probiotics: quality control

It is critical, at this juncture, to emphasize that no 2 probiotics are the same, despite commercial claims to the contrary. To be effective at their likely sites of action, probiotics need to be able to survive stomach acid, bile, and digestive enzymes and to be viable for the duration of their shelf lives; many products on supermarket shelves do not meet even these most basic standards. Many more have never been subjected to clinical evaluation in any disease category and base their claims on

Probiotics: safety

Probiotics are generally regarded as safe.103, 104, 105 Furthermore, their record in patients with IBD, a population that may be susceptible to intestinal translocation and, thus, systemic sepsis, has been reassuring. Of concern was a case of systemic dissemination leading to sepsis in a newborn given E coli strain Nissle 1917 for viral gastroenteritis.106 Although probiotics and prebiotics have a long safety record, there may still be risks in certain disease populations. Particular vigilance

Probiotics: the future

Despite the existence of a compelling narrative that supports a critical role for the gut microbiota in IBD and a large volume of laboratory data showing impressive beneficial effects of various bacterial strains in animal models of IBD, the IBD probiotic clinical portfolio is far from convincing. Several factors may contribute to this disappointment: the limitations of animal models, differences in probiotic dosage, and a failure to account for the multiple phenotypes that IBD manifests in

Summary/discussion

Despite the undoubted role of the microbiota in IBD and the attractiveness of probiotics as a therapeutic intervention, the extant literature on these therapies is far from impressive and has many limitations. Furthermore, generic issues relating to quality control continue to bedevil what is essentially a lightly regulated market. Many probiotic products on sale in supermarkets and pharmacies have not been adequately tested for the viability of their bacteria over the durations of their

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      Consistently, we demonstrated that B. amyloliquefaciens SS1 could effectively stimulate the respiratory burst activity of head kidney macrophages and increased the resistance against A. hydrophila infection. Numerous evidences suggested that probiotics could modulate anti-inflammatory response by secreting some specific metabolite [23,24]. Harry Sokol has revealed that Faecalibacterium prausnitzii or its supernatant exhibited anti-inflammatory effects by abolishing NF-κB activation and IL-1β production in 2,4,6-trinitrobenzenesulphonic acid-induced colitis mice [25].

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    Disclosure: E.M.M. Quigley holds stock in and patents with Alimentary Health and has served as an advisor/consultant to Alimentary Health, Biocodex, Bionutrec, Commonwealth Laboratories, Danone, Pharmasierra, Procter and Gamble, Salix, and Yakult. B.P. Abraham has no relevant disclosures.

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