Probiotics in inflammatory bowel disease

The rationale for using probiotics in inflammatory bowel disease (IBD) is based on convincing evidence implicating intestinal bacteria in the pathogenesis of these diseases. Encouraging results have been obtained with probiotic therapy in experimental models of colitis. In three recent controlled studies, a non-pathogenic strain of E. coli Nissle 1917 has been found to exhibit efficacy similar to that of mesalazine in maintenance treatment of ulcerative colitis (UC). We have recently studied a probiotic preparation (VSL#3) with high bacterial concentration (3 x 10(11)/g) that contains eight different bacterial strains. VSL#3 was effective in maintaining remission in both patients with UC and chronic pouchitis. With regard to its mechanism of action, it was determined that the preparation causes a significant increase in IL-10 tissue levels, together with a significant decrease in TNF-alpha, IL-1 and IFN-gamma, and matrix metalloproteinase activity. VSL#3 was also superior to placebo in preventing pouchitis in a double-blind controlled trial and, in combination with antibiotic treatment, was significantly more effective than mesalazine (4 g/day) in preventing post-operative recurrence of Crohn's disease, in a single-blind study. Therefore, Probiotics may represent a simple and attractive way to treat IBD.