The role of probiotics in managing ulcerative colitis

Ulcerative colitis (UC) is a chronic inflammatory condition of the colon that significantly impacts the quality of life of patients. The search for effective treatment modalities that can complement conventional therapies has led to the exploration of probiotics’ potential benefits. Recent studies have shown promising results in using various probiotic strains to manage ulcerative colitis, offering new hope for patients seeking alternative or adjunct treatments.

Several recent studies highlight the effectiveness of various probiotic strains in managing ulcerative colitis (UC). Here’s a summary of the findings from recent studies:

Inducing remission

• Ishikawa et al. (2011): The consumption of a freeze-dried powder containing the probiotic B. breve strain Yakult (109 CFU/g) alongside galacto-oligosaccharides over a year led to a decrease in endoscopic scores, the fecal number of Bacteroidaceae, and fecal pH, suggesting its role in inducing remission.
• Groeger et al. (2013): Patients treated with B. infantis 35624 for 6 weeks saw reductions in CRP and TNF-α levels, indicating its potential in inducing remission through the reduction of inflammation markers.
• Tamaki et al. (2016): Administration of B. longum 536 resulted in decreased UCDAI scores, EI, Mayo subscores, and rectal bleeding. Some patients achieved clinical remission, highlighting its efficacy in inducing remission.
• Agraib et al. (2022): Treatment with a probiotic product containing nine Lactobacillus and five Bifidobacterium species for 6 weeks improved Partial Mayo scores, stool frequency, global assessment, and total PMS scores. The reduction in CRP and IgA levels, along with increases in hemoglobin, hematocrit, RBC levels, and IL-10 levels, supports its role in inducing remission.
• Rayyan et al. (2023): Probiotic capsules containing nine Lactobacillus and five Bifidobacterium species administered for 6 weeks improved various domains of the SIBDQ, suggesting its effectiveness in inducing remission.

Maintenance of remission

• Bibiloni et al. (2005) and Huynh et al. (2009): These studies explored VSL#3’s role in maintaining remission in UC. VSL#3 has been shown to be effective in maintaining remission, owing to its potent probiotic blend.
• Sood et al. (2009) and Tursi et al. (2010): These studies demonstrated that VSL#3 could decrease UCDAI scores and improve stool frequency, blood in the stool score, mucosal appearance, and physician’s global assessment over 12 weeks. This suggests its role in maintaining clinical remission and preventing relapse.
• Ng et al. (2010): This study showed that VSL#3 increases IL-10 and IL-12p40 levels while decreasing DC TLR-2 expression and IL-12p40 production over 8 weeks, which could contribute to maintaining remission through immunomodulation.

The studies listed under these categories highlight the potential of specific probiotics in either inducing remission in active UC cases or maintaining remission and preventing relapse. The effectiveness of these interventions can vary between individuals, and the choice of probiotic, dosage, and treatment duration should be tailored to the patient’s specific needs.

References

1. Ishikawa H, Matsumoto S, Ohashi Y, et al. Beneficial effects of probiotic Bifidobacterium and galacto-oligosaccharide in patients with ulcerative colitis: A randomized controlled study. Digestion 2011;84:128-33.
2. Groeger D, O’Mahony L, Murphy EF, et al. Bifidobacterium infantis 35624 modulates host inflammatory processes beyond the gut. Gut Microbes 2013;4:325-39.
3. Tamaki H, Nakase H, Inoue S, et al. Efficacy of probiotic treatment with Bifidobacterium longum 536 for induction of remission in active ulcerative colitis: A randomized, double-blinded, placebo-controlled multicenter trial. Dig Endosc 2016;28:67-74.
4. Agraib LM, Yamani MI, Tayyem R, et al. Probiotic supplementation induces remission and changes in the immunoglobulins and inflammatory response in active ulcerative colitis patients: A pilot, randomized, double-blind, placebo-controlled study. Clin Nutr Espen 2022;51:83-91.
5. Rayyan YM, Agraib LM, Alkhatib B, et al. Does probiotic supplementation improve quality of life in mild-to-moderately active ulcerative colitis patients in Jordan? A secondary outcome of the randomized, double-blind, placebo-controlled study. Eur J Nutr 2023;62:3069-77.
6. Bibiloni R, Fedorak RN, Tannock GW, et al. VSL#3 probiotic-mixture induces remission in patients with active ulcerative colitis. Am J Gastroenterol 2005;100:1539-46.
7. Huynh HQ, DeBruyn J, Guan L, et al. Probiotic preparation VSL#3 induces remission in children with mild to moderate acute ulcerative colitis: A pilot study. Inflamm Bowel Dis 2009;15:760-8.
8. Sood A, Midha V, Makharia GK, et al. The probiotic preparation, VSL#3 induces remission in patients with mild-to-moderately active ulcerative colitis. Clin Gastroenterol Hepatol 2009;7:1202-9.e1
9. Tursi A, Brandimarte G, Papa A, et al. Treatment of relapsing mild-to-moderate ulcerative colitis with the probiotic VSL#3 as adjunctive to a standard pharmaceutical treatment: A double-blind, randomized, placebo-controlled study. Am J Gastroenterol 2010;105:2218-27.
10. Ng SC, Plamondon S, Kamm MA, et al. Immunosuppressive effects via human intestinal dendritic cells of probiotic bacteria and steroids in the treatment of acute ulcerative colitis. Inflamm Bowel Dis 2010;16:1286-98.