Probiotics for Ulcerative Colitis

Please note that each Ulcerative colitis probiotics trial is not described in detail. In some trials, drugs, prebiotics and/or additional nutrients were provided that may help the beneficial bacteria be more effective. Also the setting, procedure, and dose for each trial are rarely similar. For more details, search for the reference in Google to find the original publication. The simplest way is to copy and paste the title.

Studies examining the use of probiotics for Ulcerative Colitis look at both patients that have not had surgery and at patients that have been given a J-pouch. “Colitis” refers to inflammation in the colon, and “pouchitis” refers to inflammation in the J-pouch. In both situations, the goal is to either maintain remission (a symptom-free period) or to induce remission in patients with acute inflammation. To do this, patients are usually given daily probiotics with or without extra medication for several weeks to several months. Unlike Crohn’s Disease, Ulcerative Colitis appears to respond very well to probiotics. The combination probiotic VSL#3 has a particularly positive effect and is well tested.

Probiotic SupplementsImprovements Seen in TrialReferences
Bifid Triple Viable capsule (BIFICO)Maintained remission (colitis)1, 2
VSL#3Maintained remission (colitis and pouchitis)
Worked alone or in combination with other drugs.
Induced remission.
Helped treat associated arthralgia.
3-15
Bifidobacteria
Lactobacilli
Maintained remission (colitis)16
B. lactis BB-12
L. acidophilus LA-5
Maintained remission (pouchitis)
No improvement (colitis)
17-19
L. reuteri RC-14
L. rhamnosus GR-1
Reduced markers of inflammation20
L. delbruekii
L. fermentum
Reduced markers of inflammation21
B. breve (Yakult)Maintained remission (colitis)22
B. longumInduced remission
(taken in combination with prebiotic)
23
E. coli Nissle (Serotype 06: K5: H1)Maintained remission (colitis)
and induced remission
24-26
S. boulardiiInduced remission27

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment.

References

1.         Cui, H. H. C., C. L.; Wang, J. D.; Yang, Y. J.; Sun, Y.; Wang, Y. D.; Lai, Z. S. 2003. [The effects of bifidobacterium on the intestinal mucosa of the patients with ulcerative colitis]. Zhonghua Nei Ke Za Zhi 42:554-557.

2.         Cui, H. H. C., C. L.; Wang, J. D.; Yang, Y. J.; Cun, Y.; Wu, J. B.; Liu, Y. H.; Dan, H. L.; Jian, Y. T.; Chen, X. Q. 2004. Effects of probiotic on intestinal mucosa of patients with ulcerative colitis. World J Gastroenterol 10:1521-1525.

3.         Venturi, A. G., P.; Rizzello, F.; Johansson, R.; Zucconi, E.; Brigidi, P.; Matteuzzi, D.; Campieri, M. 1999. Impact on the composition of the faecal flora by a new probiotic preparation: preliminary data on maintenance treatment of patients with ulcerative colitis. Aliment Pharmacol Ther 13:1103-1108.

4.         Gionchetti, P. R., F.; Venturi, A.; Brigidi, P.; Matteuzzi, D.; Bazzocchi, G.; Poggioli, G.; Miglioli, M.; Campieri, M. 2000. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. Gastroenterology 119:305-309.

5.         Gionchetti, P. R., F.; Helwig, U.; Venturi, A.; Lammers, K. M.; Brigidi, P.; Vitali, B.; Poggioli, G.; Miglioli, M.; Campieri, M. 2003. Prophylaxis of pouchitis onset with probiotic therapy: a double-blind, placebo-controlled trial. Gastroenterology 124:1202-1209.

6.         Tursi, A. B., G.; Giorgetti, G. M.; Forti, G.; Modeo, M. E.; Gigliobianco, A. 2004. Low-dose balsalazide plus a high-potency probiotic preparation is more effective than balsalazide alone or mesalazine in the treatment of acute mild-to-moderate ulcerative colitis. Med Sci Monit 10:PI126-131.

7.         Bibiloni, R. F., R. N.; Tannock, G. W.; Madsen, K. L.; Gionchetti, P.; Campieri, M.; De Simone, C.; Sartor, R. B. 2005. VSL#3 probiotic-mixture induces remission in patients with active ulcerative colitis. Am J Gastroenterol 100:1539-1546.

8.         Karimi, O. P., A. S.; van Bodegraven, A. A. 2005. Probiotics (VSL#3) in arthralgia in patients with ulcerative colitis and Crohn’s disease: a pilot study. Drugs Today (Barc) 41:453-459.

9.         Kuhbacher, T. O., S. J.; Helwig, U.; Mimura, T.; Rizzello, F.; Kleessen, B.; Gionchetti, P.; Blaut, M.; Campieri, M.; Folsch, U. R.; Kamm, M. A.; Schreiber, S. 2006. Bacterial and fungal microbiota in relation to probiotic therapy (VSL#3) in pouchitis. Gut 55:833-841.

10.       Gionchetti, P. R., F.; Morselli, C.; Poggioli, G.; Tambasco, R.; Calabrese, C.; Brigidi, P.; Vitali, B.; Straforini, G.; Campieri, M. 2007. High-dose probiotics for the treatment of active pouchitis. Dis Colon Rectum 50:2075-2082; discussion 2082-2074.

11.       Pronio, A. M., C.; Butteroni, C.; Vecchione, S.; Mumolo, G.; Vestri, A.; Vitolo, D.; Boirivant, M. 2008. Probiotic administration in patients with ileal pouch-anal anastomosis for ulcerative colitis is associated with expansion of mucosal regulatory cells. Inflamm Bowel Dis 14:662-668.

12.       Miele, E. P., F.; Giannetti, E.; Quaglietta, L.; Baldassano, R. N.; Staiano, A. 2009. Effect of a probiotic preparation (VSL#3) on induction and maintenance of remission in children with ulcerative colitis. Am J Gastroenterol 104:437-443.

13.       Sood, A. M., V.; Makharia, G. K.; Ahuja, V.; Singal, D.; Goswami, P.; Tandon, R. K. 2009. The probiotic preparation, VSL#3 induces remission in patients with mild-to-moderately active ulcerative colitis. Clin Gastroenterol Hepatol 7:1202-1209, 1209 e1201.

14.       Ng, S. C. P., S.; Kamm, M. A.; Hart, A. L.; Al-Hassi, H. O.; Guenther, T.; Stagg, A. J.; Knight, S. C. 2010. Immunosuppressive effects via human intestinal dendritic cells of probiotic bacteria and steroids in the treatment of acute ulcerative colitis. Inflamm Bowel Dis 16:1286-1298.

15.       Tursi, A. B., G.; Papa, A.; Giglio, A.; Elisei, W.; Giorgetti, G. M.; Forti, G.; Morini, S.; Hassan, C.; Pistoia, M. A.; Modeo, M. E.; Rodino, S.; D’Amico, T.; Sebkova, L.; Sacca, N.; Di Giulio, E.; Luzza, F.; Imeneo, M.; Larussa, T.; Di Rosa, S.; Annese, V.; Danese, S.; Gasbarrini, A. 2010. 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 105:2218-2227.

16.       Santana Porben, S. 2010. [Influence of a combination of lactobacilli and bifidobacteria upon disease activity, stool pattern and nutritional status of ulcerative colitis patients]. Nutr Hosp 25:971-983.

17.       Laake, K. O. L., P. D.; Grzyb, K.; Aamodt, G.; Aabakken, L.; Roset, A.; Hvinden, A. B.; Bakka, A.; Eide, J.; Bjorneklett, A.; Vatn, M. H. 2004. Assessment of mucosal inflammation and blood flow in response to four weeks’ intervention with probiotics in patients operated with a J-configurated ileal-pouch-anal-anastomosis (IPAA). Scand J Gastroenterol 39:1228-1235.

18.       Laake, K. O. B., A.; Aamodt, G.; Aabakken, L.; Jacobsen, M.; Bakka, A.; Vatn, M. H. 2005. Outcome of four weeks’ intervention with probiotics on symptoms and endoscopic appearance after surgical reconstruction with a J-configurated ileal-pouch-anal-anastomosis in ulcerative colitis. Scand J Gastroenterol 40:43-51.

19.       Wildt, S. N., I.; Hansen, U.; Brockmann, E.; Rumessen, J. J. 2011. A randomised double-blind placebo-controlled trial with Lactobacillus acidophilus La-5 and Bifidobacterium animalis subsp. lactis BB-12 for maintenance of remission in ulcerative colitis. J Crohns Colitis 5:115-121.

20.       Lorea Baroja, M. K., P. V.; Hekmat, S.; Reid, G. 2007. Anti-inflammatory effects of probiotic yogurt in inflammatory bowel disease patients. Clin Exp Immunol 149:470-479.

21.       Hegazy, S. K. E.-B., M. M. 2010. Effect of probiotics on pro-inflammatory cytokines and NF-kappaB activation in ulcerative colitis. World J Gastroenterol 16:4145-4151.

22.       Ishikawa, H. M., S.; Ohashi, Y.; Imaoka, A.; Setoyama, H.; Umesaki, Y.; Tanaka, R.; Otani, T. 2011. Beneficial effects of probiotic bifidobacterium and galacto-oligosaccharide in patients with ulcerative colitis: a randomized controlled study. Digestion 84:128-133.

23.       Furrie, E. M., S.; Kennedy, A.; Cummings, J. H.; Walsh, S. V.; O’Neil D, A.; Macfarlane, G. T. 2005. Synbiotic therapy (Bifidobacterium longum/Synergy 1) initiates resolution of inflammation in patients with active ulcerative colitis: a randomised controlled pilot trial. Gut 54:242-249.

24.       Kruis, W. S., E.; Fric, P.; Fixa, B.; Judmaier, G.; Stolte, M. 1997. Double-blind comparison of an oral Escherichia coli preparation and mesalazine in maintaining remission of ulcerative colitis. Aliment Pharmacol Ther 11:853-858.

25.       Kruis, W. F., P.; Pokrotnieks, J.; Lukas, M.; Fixa, B.; Kascak, M.; Kamm, M. A.; Weismueller, J.; Beglinger, C.; Stolte, M.; Wolff, C.; Schulze, J. 2004. Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine. Gut 53:1617-1623.

26.       Matthes, H. K., T.; Giensch, M.; Wolff, C.; Schulze, J. 2010. Clinical trial: probiotic treatment of acute distal ulcerative colitis with rectally administered Escherichia coli Nissle 1917 (EcN). BMC Complement Altern Med 10:13.

27.       Guslandi, M. G., P.; Testoni, P. A. 2003. A pilot trial of Saccharomyces boulardii in ulcerative colitis. Eur J Gastroenterol Hepatol 15:697-698.

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