Spotlight: VSL3 is Effective for Pouchitis, Ulcerative Colitis and Irritable Bowel Syndrome

VSL3 is one of the most well-known probiotic supplements on the market. It claims to help reduce the symptoms of pouchitis, ulcerative colitis (UC) and irritable bowel syndrome (IBS). While one may doubt the effectiveness of regular probiotics, VSL3 is in a class of its own according to the scientific evidence.

VSL3 is widely endorsed by many medical organizations for its ability to treat UC, pouchitis and relieve IBS1. Developed by researchers in Italy, VSL3 contains eight different bacterial strains. This formulation is classified by the Federal Drug Administration as a medical food, and it should be taken under the supervision of a physician. This is due to much higher number and vitality of the bacterial strains that it contains1.

For managing pouchitis, UC or IBS, 225 billion to 3.6 trillion bacteria are recommended per day. These doses are very high. For other kinds of conditions, a billion to 10 billion are advised daily. Studies have shown that the probiotic bacteria colonize after one week, and maximum colonization is seen after 20 days. But this colonisation isn’t permanent. Treatments need to be continued in order to replenish the populations. After stopping the probiotic, it takes only three weeks to wash out the bacterial strains1.

VSL3 Treats Pouchitis

Pouchitis is a complication of an ileo-anal pouch surgery. During this surgery, the colon is removed, and an internal bag is formed from the small intestine. This bag, or ileal pouch, functions as a kind of colon. This surgery is usually performed when UC or even Crohn’s disease becomes too severe to control. Pouchitis develops when the newly-formed ileal pouch becomes inflamed. It is usually treated with hefty doses of antibiotics2.

Studies on the ability of VSL3 to improve pouchitis first appeared in 19983. A double-blind, placebo-controlled trial was performed to determine if VSL3 could maintain the remissions of chronic pouchitis patients for nine months. The results were clear: only 15% of the patients treated with the formulation relapsed as compared to 100% of the patients in the placebo group4. A longer, larger study was performed in 2004. It showed that after obtaining remission with antibiotics, it could be maintained for one year in 85% of those with probiotics as opposed to 6% with placebo5. Improvements appeared to be related to an improved diversity of bacterial species and a reduction of fungal flora6.

A later study looked to see if VSL3 could actually prevent the development of pouchitis after surgery. Groups of twenty patients were tested with either bacteria or a placebo. Only 10% of those treated with the probiotics developed pouchitis compared to 40% in the placebo group7.

In 2007, a therapeutic study was done to see if VSL3 could, on its own, stop inflammation in its tracks. For this trial, patients with active mild pouchitis were chosen, and probiotics were given for four weeks. Although, no placebo group was tested, the results were extremely promising. Of those treated with the probiotic mixture, 69% made it into remission8.

Ulcerative Colitis Treatment with VSL3

UC is one of the main forms of inflammatory bowel disease. Patients develop colitis and suffer from a host of painful symptoms. As patients with pouchitis are often also ulcerative colitis patients, it was only logical to also explore the possibility that VSL3 could also be of use for UC.

The first published study for ulcerative colitis in 1999 attempted to see if the probiotic mixture could maintain remission in 20 ulcerative colitis patients. The patients were treated for a year. They found that 15 patients remained in remission throughout the study, and there were no significant side-effects9. Five years later, it was found that combining VSL3 with balsalazide (a drug similar to 5-ASA) was more effective at inducing remission than balsalazide alone10. A year later, they tested the probiotics on their own. Thirty-two patients were given the probiotics, and disease activity was monitored before and after treatment. More than ¾ of the patients responded positively11. This study was followed up later with a larger, placebo-controlled study that confirmed the findings. After a 12-week treatment protocol, 42.9% in the treatment group had obtained remission while only 15.7% were better in the placebo group12.

Studies performed in children also showed similar results. the probiotic formula could both maintain and induce remissions13,14.

VSL3 for Irritable Bowel Syndrome Treatment

IBS, unlike UC, is not characterized by chronic colitis. Instead, patients are troubled by chronic abdominal pain, bloating and irregular bowel habits. The first randomized controlled trial on patients with IBS had 25 patients per group. They were either treated with probiotics or a placebo for eight weeks. There was actually no effect on the majority of the bowel symptoms. The real effects were seen in a reduction in bloating15. A larger study was performed several years later. This study also showed that the primary benefits of the probiotic mixture were the reduction of gas16.

For even more information, visit the manufacturer’s website or check out Pubmed. VSL3 can be obtained via Amazon. If you are interested in knowing more information about probiotics for IBS, go here.

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

References

  • 1. VSL#3® The Living Shield accessed July 1, 2013
  • 2. Wikipedia – Pouchitis accessed July 1, 2013
  • 3. Sandborn WJ, McLeod R, Jewell DP. Medical therapy for induction and maintenance of remission in pouchitis: a systematic review. Inflamm Bowel Dis. 1999 Feb;5(1):33-9.
  • 4. Gionchetti P, Rizzello F, Venturi A, Brigidi P, Matteuzzi D, Bazzocchi G, Poggioli G, Miglioli M, Campieri M. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. Gastroenterology. 2000 Aug;119(2):305-9.
  • 5. Mimura T, Rizzello F, Helwig U, Poggioli G, Schreiber S, Talbot IC, Nicholls RJ, Gionchetti P, Campieri M, Kamm MA. Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis. Gut. 2004 Jan;53(1):108-14.
  • 6. Kühbacher T, Ott SJ, Helwig U, Mimura T, Rizzello F, Kleessen B, Gionchetti P, Blaut M, Campieri M, Fölsch UR, Kamm MA, Schreiber S. Bacterial and fungal microbiota in relation to probiotic therapy (VSL#3) in pouchitis. Gut. 2006 Jun;55(6):833-41. Epub 2006 Jan 9.
  • 7. Gionchetti P, Rizzello F, Helwig U, Venturi A, Lammers KM, Brigidi P, Vitali B, Poggioli G, Miglioli M, Campieri M. Prophylaxis of pouchitis onset with probiotic therapy: a double-blind, placebo-controlled trial. Gastroenterology. 2003 May;124(5):1202-9.
  • 8. Gionchetti P, Rizzello F, Morselli C, Poggioli G, Tambasco R, Calabrese C, Brigidi P, Vitali B, Straforini G, Campieri M. High-dose probiotics for the treatment of active pouchitis. Dis Colon Rectum. 2007 Dec;50(12):2075-82; discussion 2082-4. Epub 2007 Oct 13.
  • 9. Venturi A, Gionchetti P, Rizzello F, Johansson R, Zucconi E, Brigidi P, Matteuzzi D, Campieri M. 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. 1999 Aug;13(8):1103-8.
  • 10. Tursi A, Brandimarte G, Giorgetti GM, Forti G, Modeo ME, Gigliobianco A.
  • 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. 2004 Nov;10(11):PI126-31. Epub 2004 Oct 26.
  • 11. Bibiloni R, Fedorak RN, Tannock GW, Madsen KL, Gionchetti P, Campieri M, De Simone C, Sartor RB. VSL#3 probiotic-mixture induces remission in patients with active ulcerative colitis. Am J Gastroenterol. 2005 Jul;100(7):1539-46.
  • 12. Sood A, Midha V, Makharia GK, Ahuja V, Singal D, Goswami P, Tandon RK. The probiotic preparation, VSL#3 induces remission in patients with mild-to-moderately active ulcerative colitis. Clin Gastroenterol Hepatol. 2009 Nov;7(11):1202-9, 1209.e1. doi: 10.1016/j.cgh.2009.07.016. Epub 2009 Jul 22.
  • 13. Huynh HQ, deBruyn J, Guan L, Diaz H, Li M, Girgis S, Turner J, Fedorak R, Madsen K. Probiotic preparation VSL#3 induces remission in children with mild to moderate acute ulcerative colitis: a pilot study. Inflamm Bowel Dis. 2009 May;15(5):760-8. doi: 10.1002/ibd.20816.
  • 14. Miele E, Pascarella F, Giannetti E, Quaglietta L, Baldassano RN, Staiano A. Effect of a probiotic preparation (VSL#3) on induction and maintenance of remission in children with ulcerative colitis. Am J Gastroenterol. 2009 Feb;104(2):437-43. doi: 10.1038/ajg.2008.118. Epub 2009 Jan 20.
  • 15. Kim HJ, Camilleri M, McKinzie S, Lempke MB, Burton DD, Thomforde GM, Zinsmeister AR. A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2003 Apr 1;17(7):895-904.
  • 16. Kim HJ, Vazquez Roque MI, Camilleri M, Stephens D, Burton DD, Baxter K, Thomforde G, Zinsmeister AR. A randomized controlled trial of a probiotic combination VSL# 3 and placebo in irritable bowel syndrome with bloating. Neurogastroenterol Motil. 2005 Oct;17(5):687-96.

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