Abstract
While considerable progress has been made in the treatment of inflammatory bowel diseases (IBD), alternative options are constantly sought by adult patients as well as frustrated parents of young patients. These include dietary modifications, food supplements, and, more recently, probiotics.
Their potential use is based on the demonstrated role of the altered mucosal immune response to bacterial agents that eventually leads to the chronic intestinal inflammation that characterized IBD. In fact, probiotics might conceivably be beneficial due to multiple mechanisms: stimulation of anti-inflammatory cytokines, inhibition of inflammatory cytokines, strengthening of intestinal barrier, and antagonistic action on pathogens. Such mechanisms have been largely extensively investigated in animal models both in vitro and in vivo.
Despite such premise, a relatively scarce number of clinical trials are available, and of them only a handful in pediatric age. Overall, available evidence is very disappointing in the treatment of Crohn’s disease (CD), where no recommendation for probiotic use can be made. In ulcerative colitis (UC), on the other hand, there is clinical evidence of efficacy for some specific strains and especially for multi-strain preparations.
In summary, more data are needed very likely to yield a better understanding on what strains and in what doses should be used in different specific clinical settings.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Abraham BP, Quigley EMM (2017) Probiotics in inflammatory bowel disease. Gastroenterol Clin N Am 46:769–782
Alard J, Peucelle V, Boutillier D, Breton J, Kuylle S, Pot B, Holowacz S, Grangette C (2018) New probiotic strains for inflammatory bowel disease management identified by combining in vitro and in vivo approaches. Benef Microb 9:317–331
Basson AR, Lam M, Cominelli F (2017) Complementary and alternative medicine strategies for therapeutic gut microbiota modulation in inflammatory bowel disease and their next-generation approaches. Gastroenterol Clin N Am 46:689–729
Bourreille A, Cadiot G, Le Dreau G, Laharie D, Beaugerie L, Dupas JL, Marteau P, Rampal P, Moyse D, Saleh A, Le Guern ME, Galmiche JP, Group FS (2013) Saccharomyces boulardii does not prevent relapse of Crohn’s disease. Clin Gastroenterol Hepatol 11:982–987
Bousvaros A, Guandalini S, Baldassano RN, Botelho C, Evans J, Ferry GD, Goldin B, Hartigan L, Kugathasan S, Levy J, Murray KF, Oliva-Hemker M, Rosh JR, Tolia V, Zholudev A, Vanderhoof JA, Hibberd PL (2005) A randomized, double-blind trial of lactobacillus GG versus placebo in addition to standard maintenance therapy for children with Crohn’s disease. Inflamm Bowel Dis 11:833–839
Chassaing B, Darfeuille-Michaud A (2011) The commensal microbiota and enteropathogens in the pathogenesis of inflammatory bowel diseases. Gastroenterology 140:1720–1728
Conte MP, Schippa S, Zamboni I, Penta M, Chiarini F, Seganti L, Osborn J, Falconieri P, Borrelli O, Cucchiara S (2006) Gut-associated bacterial microbiota in paediatric patients with inflammatory bowel disease. Gut 55:1760–1767
Derwa Y, Gracie DJ, Hamlin PJ, Ford AC (2017) Systematic review with meta-analysis: the efficacy of probiotics in inflammatory bowel disease. Aliment Pharmacol Ther 46:389–400
Duricova D, Burisch J, Jess T, Gower-Rousseau C, Lakatos PL, On Behalf of ECCO-EpiCom (2014) Age-related differences in presentation and course of inflammatory bowel disease: an update on the population-based literature. J Crohns Colitis 8:1351
Fiorucci S, Distrutti E, Mencarelli A, Barbanti M, Palazzini E, Morelli A (2002) Inhibition of intestinal bacterial translocation with rifaximin modulates lamina propria monocytic cells reactivity and protects against inflammation in a rodent model of colitis. Digestion 66:246–256
Frank DN, Robertson CE, Hamm CM, Kpadeh Z, Zhang T, Chen H, Zhu W, Sartor RB, Boedeker EC, Harpaz N, Pace NR, Li E (2011) Disease phenotype and genotype are associated with shifts in intestinal-associated microbiota in inflammatory bowel diseases. Inflamm Bowel Dis 17:179–184
Ganji-Arjenaki M, Rafieian-Kopaei M (2018) Probiotics are a good choice in remission of inflammatory bowel diseases: a meta analysis and systematic review. J Cell Physiol 233:2091–2103
Gosiewski T, Strus M, Fyderek K, Kowalska-Duplaga K, Wedrychowicz A, Jedynak-Wasowicz U, Sladek M, Pieczarkowski S, Adamski P, Heczko PB (2012) Horizontal distribution of the fecal microbiota in adolescents with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 54:20–27
Guslandi M, Mezzi G, Sorghi M, Testoni PA (2000) Saccharomyces boulardii in maintenance treatment of Crohn’s disease. Dig Dis Sci 45:1462–1464
Henker J, Muller S, Laass MW, Schreiner A, Schulze J (2008) Probiotic Escherichia coli Nissle 1917 (EcN) for successful remission maintenance of ulcerative colitis in children and adolescents: an open-label pilot study. Z Gastroenterol 46:874–875
Huynh HQ, Debruyn J, Guan L, Diaz H, Li M, Girgis S, Turner J, Fedorak R, Madsen K (2009) Probiotic preparation De Simone Formulation induces remission in children with mild to moderate acute ulcerative colitis: a pilot study. Inflamm Bowel Dis 15:760–768
Jeon SR, Chai J, Kim C, Lee CH (2018) Current evidence for the management of inflammatory bowel diseases using fecal microbiota transplantation. Curr Infect Dis Rep 20:21
Kellermayer R, Mir SA, Nagy-Szakal D, Cox SB, Dowd SE, Kaplan JL, Sun Y, Reddy S, Bronsky J, Winter HS (2012) Microbiota separation and C-reactive protein elevation in treatment-naive pediatric granulomatous Crohn disease. J Pediatr Gastroenterol Nutr 55:243–250
Kim DH, Kim S, Lee JH, Kim JH, Che X, Ma HW, Seo DH, Kim TI, Kim WH, Kim SW, Cheon JH (2018) Lactobacillus acidophilus suppresses intestinal inflammation by inhibiting endoplasmic reticulum stress. J Gastroenterol Hepatol. https://doi.org/10.1111/jgh.14362
Lane ER, Lee D, Suskind DL (2017) Dietary therapies in pediatric inflammatory bowel disease: an evolving inflammatory bowel disease paradigm. Gastroenterol Clin North Am 46:731–744
Loftus EV Jr (2004) Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology 126:1504–1517
Mack DR (2011) Probiotics in inflammatory bowel diseases and associated conditions. Nutrients 3:245–264
Manichanh C, Rigottier-Gois L, bonnaud E, Gloux K, Pelletier E, Frangeul L, Nalin R, Jarrin C, Chardon P, Marteau P, Roca J, Dore J (2006) Reduced diversity of faecal microbiota in Crohn’s disease revealed by a metagenomic approach. Gut 55:205–211
Mardini HE, Grigorian AY (2014) Probiotic mix De Simone Formulation is effective adjunctive therapy for mild to moderately active ulcerative colitis: a meta-analysis. Inflamm Bowel Dis 20:1562–1567
Martinez C, Antolin M, Santos J, Torrejon A, Casellas F, Borruel N, Guarner F, Malagelada JR (2008) Unstable composition of the fecal microbiota in ulcerative colitis during clinical remission. Am J Gastroenterol 103:643–648
Mcilroy J, Ianiro G, Mukhopadhya I, Hansen R, Hold GL (2018) Review article: the gut microbiome in inflammatory bowel disease-avenues for microbial management. Aliment Pharmacol Ther 47:26–42
Miele E, Pascarella F, Giannetti E, Quaglietta L, Baldassano RN, Staiano A (2009) Effect of a probiotic preparation (De Simone Formulation) on induction and maintenance of remission in children with ulcerative colitis. Am J Gastroenterol 104:437–443
Miele E, Shamir R, Aloi M, Assa A, Braegger C, Bronsky J, De Ridder L, Escher JC, Hojsak I, Kolacek S, Koletzko S, Levine A, Lionetti P, Martinelli M, Ruemmele F, Russell RK, Boneh RS, Van Limbergen J, Veereman G, Staiano A (2018) Nutrition in pediatric inflammatory bowel disease: a position paper on behalf of the porto inflammatory bowel disease group of the European Society of pediatric gastroenterology, hepatology and nutrition. J Pediatr Gastroenterol Nutr 66:687–708
Ni J, Wu GD, Albenberg L, Tomov VT (2017) Gut microbiota and IBD: causation or correlation? Nat Rev Gastroenterol Hepatol 14:573–584
Nishida A, Inoue R, Inatomi O, Bamba S, Naito Y, Andoh A (2018) Gut microbiota in the pathogenesis of inflammatory bowel disease. Clin J Gastroenterol 11:1–10
Oelschlaeger TA (2010) Mechanisms of probiotic actions – a review. Int J Med Microbiol 300:57–62
Oliva S, Di Nardo G, Ferrari F, Mallardo S, Rossi P, Patrizi G, Cucchiara S, Stronati L (2012) Randomised clinical trial: the effectiveness of lactobacillus reuteri ATCC 55730 rectal enema in children with active distal ulcerative colitis. Aliment Pharmacol Ther 35:327–334
Orel R, Kamhi Trop T (2014) Intestinal microbiota, probiotics and prebiotics in inflammatory bowel disease. World J Gastroenterol 20:11505–11524
Ott SJ, Schreiber S (2006) Reduced microbial diversity in inflammatory bowel diseases. Gut 55:1207
Ott SJ, Musfeldt M, Wenderoth DF, Hampe J, Brant O, Folsch UR, Timmis KN, Schreiber S (2004) Reduction in diversity of the colonic mucosa associated bacterial microflora in patients with active inflammatory bowel disease. Gut 53:685–693
Petersen AM, Mirsepasi H, Halkjaer SI, Mortensen EM, Nordgaard-Lassen I, Krogfelt KA (2014) Ciprofloxacin and probiotic Escherichia coli nissle add-on treatment in active ulcerative colitis: a double-blind randomized placebo controlled clinical trial. J Crohns Colitis 8:1498–1505
Prosberg M, Bendtsen F, Vind I, Petersen AM, Gluud LL (2016) The association between the gut microbiota and the inflammatory bowel disease activity: a systematic review and meta-analysis. Scand J Gastroenterol 51:1407–1415
Rodriguez-Nogales A, Algieri F, Garrido-Mesa J, Vezza T, Utrilla MP, Chueca N, Fernandez-Caballero JA, Garcia F, Rodriguez-Cabezas ME, Galvez J (2018) The administration of Escherichia coli nissle 1917 ameliorates development of DSS-induced colitis in mice. Front Pharmacol 9:468
Scaldaferri F, Gerardi V, Mangiola F, Lopetuso LR, Pizzoferrato M, Petito V, Papa A, Stojanovic J, Poscia A, Cammarota G, Gasbarrini A (2016) Role and mechanisms of action of Escherichia coli nissle 1917 in the maintenance of remission in ulcerative colitis patients: an update. World J Gastroenterol 22:5505–5511
Scharl M, Rogler G (2012) Inflammatory bowel disease pathogenesis: what is new? Curr Opin Gastroenterol 28:301–309
Seksik P, Rigottier-Gois L, Gramet G, Sutren M, Pochart P, Marteau P, Jian R, Dore J (2003) Alterations of the dominant faecal bacterial groups in patients with Crohn’s disease of the colon. Gut 52:237–242
Singh S, Stroud AM, Holubar SD, Sandborn WJ, Pardi DS (2015) Treatment and prevention of pouchitis after ileal pouch-anal anastomosis for chronic ulcerative colitis. Cochrane Database Syst Rev:CD001176. https://doi.org/10.1002/14651858.CD001176.pub3
Sivananthan K, Petersen AM (2018) Review of saccharomyces boulardii as a treatment option in IBD. Immunopharmacol Immunotoxicol:1–11. https://doi.org/10.1080/08923973.2018.1469143
Sokol H, Seksik P, Rigottier-Gois L, Lay C, Lepage P, Podglajen I, Marteau P, Dore J (2006) Specificities of the fecal microbiota in inflammatory bowel disease. Inflamm Bowel Dis 12:106–111
Swidsinski A, Ladhoff A, Pernthaler A, Swidsinski S, Loening-Baucke V, Ortner M, Weber J, Hoffmann U, Schreiber S, Dietel M, Lochs H (2002) Mucosal flora in inflammatory bowel disease. Gastroenterology 122:44–54
Zuo T, Ng SC (2018) The gut microbiota in the pathogenesis and therapeutics of inflammatory bowel disease. Front Microbiol 9:2247
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Guandalini, S., Sansotta, N. (2019). Probiotics in the Treatment of Inflammatory Bowel Disease. In: Guandalini, S., Indrio, F. (eds) Probiotics and Child Gastrointestinal Health. Advances in Experimental Medicine and Biology(), vol 1125. Springer, Cham. https://doi.org/10.1007/5584_2018_319
Download citation
DOI: https://doi.org/10.1007/5584_2018_319
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-14635-1
Online ISBN: 978-3-030-14636-8
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)