Advertisement

Digestive Diseases and Sciences

, Volume 53, Issue 9, pp 2524–2531 | Cite as

A Meta-Analysis on the Efficacy of Probiotics for Maintenance of Remission and Prevention of Clinical and Endoscopic Relapse in Crohn’s Disease

  • Roja Rahimi
  • Shekoufeh Nikfar
  • Fatemeh Rahimi
  • Behzad Elahi
  • Saeed Derakhshani
  • Mohammad Vafaie
  • Mohammad Abdollahi
Original Paper

Abstract

Objective To evaluate whether probiotics maintain remission in patients with Crohn’s disease (CD). Design A meta-analysis of controlled clinical trials. Methods PUBMED and Cochrane Central Register of Controlled Trials were searched for clinical trial studies investigated the efficacy of probiotics for the maintenance of remission in Crohn’s disease. Clinical relapse and endoscopic relapse were the key outcomes of interest. Data were searched within the time period of 1966 through may 2007. Result Eight randomized placebo-controlled clinical trials met our criteria and were included in the analysis. Seven determined clinical relapse and three evaluated endoscopic relapse among patients with CD received probiotics for maintenance of remission. Pooling of seven trials for the outcome of clinical relapse yielded an odds ratio of 0.92 (95% confidence interval of 0.52–1.62, P = 0.8853), a nonsignificant odds ratio. The odds ratio for three studies for the outcome of endoscopic relapse was 0.97 (95% confidence interval of 0.54–1.78, P = 0.93), a nonsignificant odds ratio. Conclusion This meta-analysis fails to demonstrate the efficacy of probiotics in maintaining remission and preventing clinical and endoscopic recurrence in CD. It is suggested to use probiotic preparations containing a mixture of lactobacillus with E. coli or Saccharomyces.

Keywords

Crohn’s disease Probiotics Clinical relapse Endoscopic relapse Meta-analysis 

References

  1. 1.
    Fow J, Grossman S (2007) A comprehensive guide to patient-focused management strategies for Crohn disease. Gastroenterol Nurs 30:93–98PubMedCrossRefGoogle Scholar
  2. 2.
    Biancone L, Tosti C, Fina D, Fantini M, De Nigris F, Geremia A, Pallone F (2003) Review article: maintenance treatment of Crohn’s disease. Aliment Pharmacol Ther 17:S31–S37CrossRefGoogle Scholar
  3. 3.
    Lemann M (2006) Review article: can post-operative recurrence in Crohn’s disease be prevented? Aliment Pharmacol Ther 24:S22–S28CrossRefGoogle Scholar
  4. 4.
    Akobeng AK, Gardener E (2005) Oral 5-aminosalicylic acid for maintenance of medically-induced remission in Crohn’s Disease. Cochrane Database Syst Rev 25:CD003715Google Scholar
  5. 5.
    Steinhart AH, Ewe K, Griffiths AM, Modigliani R, Thomsen OO (2003) Corticosteroids for maintenance of remission in Crohn’s disease. Cochrane Database Syst Rev 4:CD000301PubMedGoogle Scholar
  6. 6.
    Jones JL, Foxx-Orenstein AE (2007) The role of probiotics in inflammatory bowel disease. Dig Dis Sci 52:607–611PubMedCrossRefGoogle Scholar
  7. 7.
    Shanahan F (2003) Probiotics in inflamatory bowel disease. Gut 48:609CrossRefGoogle Scholar
  8. 8.
    Sartor RB (2003) Targeting enteric bacteria in treatment of inflammatory bowel diseases: why, how, and when. Curr Opin Gastroenterol 19:358–365PubMedCrossRefGoogle Scholar
  9. 9.
    Gionchetti P, Rizzello F, Campieri M (2002) Probiotics in gastroenterology. Curr Opin Gastroenterol 18:235–239PubMedCrossRefGoogle Scholar
  10. 10.
    Guslandi M, Mezzi G, Sorghi M, Testoni PA (2000) Saccharomyces boulardii in maintenance treatment of Crohn’s disease. Dig Dis Sci 45:1462–1464PubMedCrossRefGoogle Scholar
  11. 11.
    Prantera C, Scribano ML, Falasco G, Andreoli A, Luzi C (2002) Ineffectiveness of probiotics in preventing recurrence after curative resection for Crohn’s disease: a randomised controlled trial with Lactobacillus GG. Gut 51:405–409PubMedCrossRefGoogle Scholar
  12. 12.
    Rolfe VE, Fortun PJ, Hawkey CJ, Bath-Hextall F (2006) Probiotics for maintenance of remission in Crohn’s disease. Cochrane Database Syst Rev 18:CD004826Google Scholar
  13. 13.
    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 11:833–839PubMedCrossRefGoogle Scholar
  14. 14.
    Schultz M, Timmer A, Herfarth HH, Sartor RB, Vanderhoof JA, Rath HC (2004) Lactobacillus GG in inducing and maintaining remission of Crohn’s disease BMC Gastroenterol 4:5PubMedCrossRefGoogle Scholar
  15. 15.
    Marteau P, Lemann M, Seksik P, Laharie D, Colombel JF, Bouhnik Y, Cadiot G, Soule JC, Bourreille A, Metman E, Lerebours E, Carbonnel F, Dupas JL, Veyrac M, Coffin B, Moreau J, Abitbol V, Blum-Sperisen S, Mary JY (2006) Ineffectiveness of Lactobacillus johnsonii LA1 for prophylaxis of postoperative recurrence in Crohn’s disease: a randomised, double blind, placebo controlled GETAID trial. Gut 55:842–847PubMedCrossRefGoogle Scholar
  16. 16.
    Van Gossum A, Dewit O, Louis E, de Hertogh G, Baert F, Fontaine F, DeVos M, Enslen M, Paintin M, Franchimont D (2007) Multicenter randomized-controlled clinical trial of probiotics (Lactobacillus johnsonii, LA1) on early endoscopic recurrence of Crohn’s disease after lleo-caecal resection. Inflamm Bowel Dis 13:135–142PubMedCrossRefGoogle Scholar
  17. 17.
    Zocco MA, dal Verme LZ, Cremonini F, Piscaglia AC, Nista EC, Candelli M, Novi M, Rigante D, Cazzato IA, Ojetti V, Armuzzi A, Gasbarrini G, Gasbarrini A (2006) Efficacy of Lactobacillus GG in maintaining remission of ulcerative colitis. Aliment Pharmacol Ther 23:1567–1574PubMedCrossRefGoogle Scholar
  18. 18.
    Malchow HA (1997) Crohn’s disease and Escherichia coli. A new approach in therapy to maintain remission of colonic Crohn’s disease? J Clin Gastroenterol 25:653–658PubMedCrossRefGoogle Scholar
  19. 19.
    Rahimi R, Nikfar S, Rezaie A, Abdollahi M (2006) A meta-analysis of broad-spectrum antibiotic therapy in patients with active Crohn’s disease. Clin Ther 28:1983–1988PubMedCrossRefGoogle Scholar
  20. 20.
    MacDonald JK, McDonald JW (2007) Natalizumab for induction of remission in Crohn’s disease. Cochrane Database Syst Rev 1:CD006097PubMedGoogle Scholar
  21. 21.
    Kane SV, Schoenfeld P, Sandborn WJ, Tremaine W, Hofer T, Feagan BG (2002) The effectiveness of budesonide therapy for Crohn’s disease. Aliment Pharmacol Ther 16:1509–1517PubMedCrossRefGoogle Scholar
  22. 22.
    Campieri M, Rizzello F, Venturi A, Poggioli G, Ugolini F, Helwig U, Amadini C, Romboli E, Gionchetti P (2000) Combination of antibiotic and probiotic treatment in efficacious in prophylaxis of post-operative recurrence of crohn’s disease: a randomized controlled study versus mezalamine. Gastroenterology 118:A781CrossRefGoogle Scholar
  23. 23.
    Malin M, Suomalainen H, Saxelin M, Isolauri E (1996) Promotion of IgA immune response in patients with Crohn’s disease by oral bacteriotherapy with Lactobacillus GG. Ann Nutr Metab 40:137–145PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Roja Rahimi
    • 1
  • Shekoufeh Nikfar
    • 2
  • Fatemeh Rahimi
    • 1
  • Behzad Elahi
    • 3
  • Saeed Derakhshani
    • 4
  • Mohammad Vafaie
    • 4
  • Mohammad Abdollahi
    • 5
  1. 1.Pharmaceutical Sciences Research CenterTehran University of Medical SciencesTehranIran
  2. 2.Drug Selecting Committee, Food and Drug Organization, and Food and Drug Laboratory Research CenterMinistry of Health and Medical EducationTehranIran
  3. 3.School of MedicineTehran University of Medical SciencesTehranIran
  4. 4.Baharan Coloproctology Surgical ClinicTehranIran
  5. 5.Faculty of Pharmacy, and Pharmaceutical Sciences Research CenterTehran University of Medical Sciences (TUMS)TehranIran

Personalised recommendations