Skip to main content

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

Digestive Diseases and Sciences volume 53, pages 2524–2531 (2008)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

References

  1. Fow J, Grossman S (2007) A comprehensive guide to patient-focused management strategies for Crohn disease. Gastroenterol Nurs 30:93–98

    PubMed  Article  Google Scholar 

  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–S37

    Article  Google Scholar 

  3. Lemann M (2006) Review article: can post-operative recurrence in Crohn’s disease be prevented? Aliment Pharmacol Ther 24:S22–S28

    Article  Google Scholar 

  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:CD003715

    Google Scholar 

  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:CD000301

    PubMed  Google Scholar 

  6. Jones JL, Foxx-Orenstein AE (2007) The role of probiotics in inflammatory bowel disease. Dig Dis Sci 52:607–611

    PubMed  Article  Google Scholar 

  7. Shanahan F (2003) Probiotics in inflamatory bowel disease. Gut 48:609

    Article  Google Scholar 

  8. Sartor RB (2003) Targeting enteric bacteria in treatment of inflammatory bowel diseases: why, how, and when. Curr Opin Gastroenterol 19:358–365

    PubMed  Article  Google Scholar 

  9. Gionchetti P, Rizzello F, Campieri M (2002) Probiotics in gastroenterology. Curr Opin Gastroenterol 18:235–239

    PubMed  Article  Google Scholar 

  10. Guslandi M, Mezzi G, Sorghi M, Testoni PA (2000) Saccharomyces boulardii in maintenance treatment of Crohn’s disease. Dig Dis Sci 45:1462–1464

    PubMed  Article  CAS  Google Scholar 

  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 51:405–409

    PubMed  Article  CAS  Google Scholar 

  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:CD004826

    Google Scholar 

  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 11:833–839

    PubMed  Article  Google Scholar 

  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 4:5

    PubMed  Article  Google Scholar 

  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 55:842–847

    PubMed  Article  CAS  Google Scholar 

  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 13:135–142

    PubMed  Article  Google Scholar 

  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 23:1567–1574

    PubMed  Article  CAS  Google Scholar 

  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 25:653–658

    PubMed  Article  CAS  Google Scholar 

  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 28:1983–1988

    PubMed  Article  CAS  Google Scholar 

  20. MacDonald JK, McDonald JW (2007) Natalizumab for induction of remission in Crohn’s disease. Cochrane Database Syst Rev 1:CD006097

    PubMed  Google Scholar 

  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 16:1509–1517

    PubMed  Article  CAS  Google Scholar 

  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:A781

    Article  Google Scholar 

  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 40:137–145

    PubMed  CAS  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Roja Rahimi & Fatemeh Rahimi

  2. Drug Selecting Committee, Food and Drug Organization, and Food and Drug Laboratory Research Center, Ministry of Health and Medical Education, Tehran, Iran

    Shekoufeh Nikfar

  3. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Behzad Elahi

  4. Baharan Coloproctology Surgical Clinic, Tehran, Iran

    Saeed Derakhshani & Mohammad Vafaie

  5. Faculty of Pharmacy, and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6451, Tehran, Iran

    Mohammad Abdollahi

Authors
  1. Roja Rahimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shekoufeh Nikfar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fatemeh Rahimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Behzad Elahi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Saeed Derakhshani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mohammad Vafaie
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mohammad Abdollahi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohammad Abdollahi.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Rahimi, R., Nikfar, S., Rahimi, F. et al. A Meta-Analysis on the Efficacy of Probiotics for Maintenance of Remission and Prevention of Clinical and Endoscopic Relapse in Crohn’s Disease. Dig Dis Sci 53, 2524–2531 (2008). https://doi.org/10.1007/s10620-007-0171-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-007-0171-0

Keywords

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