Skip to main content

Advertisement

SpringerLink
Log in

Probiotics in the management of colonic disorders

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Probiotics have been used in humans for almost a century and widely recommended for the treatment of a variety of ills assumed to be of colonic origin, including diarrhea, constipation, bloating, and flatulence. More recently, probiotics have been evaluated in the management of specific colonic disorders such as inflammatory bowel disease, irritable bowel syndrome, and Clostridium difficile colitis. It is evident that no two probiotics are exactly alike; why then should we expect reproducible results from studies that employ different species or strains, variable formulations, and diverse dosing schedules? When probiotics have been studied with the rigor appropriate to a new therapeutic modality, some coherent results have emerged: specific strains are effective in certain diarrheal states, irritable bowel syndrome, ulcerative colitis, and pouchitis, as well as in the prevention of C. difficile-related colitis. Even here, not to mention other colonic disorders, further adequately powered and appropriately designed trials are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Falk PG, Hooper LV, Mittvedt T, Gordon JI: Creating and maintaining the gastrointestinal ecosystem: what we know and need to know from gnotobiology. Microbiol Mol Biol Rev 1998, 62:1157–1170.

    PubMed  CAS  Google Scholar 

  2. Shanahan F: The host-microbe interface within the gut. Best Pract Research Clin Gastroenterol 2002, 16:915–931.

    Article  Google Scholar 

  3. O’Hara AM, Shanahan F: Gut microbiota: mining for therapeutic potential. Clin Gastroenterol Hepatol 2007, 5:274–284.

    Article  PubMed  CAS  Google Scholar 

  4. Guarner F, Malagelada JR: Gut flora in health and disease. Lancet 2003, 361:512–519.

    Article  PubMed  Google Scholar 

  5. Roberfroid M: Prebiotics: the concept revisited. J Nutr 2007, 137(Suppl 2):830S–837S.

    PubMed  CAS  Google Scholar 

  6. Rachmilewitz D, Kayatura, Karmeli F, et al.: Toll-like receptor 9 signaling mediates the anti-inflammatory effects of probiotics in murine experimental colitis. Gastroenterology 2004, 126:520–528.

    Article  PubMed  CAS  Google Scholar 

  7. Shanahan F: Probiotics: a perspective on problems and pitfalls. Scand J Gastroenterol 2003, 38(Suppl):34–36.

    Article  CAS  Google Scholar 

  8. NASPGHAN Nutrition Report Committee, Michail S, Sylvester F, Fuchs G, Issenman R: Clinical efficacy of probiotics: review of the evidence with focus on children. J Pediatr Gastroenterol Nutr 2006, 43:550–557.

    Article  PubMed  Google Scholar 

  9. Isolauri E, Salminen S, Ouwehand AC: Microbial-gut interactions in health and disease. Probiotics. Best Pract Res Clin Gastroenterol 2004, 18:299–313.

    Article  PubMed  Google Scholar 

  10. Allen SJ, Okoko B, Martinez E, et al.: Probiotics for treating infectious diarrhoea. Cochrane Database Syst Rev 2004, (2):CD003048.

  11. Urbancsek H, Kazar T, Mezes I, et al.: results of a double-blind, randomized study to evaluate the efficacy and safety of Antibiophilus in patients with radiation-induced diarrhea. Eur J Gastroenterol Hepatol 2003, 13:391–396.

    Article  Google Scholar 

  12. Delia P, Sansotta G, Donato V, et al.: Use of probiotics for prevention of radiation-induced diarrhea. World J Gastroenterol 2007, 13:912–915.

    PubMed  CAS  Google Scholar 

  13. McFarland LV: Meta-analysis of probiotics for the prevention of traveler’s diarrhea. Travel Med Infect Dis 2007, 5:97–105.

    Article  PubMed  Google Scholar 

  14. Szajewska H, Skorka A, Dylag M: Meta-analysis: Saccharomyces boulardii for treating acute diarrhoea in children. Aliment Pharmacol Ther 2007, 25:257–264.

    Article  PubMed  CAS  Google Scholar 

  15. D’souza AL, Rajkumar CH, Cooke J, et al.: Probiotics in prevention of antibiotic associated diarrhea: meta-analysis. BMJ 2002, 324:1361–1366.

    Article  PubMed  Google Scholar 

  16. Ahuja MC Khamar B: Antibiotic associated diarrhea: a controlled study comparing plain antibiotic with those containing protected lactobacilli. J Indian Med Assoc 2002, 100:334–335.

    PubMed  CAS  Google Scholar 

  17. Sazawal S, Hiremath G, Dhingra U, et al.: Efficacy of probiotics in prevention of acute diarrhoea: a meta-analysis of masked, randomised, placebo-controlled trials. Lancet Infect Dis 2006, 6:374–382.

    Article  PubMed  Google Scholar 

  18. de Vrese M, Marteau PR: Probiotics and prebiotics: effects on diarrhea. J Nutr 2007, 137(Suppl 2):803S–811S.

    PubMed  Google Scholar 

  19. Chande N, McDonald JW, MacDonald JK: Interventions for treating collagenous colitis. Cochrane Database Syst Rev 2006:CD003575.

  20. Koebnick C, Wagner I, Leitzmann P, et al.: Probiotic beverage containing Lactobacillus casei Shirota improves gastrointestinal symptoms in patients with chronic constipation. Can J Gastroenterol 2003, 17:655–659.

    PubMed  Google Scholar 

  21. Amenta M, Cascio MT, Di Fiore P, Venturini I: Diet and chronic constipation. Benefits of oral supplementation with symbiotic zir fos (Bifidobacterium longum W11 + FOS Actilight). Acta Biomed 2006, 77:157–162.

    PubMed  Google Scholar 

  22. Banaszkiewicz A, Szajewska H: Ineffectiveness of Lactobacillus GG as an adjunct to lactulose for the treatment of constipation in children: a double-blind, placebo-controlled randomized trial. J Pediatr 2005, 146:364–369.

    Article  PubMed  Google Scholar 

  23. Ouwehand AC, Lagstrom H, Suomalainen T, Salminen S: Effect of probiotics on constipation, fecal azoreductase activity and fecal mucin content in the elderly. Ann Nutr Metab 2002, 46:159–162.

    Article  PubMed  CAS  Google Scholar 

  24. Borody TJ, Warren EF, Leis SM, et al.: Bacteriotherapy using fecal flora: toying with human motions. J Clin Gastroenterol 2004, 38:475–483.

    Article  PubMed  Google Scholar 

  25. Quigley EM: Germs, gas and the gut, the evolving role of the enteric flora in IBS. Am J Gastroenterol 2006, 101:334–335.

    Article  PubMed  Google Scholar 

  26. Kim HJ, Camilleri M, McKenzie S, et al.: A randomized controlled trail of a probiotic, VSL#3 on gut transit and symptoms in diarrhoea-predominant IBS. Aliment Pharmacol Ther 2003, 17:895–904.

    Article  PubMed  CAS  Google Scholar 

  27. Kim HJ, Vazquez Roque MI, Camilleri M, et al.: a randomised controlled trial of probiotic combination VSL#3 and placebo in IBS with bloating: Neurogastroenterol Motil 2005, 17:687–696.

    Article  PubMed  CAS  Google Scholar 

  28. O’Mahony L, McCarthy J, Kelly P, et al.: Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. Gastroenterology 2005, 128:541–551.

    Article  PubMed  Google Scholar 

  29. Whorwell PJ, Altinger L, Morel J, et al.: Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol 2006, 101, 326–333.

    Article  Google Scholar 

  30. Castagliuolo I, Riegler MF, Valenik L, et al.: Saccharomyces boulardii protease inhibits the effects of clostridium difficile toxins A an B in human colonic mucosa. Infect Immun 1999, 67.302–307.

    PubMed  CAS  Google Scholar 

  31. Chen X, Kokkotou EG, Mustafa N, et al.: Saccharomyces boulardii inhibits ERK1/2 mitogen-activated protein kinase activation both in vitro and in vivo and protects against Clostridium difficile toxin A-induced enteritis. J Biol Chem 2006, 281:24449–24454.

    Article  PubMed  CAS  Google Scholar 

  32. Wullt M, Hagslatt ML, Odenholt I: Lactobacillus plantarum 299v for the treatment of recurrent Clostridium difficile-associated diarrhoea: a double-blind, placebo-controlled trial. Scand J Infect Dis 2003, 35:365–367.

    Article  PubMed  Google Scholar 

  33. McFarland LV: Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Am J Gastroenterol 2006, 101:812–822.

    Article  PubMed  Google Scholar 

  34. Quigley EM, Flourie B: Probiotics and irritable bowel syndrome: a rationale for their use and an assessment of the evidence to date. Neurogastroenterol Motil 2007, 19:166–172.

    Article  PubMed  CAS  Google Scholar 

  35. Hamilton-Miller JMT: Probiotics in the management of irritable bowel syndrome: A review of clinical trials. Microb Ecol Health Dis 2001, 13:212–216.

    Article  Google Scholar 

  36. Floch MH: A hypothesis: is diverticulitis a type of inflammatory bowel disease? J Clin Gastroenterol 2006, 40(Suppl 3):S121–S125.

    Article  PubMed  Google Scholar 

  37. Tursi A, Brandimarte G, Giorgetti GM, Elisei W: Mesalazine and/or Lactobacillus casei in preventing recurrence of symptomatic uncomplicated diverticular disease of the colon: a prospective, randomized, open-label study. J Clin Gastroenterol 2006, 40:312–316.

    Article  PubMed  Google Scholar 

  38. Sheil B, Shanahan F, O’Mahony L: Probiotic effects on inflammatory bowel disease. J Nutr 2007, 137(Suppl 2):819S–824S.

    PubMed  CAS  Google Scholar 

  39. Ewaschuk JB, Tejpar QZ, Soo I, et al.: The role of antibiotic and probiotic therapies in current and future management of inflammatory bowel disease. Curr Gastroenterol Rep 2006, 8:486–498.

    Article  PubMed  Google Scholar 

  40. Sartor RB: Therapeutic manipulation of the enteric microflora in inflammatory bowel diseases: antibiotics, probiotics, and prebiotics. Gastroenterology 2004, 126:1620–1633.

    Article  PubMed  Google Scholar 

  41. Shanahan F: Physiological basis for novel drug therapies used to treat the inflammatory bowel diseases I. Pathophysiological basis and prospects for probiotic therapy in inflammatory bowel disease. Am J Physiol Gastrointest Liver Physiol 2005, 288:G417–G421.

    Article  PubMed  CAS  Google Scholar 

  42. McCarthy J, O’Mahony L, O’Callaghan L, et al.: Double-blind, placebo controlled trial of two probiotic strains in interleukin 10 knockout mice and mechanistic link with cytokines. Gut 2003, 52:975–980.

    Article  PubMed  CAS  Google Scholar 

  43. Bai AP, Ouyang Q, Xiao XR, Li SF: Probiotics modulate inflammatory cytokine secretion from inflamed mucosa in active ulcerative colitis. Int J Clin Pract 2006, 60:284–288.

    Article  PubMed  Google Scholar 

  44. Cui HH, Chen CL, Wang JD, et al.: Effects of probiotic on intestinal mucosa of patients with ulcerative colitis. World J Gastroenterol 2004, 10:1521–1525.

    PubMed  CAS  Google Scholar 

  45. Borruel N, Carol M, Casellas F, et al.: Increased mucosal tumour necrosis factor alpha production in Crohn’s disease can be downregulated ex vivo by probiotic bacteria. Gut 2002, 51:659–664.

    Article  PubMed  CAS  Google Scholar 

  46. Grabig A, Paclik D, Guzy C, et al.: Escherichia coli strain Nissle 1917 ameliorates experimental colitis via toll-like receptor 2-and toll-like receptor 4-dependent pathways. Infect Immun 2006, 74:4075–4082.

    Article  PubMed  CAS  Google Scholar 

  47. Kruis W, Schutz E, Fric P, et al.: Double-blind comparison of an oral Escherichia coli preparation and mesalazine in maintaining remission of ulcerative colitis. Aliment Pharmacol Ther 1997, 11:853–858.

    Article  PubMed  CAS  Google Scholar 

  48. Rembacken BJ, Snelling AM, Hawkey PM, et al.: Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: a randomised trial. Lancet 1999, 354:635–639.

    Article  PubMed  CAS  Google Scholar 

  49. Ishikawa H, Akedo I, Umesaki Y, et al.: Randomized controlled trial of the effect of bifidobacteria-fermented milk on ulcerative colitis. J Am Coll Nutr 2003, 22:55–63.

    Google Scholar 

  50. Kruis W, Fric P, Pokrotnieks J, et al.: Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine. Gut 2004, 53:1617–1623.

    Article  PubMed  CAS  Google Scholar 

  51. Zocco MA, dal Verme LZ, Cremonini F, et al.: Efficacy of Lactobacillus GG in maintaining remission of ulcerative colitis. Aliment Pharmacol Ther 2006, 23:1567–1574.

    Article  PubMed  CAS  Google Scholar 

  52. Kato K, Mizuno S, Umesaki Y, et al.: Randomized placebo-controlled trial assessing the effect of bifidobacteria-fermented milk on active ulcerative colitis. Aliment Pharmacol Ther 2004, 20:1133–1141.

    Article  PubMed  CAS  Google Scholar 

  53. Guslandi M, Giollo P, Testoni PA: A pilot trial of Saccharomyces boulardii in ulcerative colitis. Eur J Gastroenterol Hepatol 2003, 15:697–698.

    Article  PubMed  Google Scholar 

  54. Tursi A, Brandimarte G, Giorgetti GM, et al.: 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, 10:PI126–PI131.

    PubMed  CAS  Google Scholar 

  55. Bibiloni R, Fedorak RN, Tannock GW, et al.: VSL#3 probiotic-mixture induces remission in patients with active ulcerative colitis. Am J Gastroenterol 2005, 100:1539–1546.

    Article  PubMed  Google Scholar 

  56. Borody TJ, Warren EF, Leis S, et al.: Treatment of ulcerative colitis using fecal bacteriotherapy. J Clin Gastroenterol 2003, 37:42–47.

    Article  PubMed  Google Scholar 

  57. Gionchetti P, Rizzello F, Helwig U, et al.: Prophylaxis of pouchitis onset with probiotic therapy: a double-blind, placebo-controlled trial. Gastroenterology 2003, 124:1202–1209.

    Article  PubMed  Google Scholar 

  58. Mimura T, Rizzello F, Helwig U, et al.: Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis. Gut 2004, 53:108–114.

    Article  PubMed  CAS  Google Scholar 

  59. Gosselink MP, Schouten WR, van Lieshout LM, et al.: Delay of the first onset of pouchitis by oral intake of the probiotic strain Lactobacillus rhamnosus GG. Dis Colon Rectum 2004, 47:876–884.

    Article  PubMed  Google Scholar 

  60. Kuisma J, Mentula S, Jarvinen H, et al.: Effect of Lactobacillus rhamnosus GG on ileal pouch inflammation and microbial flora. Aliment Pharmacol Ther 2003, 17:509–515.

    Article  PubMed  CAS  Google Scholar 

  61. Laake KO, Bjorneklett A, Aamodt G, Aabakken et al.: Outcome of four weeks’ intervention with probiotics on symptoms and endoscopic appearance after surgical reconstruction with a J-configurated ileal-pouch-analanastomosis in ulcerative colitis. Scand J Gastroenterol 2005, 40:43–51.

    Article  PubMed  CAS  Google Scholar 

  62. Campieri M, Rizzello F, Venturi A, et al.: Combination of antibiotic and probiotic treatment is efficacious in prophylaxis of post-operative recurrence of Crohn’s disease: a randomized controlled study vs mesalamine. Gastroenterology 2000, A781:4179.

    Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  64. Gupta P, Andrew H, Kirschner BS, Guandalini S: Is lactobacillus GG helpful in children with Crohn’s disease? Results of a preliminary, open-label study. J Pediatr Gastroenterol Nutr 2000, 31:453–457.

    Article  PubMed  CAS  Google Scholar 

  65. Karimi O, Pena AS, van Bodegraven AA: Probiotics (VSL#3) in arthralgia in patients with ulcerative colitis and Crohn’s disease: a pilot study. Drugs Today (Barc) 2005, 41:453–459.

    Article  CAS  Google Scholar 

  66. Prantera C, Scribano ML, Falasco G, et al.: Ineffectiveness of probiotics in preventing recurrence after curative resection for Crohn’s disease: a randomised controlled trial with Lactobacillus GG. Gut 2002, 51:405–409.

    Article  PubMed  CAS  Google Scholar 

  67. Rolfe VE, Fortun PJ, Hawkey CJ, Bath-Hextall F: Probiotics for maintenance of remission in Crohn’s disease. Cochrane Database Syst Rev 2006, 18:CD004826.

  68. Marteau P, Lemann M, Seksik P, et al.: Ineffectiveness of Lactobacillus johnsonii LA1 for prophylaxis of postoperative recurrence in Crohn’s disease: a randomised, double blind, placebo controlled GETAID trial. Gut 2006, 55:842–847.

    Article  PubMed  CAS  Google Scholar 

  69. Bousvaros A, Guandalini S, Baldassano RN, et al.: 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 2005, 11:833–839.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland

    Eamonn M. M. Quigley

Authors
  1. Eamonn M. M. Quigley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eamonn M. M. Quigley.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Quigley, E.M.M. Probiotics in the management of colonic disorders. Curr Gastroenterol Rep 9, 434–440 (2007). https://doi.org/10.1007/s11894-007-0055-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-007-0055-7

Keywords

Search

Navigation