Commentary: the effects of probiotics on barrier function and mucosal pouch microbiota during maintenance treatment for severe pouchitis in patients with ulcerative colitis – authors' reply

Abstract

In the study by Persborn et al., UC patients with pou-chitis entering remission following 4 weeks of combina-tion antibiotic therapy were treated with Ecologic 825for 8 weeks. They demonstrated that probiotics mayrestore mucosal barrier function and that bacterialdiversity correlates with barrier function. However, theprobiotic supplement did not influence the compositionof the mucosal pouch microbiota and, in the absence ofa control or placebo group, these findings may representconsequences of mucosal healing following induction ofremission with antibiotics.Larger studies are needed to assess whether, and bywhat mechanisms, probiotics affect epithelial barrierfunction in the maintenance of pouchitis and other typesof IBD and whether this mechanism of action is linkedto prevention of relapse. However, this study raisesimportant issues regarding the use of probiotics in thetreatment of IBD. It is essential to consider whether theprobiotic is intended to affect a particular immunothera-peutic target, or to alter the mucosal or the luminal com-position of the microbiota. It is also important toconsider the phase of disease in which probiotic therapymay be most efficacious, perhaps depending on theintended therapeutic target.ACKNOWLEDGEMENTDeclaration of personal interests: Dr Landy has receivedresearch funding from the Broad foundation as anemployee of Imperial College London. Dr Hart has beena speaker for and is on the adivsory board for MSD,Shire and Abbott. Dr Hart is an employee of North WestLondon Hospitals Trust.Declaration of funding interests: None.REFERENCES