Prebiotics and Probiotics in Inflammatory Bowel Disease (IBD)

Abstract

Modifying the microbiome as a therapeutic strategy in inflammatory bowel disease (IBD) through the use of probiotics and prebiotics makes theoretical sense as current evidence indicates a fundamental role for luminal bacteria in the pathophysiology of IBD. Clinical studies, however, have not, to date, realized this promise. There is no substantial evidence to support the use of prebiotics or probiotics in Crohn’s disease. Studies in ulcerative colitis are conflicting but suggest potential value in some clinical contexts where a trend toward clinical benefit has been seen. Prebiotics may improve quality of life but not influence more traditional clinical end points. However, the most convincing evidence for the use of probiotics in IBD is in pouchitis where benefits in both primary prevention and maintenance of remission have been demonstrated. Several limitations limit the interpretation of most all studies performed to date: small size of study populations, heterogeneity of strains, dosing and formulations as well as a failure to account for important confounders such as concurrent medications, and diet; these deficiencies provide the impetus for future well-designed and adequately powered studies.