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Probiotics News

Probiotics for Inflammatory Bowel Disease (IBD)

• of human origin;
  
• non pathogenic (does not cause disease, e.g., a strain of E. coli that does not cause disease);
  
• resistant to acid in the upper gastrointestinal (GI) tract;
  
• capable of adhering to the epithelium (the lining of the intestine);
  
• able to produces substances that can destroy pathogenic (disease-causing) bacteria;
  
• able to modulate the immune system.
  

• an antigen, that is, a bacteria or bacteria product that passes through the epithelium;
  
• defects in the permeability of the epithelium, possibly because of genetic susceptibility to these defects, allowing the antigen into the intestine
  
• a dysregulated immune response that occurs in response to the antigen, also genetically controlled
  

• B. J. Rembacken, MRCP, and colleagues (The General Infirmary at Leeds, UK, et al.) reported on a trial of E. coli in active ulcerative colitis (The Lancet, August 21, 1999). They randomly assigned 116 patients to receive steroids and either E. coli or mesalamine. Three months later, 68 percent of group on E. coli were in remission, compared with 75 percent of the mesalamine group. All patients were weaned off steroids, and those in remission were permitted to continue receiving E. coli or mesalamine alone at half the dose. At 12 months, 67 percent of those receiving E. coli had relapsed, along with 73 percent of those receiving mesalamine. "The authors conclude that this probiotic was able to keep a similar number of patients in remission over one year as mesalamine," said Dr. Fedorak, noting that this conclusion should be viewed cautiously. "Patients were receiving low doses of 5-ASA, maybe lower than what you would normally administer to maintain remission, and the rate of relapse at one year was near placebo rates."
  
  
• Wolfgang Kruis MD, and colleagues (University of Cologne, Germany) treated 120 patients whose ulcerative colitis was in remission with either E. coli or mesalamine (Alimentary Pharmacology & Therapeutics, October 1997). After three months, 16 percent relapsed in the E. coli group, compared with 11 percent in the mesalamine group. "They conclude that E. coli is similar to this dose of mesalamine in preventing relapse," says Dr. Fedorak. "But this was a limited number of patients, who were only followed for a short time. Again, the dose of mesalamine (1.5 grams/day) was low for maintenance therapy."
  
• Alessandro Venturi, MD, and colleagues (University of Bologna, Italy) treated 20 patients, also with ulcerative colitis in remission, with VSL-3, a combination of four strains of lactobacilli, three bifidobacteria, and one streptococcus (Alimentary Pharmacology & Therapeutics, August 1999). "Perhaps this is a good idea, because these probiotic strains are working through different mechanisms," mused Dr. Fedorak. "If one doesn't survive, the other likely will." At 12 months, the rate of relapse was 25 percent, a level that would be expected with mesalamine. "Again, this was an open, unblinded trial [a study where participants know the drug under study, and there is no comparison to another drug or to placebo] of a small number of subjects; it needs to be expanded."
  
  
• The lone trial of probiotics in Crohn's was presented at DDW. Mario Guslandi, MD (S. Raffaele Hospital, Milan) treated 32 patients with Crohn's of the ileum or colon in remission, with S. boulardii and mesalamine, or mesalamine alone. At six months, one of 16 patients in the S. boulardii group had relapsed, compared with six of 16 in the mesalamine group. "This is a tantalizing piece of evidence to suggest that this yeast may be effective in maintaining remission in Crohn's," noted Dr. Fedorak, noting once again, however, that this was a small, open trial.
  
  
• Dr. Paolo Gionchetti, MD, PhD, and colleagues (University of Bologna, Italy) reported findings on preventing pouchitis using VSL-3, at a Distinguished Abstract Plenary Session during DDW. They administered this probiotic cocktail to 20 patients immediately after the pouch procedure, while 20 others received placebo. Relapse rates at 12 months were 10 percent in the group receiving probiotics, and 40 percent in those receiving placebo. Gerald Friedman, MD, and James George, MD (Mount Sinai School of Medicine, NY), treated 10 patients with unresponsive pouchitis with Lactobacillus GG. All had complete remission of symptoms and damage found on endoscopy.