The incidence, prevalence, and cost of care associated with diagnosis and management of
inflammatory bowel disease are on the rise. The role of gut microbiota in the causation of Crohn's
disease and ulcerative colitis has not been established yet. Nevertheless, several animal models and
human studies point towards the association. Targeting intestinal dysbiosis for remission induction,
maintenance, and relapse prevention is an attractive treatment approach with minimal adverse effects.
However, the data is still conflicting. The purpose of this article is to provide the most comprehensive
and updated review on the utility of prebiotics and probiotics in the management of
active Crohn’s disease and ulcerative colitis/pouchitis and their role in the remission induction,
maintenance, and relapse prevention. A thorough literature review was performed on PubMed, Ovid
Medline, and EMBASE using the terms “prebiotics AND ulcerative colitis”, “probiotics AND ulcerative
colitis”, “prebiotics AND Crohn's disease”, “probiotics AND Crohn's disease”, “probiotics
AND acute pouchitis”, “probiotics AND chronic pouchitis” and “prebiotics AND pouchitis”. Observational
studies and clinical trials conducted on humans and published in the English language
were included. A total of 71 clinical trials evaluating the utility of prebiotics and probiotics in the
management of inflammatory bowel disease were reviewed and the findings were summarized.
Most of these studies on probiotics evaluated lactobacillus, De Simone Formulation or Escherichia
coli Nissle 1917 and there is some evidence supporting these agents for induction and maintenance
of remission in ulcerative colitis and prevention of pouchitis relapse with minimal adverse effects.
The efficacy of prebiotics such as fructooligosaccharides and Plantago ovata seeds in ulcerative
colitis are inconclusive and the data regarding the utility of prebiotics in pouchitis is limited. The
results of the clinical trials for remission induction and maintenance in active Crohn's disease or
post-operative relapse with probiotics and prebiotics are inadequate and not very convincing. Prebiotics
and probiotics are safe, effective and have great therapeutic potential. However, better designed
clinical trials in the multicenter setting with a large sample and long duration of intervention
are needed to identify the specific strain or combination of probiotics and prebiotics which will be
more beneficial and effective in patients with inflammatory bowel disease.
Placebo controls in clinical trials: concerns about use in relapse prevention studies in schizophrenia
