Probiotics in Ulcerative Colitis
Two studies have shown a significant decrease in lactobacilli concentration in colonic biopsies in patients with ulcerative colitis. Preventing or controlling the colitis is reported when the concentration of Lactobacillus was modulated through dietary supplementation with lactulose (prebiotic). This is a non digestible food ingredient that affects the host by selectively stimulating the growth and activity of one or more "probiotic" bacteria, such as Bifidobacterium and Lactobacillus that have health-promoting properties (104).
Ulcerative Colitis is a chronic inflammation of the rectal and colonic mucosa, with a poorly defined etiology. Its characteristics are bloody diarrhea and mucus associated with a negative stool culture for bacteria, ova, or parasites. There is also fecal stasis with bacterial overgrowth and mucosal ischemia.
The therapeutic role of probiotics is shown through two studies; in one of these, oral administration of Lactobacillus GG caused an increase in intestinal IgA immune response in patients with Crohn's disease. In the other study, exogenous administration of L. reuteri (pure bacterial suspension or as fermented oatmeal soup) prevented acetic acid-induced colitis or methotrexate-induced colitis in rats.
These studies showed a significant decrease in lactobacilli concentration in patients with active ulcerative colitis. The results showed that L. plantarum was more effective in methotrexate-induced colitis, and Lactobacillus treatment prevented development of spontaneous colitis in IL-10 gene-deficient mice.
In an open label study with 20 patients, intolerant or allergic to 5-aminosalicylic acid (5-ASA), a' treatment consisting of VSL3 6 g (1800 billions bacteria)/day for 12 months was instituted. Clinical, endoscopic assessment and stool culture and fecal pH determination were recorded (105). Nineteen patients completed the trial and 15 were in remission for the whole year. Fecal concentrations of bifidobacteria, lactobacilli, and S. salivarius spp. Thermophilus were significantly increased in all patients and remained stable throughout the study. No changes were noted in the concentrations of total aerobic bacteria, suggesting that the beneficial effects of VSL3 were not related to suppression of endogenous luminal flora. The treatment was welltolerated with no reported significant side effects like those seen in the treatment with 5-ASA oral compounds.
This shows that the probiotic preparation was able to colonize the intestine and suggested its possible usefulness in maintaining remission in ulcerative colitis patients intolerant or allergic to 5ASA (105). The hypothesis from these studies is that the intestinal environment may contribute to the pathophysiology of ulcerative colitis.
Guslandi et al. (106) studied the efficacy of S. boulardii in ulcerative colitis patients. Twenty-five patients with a mild to moderate clinical flareup of ulcerative colitis received additional treatment with S. boulardii 250 mg three times a day for 4 weeks during maintenance treatment with mesalazine. These patients were unsuitable for steroid therapy. Rachmilewitz's clinical activity index was calculated before and after the treatment. Of the 24 patients who completed the study, 17 attained clinical remission; this was endoscopically confirmed. The preliminary results suggested that S. boulardii may be effective in the treatment of ulcerative colitis.