Probiotics in Crohn's disease
The therapeutic role of probiotics in the prevention of postoperative recurrence of Grohn's disease has been reported in some studies. Gampieri et al. (111) studied the effects of VSL3 in a randomized, investigator-blind trial. Forty patients with curative resection randomized within 1 week post surgery were divided into two groups of 20 patients. One group received mesalazine 4 g/day for 1 year and the other group received rifaximin 1.8 g/day for 3 months followed by VSL#3 6 g/day for 9 months. The endoscopic activity was assessed after 3 and 12 months. In the mesalazine group, eight patients had severe endoscopic recurrence after 3 months as well as after 12 months, whereas in the group with rifaximin and VSL3, two patients had a severe recurrence after 3 months and two patients after 12 months.
These results suggested the efficacy of the combination of a nonabsorbable antibiotic with a highly concentrated probiotic preparation in the prevention of severe endoscopic recurrence of Crohns disease after surgical resection.
In a pilot study Guandalini et al (112) investigated the possible effect of Lactobacillus GG in children with active Crohns disease. Four male patients with a median age of 14.5 years (range 10-18) were enrolled. In terms of clinical outcome, the patients showed significant improvement. In three patients receiving Lactobacillus GG, it was possible to taper the dose of steroids.
In a third published study using Lactobacillus GG this effect could not be confirmed. Forty-five patients were randomized to receive Lactobacillus GG 12 billion GFU/day (23 patients) or placebo (22 patients). A clinical remission after 52 weeks was seen in 15 of the 23 patients with Lactobacillus GG (83.3%) and in 17 of the 22 patients with placebo (89.4%).
Mild endoscopic activity was seen in nine of the 15 patients with remission in the Lactobacillus GG group (60%) and in six of the 17 patients with remission in the placebo group (35.3%). This study failed to show effectiveness in the postoperative prevention on Crohn's disease (113). More studies are therefore necessary. The limited experience indicates that different probiotics have different capacity to prevent intestinal inflammation.