Probiotics and Inflammatory Bowel Disease

Dieticians are often asked whether probiotics are beneficial in the treatment of Crohn’s disease and ulcerative colitis (also known as Inflammatory Bowel Disease or IBD). Before reviewing the research, let’s discuss what probiotics are.

The human gut is host to thousands of organisms such as bacteria, fungi, yeast, and bacteriophages collectively known as the gut microbiota. There are at least 15,000 different species of bacteria in our gut, which makes up over 1 kg of our total body weight. The primary location of bacteria in our gut is the colon, or large intestine.

There is some evidence that suggests changes in our gut microbiota can affect our risk of developing IBD, and that some therapies for the treatment of IBD can affect the gut microbiota. For example, antibiotics can kill some of the healthy bacteria in our gut. Therefore, it is important for us to replenish our bodies with this healthy bacteria after an insult, like antibiotic therapy, diarrhea, or other GI symptoms.

Replenishing a depleted microbiota is where probiotics come into the picture. According to the World Health Organization (WHO), probiotics are live microorganisms (bacteria) that, when given in appropriate amounts, confer a health benefit to the host. There are many different strains of probiotics, and each type may have a different use. Therefore, not all probiotics are created equal. You may be familiar with the names Lactobacillus and Bifidobacteria, which are two of the most common strains of probiotics.

When taking probiotics to replenish lost gut bacteria it is important to remember that they are living organisms and they need food to survive. Prebiotics are their food. Prebiotics are non-digested food ingredients that stimulate the growth of bacteria. They cannot be absorbed until they reach the colon, where they are fermented by probiotics. Examples of prebiotics include fructooligosaccharides, galactooligosaccharides, lactulose, and inulin. It is often useful to take a prebiotic and probiotic together for maximum benefit to your gut microbiota.

Most evidence for probiotic use in IBD is in patients with ulcerative colitis. You’ll remember the primary location of bacteria in the gut is the colon or large intestine, and ulcerative colitis is isolated to the colon, whereas Crohn’s disease can affect the entire digestive tract. The probiotic called VSL#3 (a combination of strains of Bifidobacteria, Lactobacillus, and Streptococcus) has been shown to prevent pouchitis and maintain remission in patients with recurrent or refractory pouchitis (UC)*.

Unfortunately, probiotics have not been shown to be beneficial in maintaining remission and preventing flares in Crohn’s disease. The most beneficial aspect of probiotics in Crohn’s seems to be during antibiotic therapy (since antibiotics and other GI symptoms deplete healthy bacteria, replenishing the gut microbiota is important). Like the diseases themselves, each patient is different. That means the response to something like probiotics can vary greatly between individuals. When considering the use of probiotics it is always important to have a conversation with your gastroenterologist.

*Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis; Gut 2004; 53:108–114

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Editor's note: This post was reviewed and approved by Rebecca Suddock – Registered Dietitian at Oklahoma University Medical Center on 2/6/2018.