COMMENTARY

Probiotics in the Management of Inflammatory Bowel Disease

Robert M. Penner, MD, FRCPC; Richard N. Fedorak, MD, FRCPC

Disclosures

July 18, 2005

In This Article

Introduction

Little doubt remains that in addition to genetic and environmental factors, bacteria play a key role in the pathogenesis of inflammatory bowel disease (IBD). Patients with IBD suffer from dysbiosis -- a term used to describe the abnormalities in intestinal bacterial content and host-bacterial interaction that characterize the disease. What remains controversial is how our knowledge of this dysbiotic state can best be put to therapeutic use. Three strategies currently exist: antibiotics, probiotics, and synbiotics.

Antibiotics have long been used to treat IBD with limited success, and with the knowledge that they currently represent a "blind attack" on intestinal bacteria because there is no clear idea of which organisms are being targeted. Probiotics and synbiotics are clinically administered bacteria, with or without a coadministered nutrient to facilitate bacterial growth. The rationale for the use of these agents derives from the fact that different bacterial species have variable effects on intestinal inflammation in IBD and that some bacteria seem to have relatively beneficial effects. Researchers have examined the use of these agents in several clinical settings; however, the quality of evidence differs between these settings as does the apparent clinical effect. The clinical settings of interest can be stratified as follows: pouchitis, Crohn's disease, and ulcerative colitis.

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