A pilot trial of Saccharomyces boulardii in ulcerative colitis Double blind, placebo controlled trial of metronidazole in Crohn's disease. Prophylaxis of pouchitis onset with probiotic therapy: A double‐blind, placebo‐controlled trial Ineffectiveness of probiotics in preventing recurrence after curative resection for Crohn's disease: a randomised controlled trial with Lactobacillus GG Probiotic therapy fails to improve gut permeability in a hapten model of colitis. Saccharomyces boulardii in Maintenance Treatment of Crohn’s Disease Impact on the composition of the faecal flora by a new probiotic preparation: preliminary data on maintenance treatment of patients with ulcerative colitis Crohn's disease and Escherichia coli. A new approach in therapy to maintain remission of colonic Crohn's disease? Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: a randomised trial Double‐blind comparison of an oral Escherichia coli preparation and mesalazine in maintaining remission of ulcerative colitis
Objectives Probiotics can be useful in the treatment of inflammatory bowel disease . In a previous report , the non-pathogenic yeast Saccharomyces boulardii was found to be beneficial in the maintenance treatment of Crohn 's disease . The aim of this study was to assess the efficacy of S. boulardii in ulcerative colitis patients . Methods A group of 25 patients with a mild to moderate clinical flare-up 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 . Before and after treatment , Rachmilewitz 's clinical activity index was calculated . The probiotic treatment was considered a therapeutic success only when the final score was lower than 6 . Results Of the 24 patients who completed the study , 17 attained clinical remission ; this was confirmed endoscopically . Conclusions Our preliminary results suggest that S. boulardii can be effective in the treatment of ulcerative colitis . Controlled studies with this probiotic agent are warranted A double blind study compared the efficacy of metronidazole in two doses ( 20 mg/kg , 10 mg/kg ) with placebo in patients with Crohn 's disease . One hundred and five patients participated but only 56 completed the 16 week study -21 were withdrawn for deterioration of symptoms , 17 for adverse experiences , and 11 for protocol violation . Significant improvement in disease activity as measured by the Crohn 's disease activity index  ( metronidazole 20 mg/kg , 97 units ; metronidazole 10 mg/kg , 67 units ; placebo -1 unit , p = 0.002 ) and serum orosomucoid  ( metronidazole 20 mg/kg/day , 49 ; 10 mg/kg/day , 38 ; placebo , -9 , p = 0.001 ) ) were detected . Changes in C reactive protein concentrations did not achieve significance when all three groups were considered but were significant when all metronidazole treated patients were grouped and compared with the placebo treated patients ( 0.8 v -0.9 , p less than 0.05 ) . Although patients receiving metronidazole 20 mg/kg/day had a greater improvement in disease activity than those receiving 10 mg/kg/day ( difference 30 units ( 95 % confidence intervals -27 - 87 ) , the small sample size may have precluded the detection of statistical significance . Preliminary analysis suggests that metronidazole was more effective in patients with disease confined to the large intestine or affecting both small and large bowel than in those with small bowel disease only . There were no differences in remission rates between metronidazole and placebo treated patients . We conclude that metronidazole warrants further assessment in the treatment of patients with active Crohn 's disease BACKGROUND & AIMS We have recently documented the efficacy of a highly concentrated probiotic preparation ( VSL#3 ) in the prevention of flare-up in patients with chronic pouchitis . The aim of this study was to compare probiotic therapy with VSL#3 versus placebo in the ability to prevent the onset of acute pouchitis during the first year after ileal pouch-anal anastomosis . METHODS Forty consecutive patients who underwent ileal pouch-anal anastomosis for ulcerative colitis were r and omized to receive either VSL#3 ( 1 packet containing 900 billion bacteria/day ) ( n = 20 ) or an identical placebo ( n = 20 ) immediately after ileostomy closure for 1 year . The patients were assessed clinical ly , endoscopically , and histologically after 1 , 3 , 6 , 9 , and 12 months . Health-related quality of life was assessed using the Inflammatory Bowel Disease Question naire . RESULTS Two of the 20 patients ( 10 % ) treated with VSL#3 had an episode of acute pouchitis compared with 8 of the 20 patients ( 40 % ) treated with placebo ( log-rank test , z = 2.273 ; P < 0.05 ) . Treatment with VSL#3 determined a significant improvement in Inflammatory Bowel Disease Question naire score , whereas this was not the case with placebo . CONCLUSIONS Treatment with VSL#3 is effective in the prevention of the onset of acute pouchitis and improves quality of life of patients with ileal pouch-anal anastomosis Background and aims : Experimental studies have shown that luminal bacteria may be involved in Crohn 's disease . Probiotics are a possible alternative to antibiotics . The aim of this r and omised placebo controlled study was to determine if Lactobacillus GG , given by mouth for one year , could prevent Crohn 's recurrent lesions after surgery or to reduce their severity . Methods : Patients operated on for Crohn 's disease in whom all of the diseased gut had been removed were r and omly allocated to receive 12 billion colony forming units of Lactobacillus or identical placebo for one year . Ileocolonoscopy was performed at the end of the trial or at the onset of symptoms . Endoscopic recurrence was defined as grade 2 or higher of Rutgeerts scoring system . Results : Eight of 45 patients were excluded from the trial ( three for non-compliance and five for protocol violations ) .  Clinical recurrence was ascertained in three ( 16.6 % ) patients who received Lactobacillus and in two ( 10.5 % ) who received placebo . Nine of 15 patients in clinical remission on Lactobacillus ( 60 % ) had endoscopic recurrence compared with six of 17 ( 35.3 % ) on placebo ( p=0.297 ) . There were no significant differences in the severity of the lesions between the two groups . Conclusions : Lactobacillus GG seems neither to prevent endoscopic recurrence at one year nor reduce the severity of recurrent lesions BACKGROUND Studies in clinical and experimental inflammatory bowel disease ( IBD ) have shown disturbances in intestinal bacterial flora with an increase in potentially pathogenic and a decrease in protective organisms . It was hypothesized that Lactobacillus plantarum species 299 ( LP299 ) , a probiotic , would ameliorate colitis and improve intestinal permeability in experimental colitis . This study investigated the effect of LP299 in the trinitrobenzenesulfonic acid/ethanol ( TNBS/E ) rat model of colitis . METHODS Twelve week old male Wistar rats were r and omized to receive rectal instillates of either TNBS/E ( n = 48 ) or saline ( n = 16 ) . For the next 7 days the animals were gavaged with 2.5 ml of oat fibre suspension containing 10(9 ) colony forming units ( CFU ) of LP299 ( LP299/OF ) , oat fibre suspension alone ( OF ) or no treatment . At the end of the experiment rats received radiolabelled polyethylene glycol and urine was collected for 24 h to assess permeability . Animals were then anaesthetized and colons were harvested for colon macroscopic scoring ( CMS ) . RESULTS TNBS/E per rectum result ed in a greater CMS ( P < 0.001 ) and gut permeability ( P = 0.006 ) than saline . Administration of LP299/OF or oat fibre alone did not result in a reduction in CMS or gut permeability when compared to colitic controls . CONCLUSIONS LP299/OF , when administered after TNBS instillation , does not reduce the severity of colitis or improve gut permeability in this hapten model of colitis The possible role of Saccharomyces boulardii , a nonpathogenic yeast with beneficial effects on the human intestine , in the maintenance treatment of Crohn ’s disease has been evaluated . Thirty-two patients with Crohn ’s disease in clinical remission ( CDAI < 150 ) were r and omly treated for six months with either mesalamine 1 g three times a day or mesalamine 1 g two times a day plus a preparation of Saccharomyces boulardii 1 g daily . Clinical relapses as assessed by CDAI values were observed in 37.5 % of patients receiving mesalamine alone and in 6.25 % of patients in the group treated with mesalamine plus the probiotic agent . Our results suggest that Saccharomyces boulardii may represent a useful tool in the maintenance treatment of Crohn ’s disease . However , in view of the product ’s cost , further controlled studies are needed to confirm these preliminary data : Although 5‐aminosalicylic acid ( 5‐ASA ) oral compounds are the st and ard maintenance treatment for ulcerative colitis in remission , some patients can not use them because of side‐effects . Clinical and experimental observations have suggested the potential role of probiotics in inflammatory bowel disease therapy Involvement of pathogenic or potentially pathogenic bacteria in the pathogenesis of inflammatory bowel disease has long been suggested because , among other reasons , the inflammatory response resembles that in infectious bowel diseases . Elevated antibody levels to pathogen antigens and a changed metabolic activity of the intestinal microflora have been detected in patients with Crohn 's disease . Several studies have revealed a possible etiologic link between intestinal microorganisms and inflammatory bowel disease . Therefore , several therapeutic strategies , including reduction or dilution of bacterial components in the intestine by antibiotics or intestinal lavage , respectively , inactivation of inflammatory bacterial products , and reconstitution of intestinal microflora have been employed , substantiating the idea that dysfunction of the intestinal mucosal barrier and an alteration of bacterial composition contribute to the inflammatory disease . However , the beneficial effect of restoration of the physiologic intestinal microflora in colonic inflammation by exogenous administration of a viable nonpathogenic bacterium has not been investigated before in a placebo-controlled study . Promising results came from the present pilot study in which the nonpathogenic Escherichia coli strain Nissle 1917 was tested for efficacy and tolerance in maintaining remission in patients with colonic Crohn 's disease . Application of the physiologic bacteria reduced the risk for relapse and minimized the need for glucocorticoids . Therefore we are convinced that in Crohn 's disease parts of the intestinal microflora , including the host 's immune response toward indigenous flora or an impairment of the gut flora 's metabolic activity are involved in the development or at least in the onset of relapse from remissive of colonic Crohn 's disease . However , more data are necessary to prove the benefit of E. coli strain Nissle 1917 as a new therapy to maintain remission of colonic Crohn 's disease BACKGROUND Ulcerative colitis has been suggested to be caused by infection and there is circumstantial evidence linking Escherichia coli with the condition . Our aim was to find out whether the administration of a non-pathogenic strain of E. coli ( Nissle 1917 ) was as effective as mesalazine in preventing relapse of ulcerative colitis . We also examined whether the addition of E. coli to st and ard medical therapy increased the chance of remission of active ulcerative colitis . METHODS This was a single-centre , r and omised , double-dummy study in which 120 patients with active ulcerative colitis were invited to take part . 116 patients accepted ; 59 were r and omised to mesalazine and 57 to E. coli .  All patients also received st and ard medical therapy together with a 1-week course of oral gentamicin . After remission , patients were maintained on either mesalazine or E. coli and followed up for a maximum of 12 months . A two-stage , conditional , intention-to-treat analysis was done . FINDINGS 44 ( 75 % ) patients in the mesalazine group attained remission compared with 39 ( 68 % ) in the E. coli group . Mean time to remission was 44 days ( median 42 ) in the mesalazine group and 42 days ( median 37 ) for those treated with E. coli . In the mesalazine group , 32 ( 73 % ) patients relapsed compared with 26 ( 67 % ) in the E. coli group . Mean duration of remission was 206 days in the mesalazine group ( median 175 ) and 221 days ( median 185 ) in the E. coli group . INTERPRETATION Our results suggest that treatment with a non-pathogenic E. coli has an equivalent effect to mesalazine in maintaining remission of ulcerative colitis . The beneficial effect of live E. coli may provide clues to the cause of ulcerative colitis Aminosalicylates are used as st and ard treatment for maintaining remission in ulcerative colitis . As yet , there is no other existing alternative with proven efficacy . In light of the hypothesis that the intestinal environment may contribute to the pathophysiology of ulcerative colitis , a trial was conducted to test the effects of probiotic treatment with an oral preparation of non‐pathogenic E. coli
BACKGROUND Crohn 's disease ( CD ) is characterised by episodes of disease activity and symptom-free remission .
Probiotics are microorganisms that can potentially benefit health , and have been evaluated as an alternate means of preventing relapse in patients with CD .
OBJECTIVES To assess the effectiveness of probiotics for the maintenance of remission in CD .