Probiotics and Ulcerative Colitis
The gastrointestinal tract contains millions of tiny bacteria, which are beneficial and necessary for health. However, an imbalance or any alteration in the bacteria in the gut can lead to inflammatory processes that can result in illness. One way gut bacteria can be altered in a beneficial way is through the use of probiotics.
What are probiotics?
Probiotics are actual bacteria, which are shown to promote health. They are made from food sources, usually cultured milk, and come in the form of pills, capsules, and dissolvable powders. Some bacteria are genetically engineered to have properties that positively influence the inflammatory response in the gut. This has been found to improve treatment of gastrointestinal inflammatory disorders, such as UC and Crohn’s disease (CD).
Do they have any benefit to the gut? How?
Probiotics can be extremely beneficial to the gut in several ways:
- They can act as a barrier against other, potentially harmful, bacteria in the intestines that might trigger an immune response in the intestinal lining.
- Probiotics also increase the amount of mucus produced in the intestines. A thick mucus layer helps prevent harmful bacteria from invading the intestinal lining and alters which bacteria stick to the intestinal wall.
- Probiotics also help promote secretion of protective proteins from the intestinal immune system. These proteins help block the inflammatory response in the gut lining.
How can they help in UC?
UC is an inflammatory bowel disease that is characterized by a chronically active inflammatory response in the lining of the colon. It is thought that an underlying genetic mutation allows for more aggressive bacteria to trigger this response in the colon lining. Probiotics could change the bacteria in the colon to less aggressive colonies, thereby decreasing inflammation. Also, since probiotics work at the part of the lining of the colon affected by the disease, they could potentially have many beneficial effects.
Which probiotics are better to use?
While several probiotics have shown benefit in patients with UC, the studies are small and too few studies are available to support using probiotics for induction or maintenance of remission in active UC. However, combining certain probiotics with traditional medications for UC has shown benefit in controlling disease.
Two probiotics that show benefit in treating UC are E. Coli Nissle and VSL#3 (a combination of 8 probiotics). Recent studies show that VSL#3 may induce remission and decrease disease activity without any other medical therapies in mild UC. More studies are needed before adopting this as standard practice.
Do they help in Crohn’s disease, too?
Unfortunately, the use of probiotics in Crohn’s disease does not appear to have the same positive influence in disease activity as in UC. The reason behind the differing effects of probiotics in CD and UC remains unclear. It is possible that in CD, different strains of bacteria are needed to see any positive effects.
Also, CD affects the entire thickness of the intestinal lining, whereas UC only affects a few of the more superficial layers of the lining. Since probiotics work at superficial lining, they do not change inflammatory processes in deeper layers of the intestinal lining. Probiotics are not recommended at this time for use in CD.
Take home message
While probiotics show significant promise in treatment of UC, we need more, larger, and stronger studies before they can be used as standard therapy or as a single agent for treating UC. Probiotics are in general safe to use. However, they do have potentially harmful side effects, especially in those with certain medical conditions. Before starting any probiotic for any symptom, you should consult your physician.
Constance Pietrzak, MS MD is a gastroenterologist with Advocate Medical Group in Chicago. Through her work with HealthCentral, she strives to expand knowledge on Gastroesophageal reflux disease (GERD) and Inflammatory Bowel Disease (IBD). Follow Constance on Facebook and Twitter for timely updates on IBD, and more.