Synopsis

Source of validity: Scientific
Rating (out of 5): 3

Lactobacillus species, particularly as mixed probiotic formulations, have been researched as adjunctive therapy in various forms of colitis, including ulcerative colitis (UC) and, to a lesser extent, Crohn's disease and microscopic colitis. Several randomized controlled trials and meta-analyses have investigated the efficacy of Lactobacillus-containing probiotics. Evidence suggests that certain mixed probiotics (often including Lactobacillus, Bifidobacterium, and Streptococcus strains) can help maintain remission in patients with ulcerative colitis, with some studies showing modest improvement in clinical symptoms and mucosal healing compared to placebo. The mechanism is thought to involve modulation of the intestinal microbiota, enhancement of the mucosal barrier, and immunomodulatory effects. However, the benefits are generally moderate, and results between studies are mixed, with some reporting no significant advantage over standard therapy or placebo.

For infectious or antibiotic-associated colitis (such as Clostridioides difficile-associated diarrhea), some evidence supports the use of Lactobacillus species to reduce the risk of recurrence, although the strength of evidence is variable. There is less direct evidence for benefits in Crohn’s disease or microscopic colitis, where results are largely inconclusive. Clinical guidelines sometimes recommend probiotics as an adjunct, but not as a replacement for standard anti-inflammatory or immunosuppressive therapies.

Overall, while there is a scientific basis and moderate evidence supporting the adjunctive use of mixed Lactobacillus probiotics in certain forms of colitis, it is not definitive or universally recommended as a primary treatment.

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