Synopsis

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

Lactobacillus species are among the most commonly studied probiotics for the management of colitis, particularly ulcerative colitis (UC), a form of inflammatory bowel disease (IBD). The rationale for their use is based on the modulation of the gut microbiota, enhancement of intestinal barrier function, and immunomodulatory effects. Several clinical trials and meta-analyses have evaluated the efficacy of Lactobacillus-containing probiotics (often in combination with other probiotic strains) in inducing or maintaining remission in UC. Results are mixed but generally suggest a modest benefit, especially when used alongside standard therapies. For example, a 2020 Cochrane review concluded that probiotics may be more effective than placebo for maintaining remission in UC, though the effect size is small and the quality of evidence is moderate.

Evidence for Crohn's disease or microscopic colitis is less convincing, with most studies showing no significant benefit. Notably, the term "Lactobacillus (unspecified)" is broad, and outcomes can vary significantly depending on the specific strain used, as probiotic effects are strain-dependent. Despite these limitations, the use of Lactobacillus for colitis is supported by both preclinical models and human studies, though it is not considered a replacement for standard medical treatments. Overall, the evidence base justifies cautious use as an adjunct, with the strongest support in mild to moderate ulcerative colitis.

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