Synopsis

Source of validity: Scientific
Rating (out of 5): 4

Bacteria, specifically in the form of probiotics, are increasingly used to support the management of Inflammatory Bowel Disorders (IBD) such as Crohn’s disease and ulcerative colitis. The scientific rationale is based on the role of gut microbiota in modulating immune responses and maintaining intestinal barrier function. Dysbiosis, or an imbalance in the gut microbial community, is a recognized feature in IBD patients. Several randomized controlled trials and meta-analyses have demonstrated that certain probiotic strains, such as Escherichia coli Nissle 1917 and multi-strain formulations like VSL#3, can be beneficial, particularly in maintaining remission in ulcerative colitis and preventing pouchitis (a complication following surgical treatment of ulcerative colitis). The evidence is stronger for ulcerative colitis and pouchitis than for Crohn’s disease, where results are mixed and less convincing. Guidelines from organizations such as the European Crohn’s and Colitis Organisation (ECCO) acknowledge the use of specific probiotics for certain subtypes of IBD, especially for maintenance of remission and treatment of pouchitis. However, not all probiotics are effective, and the benefits are strain- and condition-specific. Overall, while probiotics are not a replacement for standard therapies, there is a solid scientific foundation for their adjunctive use in select IBD cases, justifying a relatively high evidence rating.

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