Probiotics for treatment of active Crohn's disease

Butterworth AD, Thomas AG, Akobeng AK

Published Online:

July 16, 2008

Crohn's disease is a chronic inflammatory disease of the intestines which has periods of inactivity and periods when it flares up. Crohn's disease can affect any part of the digestive tract, from the mouth to the anus. The most common symptoms of Crohn's disease are abdominal pain, and diarrhoea. Probiotics are living microorganisms that are thought to benefit health by altering the growth of bacteria in the intestines thereby reducing inflammation. Only one study was identified and this did not show that probiotics had any effect in treating active Crohn's disease. However this study was only small (11 patients) and no definite conclusion can be made regarding the effectiveness of probiotics. Probiotics were generally well tolerated and no side effects were reported. There is insufficient evidence to make any conclusions about the effectiveness of probiotics for treatment of active Crohn's disease.

Abstract (click to read)

Background:

Crohn's disease has a high morbidity and there is no known cure. Current treatments have multiple side effects and an effective treatment with minimal side effects is desired. Probiotics have been proposed as such a treatment but their efficacy is undetermined. There is some evidence that probiotics are effective in other conditions affecting the gastrointestinal tract and they are popular with patients. They are thought to work through competitive action with commensal and pathogenic flora, influencing the immune response.

Objectives:

To determine if there is any evidence for the efficacy of probiotics for the induction of remission in Crohn's disease.

Search strategy:

The Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 1, 2007), MEDLINE (1966 to 2007), Excerpta Medica/EMBASE (1974 to 2007), CINAHL (1982-2007) and the Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Group Specialised Trial Register were searched. Manufacturers of probiotics were also contacted to identify any unpublished trials. References of trials were also searched for any additional trials.

Selection criteria:

Randomised controlled trials (RCTs) that compared probiotics against placebo or any other intervention for the induction of remission in Crohn's disease were eligible for inclusion.

Data collection and analysis:

Data extraction and assessment of methodological quality of included studies were independently performed by two authors. The main outcome measure was the occurrence of clinical remission. Odds ratios and 95% confidence intervals were calculated for dichotomous outcomes.

Main results:

One small study (n = 11) met the inclusion criteria and was included in the review. There were some methodological concerns with this study. Four of 5 patients in the probiotic group achieved remission compared to 5 of 6 in the placebo group (OR 0.80; 95% CI 0.04 to 17.20).

Authors' conclusions:

There is insufficient evidence to make any conclusions about the efficacy of probiotics for induction of remission in Crohn's disease. There is a lack of well designed RCTs in this area and further research is needed.

This record should be cited as:

Butterworth AD, Thomas AG, Akobeng AK. Probiotics for induction of remission in Crohn's disease. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD006634. DOI: 10.1002/14651858.CD006634.pub2

Assessed as up to date:

April 21, 2008

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Primary Review Group:

Inflammatory Bowel Disease and Functional Bowel Disorders Group

Health topics:

Gastroenterology > Inflammatory bowel disease > Crohn's disease: induction of remission

Complementary & alternative medicine > Gastroenterology > Inflammatory bowel disease

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Probiotics for treatment of active Crohn's disease

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