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Efficacy of probiotics for the management of inflammatory bowel disease.

RBS Normal gut bacteria (microbiota) have been implicated in the pathogenesis of Crohn’s disease (CD) and pouchitis, and they probably contribute to ulcerative colitis (UC) as well. Probiotics are thought to work by several different mechanisms. One mechanism involves altering the composition of the intestinal microbiota by producing bacteriocins, which are products that eliminate certain bacteria, or by altering pH, which will alter the growth characteristics of certain bacteria. As a result of these changes, probiotics could decrease the concentration and perhaps composition of gut bacteria that preferentially cause inflammatory bowel disease (IBD). A second mechanism involves altering the epithelial barrier function of the intestine. For example, some probiotics produce a metabolite called butyrate, which is a short-chain fatty acid (SCFA) that is very important for the health of colonocytes, particularly the epithelial cells in the rectum and left colon. In addition to improving the viability, health, and repair of the mucosal lining through production of SCFAs, probiotics have been shown to block attachment of pathogenic bacteria to gut epithelial cells, thereby preventing invasion by pathogenic gut bacteria. Finally, probiotics have been shown to have important immunoregulatory activity, so certain probiotics and their products can activate regulatory T cells and regulatory pathways, leading to downregulation of inflammation. Conversely, probiotic products can directly turn off effector immune cells that cause tissue damage. Together, these mechanisms suggest that probiotics have great therapeutic potential, at least from a theoretical standpoint; unfortunately, they have not realized this potential in clinical trials.