Prebiotics Show Promise in Crohn's and Colitis

ROCKVILLE, MD. — Prophylactic use of dietary prebiotics could benefit patients with ulcerative colitis and Crohn's disease, based on data from preliminary but promising studies, said Dr. Leo Dieleman of the division of gastroenterology at the University of Alberta, Edmonton.

In contrast to probiotics, which are live microorganisms that benefit their hosts, prebiotics are nondigestible fermentable dietary oligosaccharides that affect the growth and activity of certain types of protective bacteria found in the gastrointestinal tract.

Previous studies of probiotics have shown that adding probiotic bacteria to the diets of patients with inflammatory bowel disease (IBD) improved their symptoms, Dr. Dieleman said. Certain types of probiotics such as Lactobacilli and Bifidobacteria species, when added to the diet, can be protective against IBD, he added.

But for probiotics to be effective, patients must consume large amounts of them, which can be difficult and inconvenient, Dr. Dieleman said at a meeting sponsored by the National Institutes of Health. Prebiotics might be a viable alternative because they are inexpensive, easy to administer in the diet—in powder form, for example—and they have been shown to be safe, he said.

Based on the promising results of probiotic research, investigators have begun to study prebiotics for treating IBD patients.

“Everyone has a unique intestinal microbiotic profile,” Dr. Dieleman said. But inflammation tends to reduce the diversity of microflora in the gut, and studies have shown that a subset of Crohn's disease and ulcerative colitis patients have distinctly abnormal microflora, compared with non-IBD controls.

Patients with IBD tend to have a microbiotic profile that is deficient in firmicutes and bacteroidetes, organisms that are thought to be associated with a healthy gastrointestinal tract. Sometimes ingesting probiotics can help these patients. “But not all probiotics are effective for each patient,” Dr. Dieleman said.

Because prebiotics stimulate the growth of several different intestinal protective bacteria, there may a place for prebiotics in IBD treatment.

Dr. Dieleman identified three criteria that make prebiotics potentially useful for treating gastrointestinal disorders.

First, prebiotics are nondigestible ingredients. As such, they transfer unchanged into the large intestine. Second, prebiotics are fermented by colonic bacteria that already exist in the large intestine. Third, prebiotics induce selective stimulation of bacterial growth and activity. Studies have shown that prebiotics change the profile of intestinal microflora by increasing the growth of specific protective intestinal bacteria. After ingestion of prebiotics, there will be more protective bacteria in the gut.

The prebiotics that have been used most often in clinical trials completed to date are the compounds inulin and oligofructose. Studies of other compounds are ongoing, he said.

Data from a randomized pilot study of 20 adults with ulcerative colitis showed that those who took Synergyl, an oral combination of oligofructose and inulin, at a dose of 12 g/day for 2 weeks showed significant improvement in disease activity scores and significant reductions in levels of fecal calprotectin (a calcium-binding inflammatory protein found in feces), compared with those who took a placebo (Aliment. Pharmacol. Ther. 2007;25:1061–7).

Prebiotics also have shown positive effects on adults with Crohn's disease, Dr. Dieleman said. The results from a recent open-label study of 10 patients with mild to moderate Crohn's disease showed that treatment for 3 weeks with 15 g/day of a 30% inulin/70% oligofructose combination supplement was associated with improved disease activity and increased expression of the anti-inflammatory interleukin-10, which is expressed in dendritic cells (Gut 2006;55:348–55).

Dr. Dieleman also described an ongoing open-label study at his institution, the University of Alberta, in which 25 patients with active ulcerative colitis are being treated with oligofructose-enriched inulin when they experience flaring on a stable dose of 5-aminosalicylate. The patient evaluations will include assessment of disease activity, including endoscopy results, and analyses of microflora and mucosal cytokines.

“Animal models have taught us a lot about the pathogenesis of IBD,” Dr. Dieleman said. But larger studies in humans are needed to better characterize the role of prebiotics, he added.

ROCKVILLE, MD. — Prophylactic use of dietary prebiotics could benefit patients with ulcerative colitis and Crohn's disease, based on data from preliminary but promising studies, said Dr. Leo Dieleman of the division of gastroenterology at the University of Alberta, Edmonton.

In contrast to probiotics, which are live microorganisms that benefit their hosts, prebiotics are nondigestible fermentable dietary oligosaccharides that affect the growth and activity of certain types of protective bacteria found in the gastrointestinal tract.

Previous studies of probiotics have shown that adding probiotic bacteria to the diets of patients with inflammatory bowel disease (IBD) improved their symptoms, Dr. Dieleman said. Certain types of probiotics such as Lactobacilli and Bifidobacteria species, when added to the diet, can be protective against IBD, he added.

But for probiotics to be effective, patients must consume large amounts of them, which can be difficult and inconvenient, Dr. Dieleman said at a meeting sponsored by the National Institutes of Health. Prebiotics might be a viable alternative because they are inexpensive, easy to administer in the diet—in powder form, for example—and they have been shown to be safe, he said.

Based on the promising results of probiotic research, investigators have begun to study prebiotics for treating IBD patients.

“Everyone has a unique intestinal microbiotic profile,” Dr. Dieleman said. But inflammation tends to reduce the diversity of microflora in the gut, and studies have shown that a subset of Crohn's disease and ulcerative colitis patients have distinctly abnormal microflora, compared with non-IBD controls.

Patients with IBD tend to have a microbiotic profile that is deficient in firmicutes and bacteroidetes, organisms that are thought to be associated with a healthy gastrointestinal tract. Sometimes ingesting probiotics can help these patients. “But not all probiotics are effective for each patient,” Dr. Dieleman said.

Because prebiotics stimulate the growth of several different intestinal protective bacteria, there may a place for prebiotics in IBD treatment.

Dr. Dieleman identified three criteria that make prebiotics potentially useful for treating gastrointestinal disorders.

First, prebiotics are nondigestible ingredients. As such, they transfer unchanged into the large intestine. Second, prebiotics are fermented by colonic bacteria that already exist in the large intestine. Third, prebiotics induce selective stimulation of bacterial growth and activity. Studies have shown that prebiotics change the profile of intestinal microflora by increasing the growth of specific protective intestinal bacteria. After ingestion of prebiotics, there will be more protective bacteria in the gut.

The prebiotics that have been used most often in clinical trials completed to date are the compounds inulin and oligofructose. Studies of other compounds are ongoing, he said.

Data from a randomized pilot study of 20 adults with ulcerative colitis showed that those who took Synergyl, an oral combination of oligofructose and inulin, at a dose of 12 g/day for 2 weeks showed significant improvement in disease activity scores and significant reductions in levels of fecal calprotectin (a calcium-binding inflammatory protein found in feces), compared with those who took a placebo (Aliment. Pharmacol. Ther. 2007;25:1061–7).

Prebiotics also have shown positive effects on adults with Crohn's disease, Dr. Dieleman said. The results from a recent open-label study of 10 patients with mild to moderate Crohn's disease showed that treatment for 3 weeks with 15 g/day of a 30% inulin/70% oligofructose combination supplement was associated with improved disease activity and increased expression of the anti-inflammatory interleukin-10, which is expressed in dendritic cells (Gut 2006;55:348–55).

Dr. Dieleman also described an ongoing open-label study at his institution, the University of Alberta, in which 25 patients with active ulcerative colitis are being treated with oligofructose-enriched inulin when they experience flaring on a stable dose of 5-aminosalicylate. The patient evaluations will include assessment of disease activity, including endoscopy results, and analyses of microflora and mucosal cytokines.

“Animal models have taught us a lot about the pathogenesis of IBD,” Dr. Dieleman said. But larger studies in humans are needed to better characterize the role of prebiotics, he added.

ROCKVILLE, MD. — Prophylactic use of dietary prebiotics could benefit patients with ulcerative colitis and Crohn's disease, based on data from preliminary but promising studies, said Dr. Leo Dieleman of the division of gastroenterology at the University of Alberta, Edmonton.

In contrast to probiotics, which are live microorganisms that benefit their hosts, prebiotics are nondigestible fermentable dietary oligosaccharides that affect the growth and activity of certain types of protective bacteria found in the gastrointestinal tract.

Previous studies of probiotics have shown that adding probiotic bacteria to the diets of patients with inflammatory bowel disease (IBD) improved their symptoms, Dr. Dieleman said. Certain types of probiotics such as Lactobacilli and Bifidobacteria species, when added to the diet, can be protective against IBD, he added.

But for probiotics to be effective, patients must consume large amounts of them, which can be difficult and inconvenient, Dr. Dieleman said at a meeting sponsored by the National Institutes of Health. Prebiotics might be a viable alternative because they are inexpensive, easy to administer in the diet—in powder form, for example—and they have been shown to be safe, he said.

Based on the promising results of probiotic research, investigators have begun to study prebiotics for treating IBD patients.

“Everyone has a unique intestinal microbiotic profile,” Dr. Dieleman said. But inflammation tends to reduce the diversity of microflora in the gut, and studies have shown that a subset of Crohn's disease and ulcerative colitis patients have distinctly abnormal microflora, compared with non-IBD controls.

Patients with IBD tend to have a microbiotic profile that is deficient in firmicutes and bacteroidetes, organisms that are thought to be associated with a healthy gastrointestinal tract. Sometimes ingesting probiotics can help these patients. “But not all probiotics are effective for each patient,” Dr. Dieleman said.

Because prebiotics stimulate the growth of several different intestinal protective bacteria, there may a place for prebiotics in IBD treatment.

Dr. Dieleman identified three criteria that make prebiotics potentially useful for treating gastrointestinal disorders.

First, prebiotics are nondigestible ingredients. As such, they transfer unchanged into the large intestine. Second, prebiotics are fermented by colonic bacteria that already exist in the large intestine. Third, prebiotics induce selective stimulation of bacterial growth and activity. Studies have shown that prebiotics change the profile of intestinal microflora by increasing the growth of specific protective intestinal bacteria. After ingestion of prebiotics, there will be more protective bacteria in the gut.

The prebiotics that have been used most often in clinical trials completed to date are the compounds inulin and oligofructose. Studies of other compounds are ongoing, he said.

Data from a randomized pilot study of 20 adults with ulcerative colitis showed that those who took Synergyl, an oral combination of oligofructose and inulin, at a dose of 12 g/day for 2 weeks showed significant improvement in disease activity scores and significant reductions in levels of fecal calprotectin (a calcium-binding inflammatory protein found in feces), compared with those who took a placebo (Aliment. Pharmacol. Ther. 2007;25:1061–7).

Prebiotics also have shown positive effects on adults with Crohn's disease, Dr. Dieleman said. The results from a recent open-label study of 10 patients with mild to moderate Crohn's disease showed that treatment for 3 weeks with 15 g/day of a 30% inulin/70% oligofructose combination supplement was associated with improved disease activity and increased expression of the anti-inflammatory interleukin-10, which is expressed in dendritic cells (Gut 2006;55:348–55).

Dr. Dieleman also described an ongoing open-label study at his institution, the University of Alberta, in which 25 patients with active ulcerative colitis are being treated with oligofructose-enriched inulin when they experience flaring on a stable dose of 5-aminosalicylate. The patient evaluations will include assessment of disease activity, including endoscopy results, and analyses of microflora and mucosal cytokines.

“Animal models have taught us a lot about the pathogenesis of IBD,” Dr. Dieleman said. But larger studies in humans are needed to better characterize the role of prebiotics, he added.