With all the buzz regarding how a patient’s microbiome seems to affect everything from metabolic syndrome and colic to autoimmune diseases and inflammatory bowel disease, more attention has been paid in attempts to alter the microbiome for therapeutic benefits. In Crohn’s disease (CD), the fact that antibiotics have shown beneficial effects have led to a number of studies of probiotics. A recent study, like previous ones, did not demostrate any benefit with Saccharomyces boulardii (Clin Gastroenterol Hepatol 2013; 11: 982-87).
In this prospective double-blind, placebo-controlled study of 165 patients who achieved remission after steroids or salicylates, subjects were randomly assigned to groups given S boulardii (1 gram per day) or placebo for 52 weeks.
- CD relapse occurred in 80 patients: 38 (47.5%) in the probiotic group and 42 (53.2%) in the placebo group
- Time to relapse did not differ significantly: 40.7 weeks in probiotic group vs 39 weeks in placebo group
- No differences were seen in disease activity scores or serum inflammatory markers
- In post hoc analysis, nonsmokers given S boulardii were less likely to experience a relapse compared with nonsmoker control patients (34.5 % vs. 72%)
One important limitation of this study was not examining the effects of the probiotic on the microbiome of these patients. Perhaps, other probiotics would be more effective in restoring a “healthy” flora.
Based on these results, and others, the accompanying editorial (pg 988-89), advocates use of probiotics only for prevention of antibiotic-associated diarrhea, prevention of recurrent Clostridium difficile, and treatment/prevention of pouchitis.
Bottom-line: Probiotics have not been demonstrated to be helpful for Crohn’s disease.
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