Prebiotics for inflammatory bowel disease: Human studies (Part 1)

To our knowledge there are nine published papers on the use of prebiotics in some form in IBD (Table 2). Two studies are with fibre that represent candidate prebiotics in an expanding definition from the original. The first of these studies evaluated 29 patients with UC in remission. Over a four-month period Hallert et al evaluated the effect of Ispaghula husks (Plantago ovata) against placebo while patients were maintained on standard therapy. There was a statistically significant quantity of symptomatic improvement in the intervention group (69% versus 24%).

The largest study is a randomized controlled trial in UC patients using fibre (P ovata). The study was conducted with 105 participants over 12 months and compared treatment failure rates between P ovata and 1.5 g per day messalamine or a combination of both. The failure rate was 14 of 35 for fibre, 13 of 37 in the 5-aminosalicylic acid (5-ASA) group and 9 of 30 in the combination group. None of these differences were statistically or clinically significant, leading to the suggestion that fibre, while no better than 5-ASA, was of equivalent benefit for maintenance of remission. Patients treated with fibre had significantly increased measured butyrate in their stool. Dreaming of a reliable pharmacy that could give you an opportunity to buy any amounts of birth control yasmin with no prescription required and spend less money?

TABLE 2 Human studies of inflammatory bowel disease using prebiotics

Author (ref) Patients (n) Disease Study type Length Active agent Control Outcome
Hallert et al 29 remission UC RCT 4 months Ispaghula husk Placebo Improved symptoms
Fernandez-Banares et al 105 remission UC RCT open label 1 year Plantago ovata 5-ASA Equivalent effect
Mitsuyama et al 10 active UC Pilot open label 4 weeks GBF Clinical endoscopic improvement
Kanauchi et al 18 mild-moderate reactive UC Open label + standard therapy 4 weeks GBF 20 g/day to 30 g/day  Standard  therapy ImprovementI  bifido

I  eubacteria

Kanauchi et al 21 mild-moderate reactive UC Open label + standard therapy 24 weeks GBF Clinical score improved
Hussey et al 10 active CD Open 6 weeks Fructooligosaccharides + inulin Weight gain PCDAi D , ESr  D
Szilagyi et al 10 remission 10 remission UCCD Open control + standard therapy 3 weeks Lactulose 10 g twice daily Failure of adaptation
Welters et al 20 active IPAA Double-blind RCT crossover 3 weeks 24 g inulin Placebo Inflammation improved D Bacteroides fragilis

D  2° bile acids

I  butyrate

Kuisma et al 21 active IPAA Open retrospective diet questionnaire Lactose Inverse correlation with bacteria, sulfomucins

5-ASA 5-Aminosalicylic acid; CD Crohn’s disease; ESR Erythrocyte sedimentation rate; GBF Germinated barley foodstuffs; IPAA Ileal-pouch-anal-anastomosis (pouchitis); PCDAI Pediatric Crohn’s disease activity index; RCT Randomized controlled trial; UC Ulcerative colitis; D Decrease; I Increase

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