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
|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
|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