Probiotics in ulcerative colitis (UC)

Points of note with respect to the diet of those with ulcerative colitis:

• neither elemental diets nor hyperalimentation with bowel rest are of benefit in ulcerative colitis, unlike in Crohn's disease.
  
  
• fish oil, or other forms of eicosapentanoic acids:
  • these divert arachidonic acid metabolites away from the pro-inflammatory leukotriene B4 to less inflammatory leukotrienes
  • various studies have shown the potential to modulate luminal and tissue eicosanoids in ulcerative colitis and to allow reduction of steroid therapy. However, long-term benefits have yet to been shown
  • the importance of dietary intake of PUFA has been gleaned from epidemiological observations that Eskimos have a low incidence of inflammatory bowel disease (IBD)
    
    
• probiotics - there is ongoing interest in the use of probiotics in the treatment of IBD.
  • is effective in maintaining remission in UC (1)
  • probiotics are live non-pathogenic organisms such as various Lactobacillus species, which aim to confer health benefits by improving the gut micro-organism environment (2)
  • although there is no clear evidence for the efficacy of this method, a probiotic strain (Escherichia coli Nissle 1917) and the probiotic preparation VSL3 have been shown to be effective (3)
  • a systematic review concluded that (4):
    • low-certainty evidence suggests that probiotics may induce clinical remission in active ulcerative colitis when compared to placebo. There
      may be little or no difference in clinical remission with probiotics alone compared to 5-ASAs
    • growing evidence looking at the effects of probiotics in the use of inducing remission in ulcerative colitis since a previous Cochrane review (2007)
      • due to the part that dysbiosis plays in ulcerative colitis, there is potential benefit in trying to restore the indigenous flora.
      • therapeutic efficacy of probiotics has been demonstrated in various models of experimental colitis, including interleukin-10 deficient mice

Reference:

• (1) Travis SPL et al. European evidence-based Consensus on the diagnosis and management of ulcerative colitis: Current management. Journal of Crohn's and Colitis (2008) 2, 24-62
• (2) Prescriber (2004); 15(5).
• (3) Collins P, Rhodes J. Ulcerative colitis: diagnosis and management. BMJ. 2006;333(7563):340-3
• (4) Kaur L et al.Probiotics for induction of remission in ulcerative colitis.Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD005573. DOI: 10.1002/14651858.CD005573.pub3