The prevalence of inflammatory bowel disease (IBD) exceeds 0.3% in many European countries, with ulcerative colitis reported in 505 per 100,000 in Norway and Crohn’s disease reported in 322 per 100,000 in Germany (Ng et al. 2017).
The range of IBD conditions includes:
• Ulcerative colitis (UC): Onset is often between the ages of 15 and 30 years. Acute and chronic inflammation affects the mucosa of all or part of the colon (always the rectum), which may become ulcerated. This commonly results in symptoms such as diarrhoea, bleeding from the anus and abdominal pain. Sufferers may also experience flatulence, constipation, passing of mucus and tiredness.
• Crohn’s disease (CD): Any part of the gut can be affected, from mouth to anus, but inflammation is most common in the ileum and colon, and can be transmural. Symptoms are non-specific abdominal pain and diarrhoea, often with blood and mucus.
• Pouchitis: Affects patients with serious UC who have undergone surgical resection of the colon. The bowel is reconnected and an internal pouch created from the small intestine to hold waste before elimination. Inflammation of the lining of this pouch occurs in up to 50% of patients. Symptoms include abdominal pain, more frequent bowel activity and rectal bleeding, as well as malaise and fever.
Gut Microbiota and IBD
Different lines of evidence suggest the intestinal microbiota may be involved in IBD pathogenesis, suggesting there may be benefit in manipulating the intestinal microbiota, perhaps with probiotics (Derwa et al. 2017).
Antibiotic use is associated with the occurrence of CD
• The diversity of gut bacteria is reduced in in IBD
• Patients have been shown to have an altered microbiome compared to healthy subjects
• Anti-inflammatory species, e.g. Faecalibacterium prausnitzii, are reduced in IBD, while pro-inflammatory species are more abundant
• During active phases of IBD the gut microbiota changes
A recent meta-analysis states that “probiotics might be as effective as 5-ASAs in preventing relapse of quiescent UC” (Derwa et al. 2017). Research using L. casei Shirota has been conducted in patients with active CD (Fujimori et al. 2007) and UC (detailed below), and mechanistic studies have been conducted using cells from patients with UC (Mann et al. 2013, Mann et al. 2014).
Study: Inflammatory bowel disease
Effects on symptoms of ulcerative colitis (adults) - Mitsuyama et al. (2008) J Clin Biochem Nutr 43(1):78-81 (25).
Method: In an open-label trial, ten patients with mild to moderately active UC consumed a daily fermented milk drink containing L. casei Shirota (8 x 1010 CFU) for eight weeks in conjunction with conventional therapy (aminosalicylates and/or prednisolone). Changes in clinical status were measured by a clinical activity index score at baseline and at two-week intervals, which recorded several disease aspects (diarrhoea episodes, nocturnal diarrhoea, visible faecal blood, abdominal pain or cramping, general wellbeing, abdominal tenderness, need for anti-diarrhoeal medication). The control group were nine previously-treated patients with active UC, whose baseline characteristics were similar to the study group and who had previously received conventional therapy but not a probiotic.
Results: Compared to the control group, probiotic consumption was associated with significantly improved clinical activity index scores after four weeks (P=0.033), six weeks (P=0.026) and eight weeks (P =0.012). When compared to pre-treatment clinical activity index scores, a trend for improved clinical status was observed in the probiotic group but not in the control group, at six weeks (P=0.010) and eight weeks (P=0.035). There were indications that the mechanism of activity may involve inhibition of IL-6 signalling.