Probiotics/prebiotics: Large-scale trials needed to asses Crohn’s disease potential

By Gary Scattergood

- Last updated on GMT

There is 'insufficient evidence' to make any conclusions about the efficacy of probiotics in cases of Crohn’s Disease. ©iStock
There is 'insufficient evidence' to make any conclusions about the efficacy of probiotics in cases of Crohn’s Disease. ©iStock

Related tags Ulcerative colitis

Large trials are desperately needed to understand if supplements and dietary interventions can play a positive role in the treatment of Crohn’s disease, according to academics in Japan.

Experts from the Inflammatory Bowel Disease Centre at Yokkaichi Hazu Medical Centre, said a raft of supplements, including probiotics, omega-3 and glutamine were commonly used to treat bowel conditions.

However, writing in the journal Current Opinion in Biotechnology, they added: “The ability of such strategies to…achieve therapeutic efficacy remains to be elucidated.”

In terms of probiotics, the researchers say there is evidence to support their use for induction and maintenance of remission in cases of ulcerative colitis and pouchitis.

However, for Crohn’s disease, several systematic reviews of randomised controlled trials on their use of have been conducted, but only one concerns the induction of remission,

“Thus, there is insufficient evidence to make any conclusions about the efficacy of probiotics for induction of remission in Crohn’s Disease because of a lack of well-designed RCTs,”​ they wrote.

For prebiotics, there have been only small clinical trials to evaluate their efficacy in Crohn’s treatment, with conflicting results reported.

“Further studies are necessary to rigorously evaluate the efficacy of prebiotics in Crohn’s Disease,”​ they added.

Likewise, synbiotic combinations present a promising opportunity for clinical investigation, but “very few studies supporting the usefulness of symbiotic supplementation were published”​ in relation to Crohn’s.

There have been more studies assessing the potential of omega-3, but it appears they are probably ineffective for maintaining remission.

“The Cochrane group conducted a meta-analysis to evaluate the efficacy of omega-3 polyunsaturated fatty acids for maintenance of remission in Crohn’s disease,”​ the paper states.

Thirty-nine per cent of patients in the omega-3 group relapsed at 12 months compared to 47% of placebo patients (6 studies, 1039 patients).

Not statisiically significant

However, “When two large studies at low risk of bias were considered, the benefit was no longer statistically significant. Thirty-seven per cent of patients in the omega-3 group relapsed at 12 months compared to 42% in the placebo group.”

Meanwhile, a systematic review suggests that glutamine supplementation may not be beneficial in active cases of Crohn’s Disease, but the researchers warn these results need to be interpreted with caution as they are based on small numbers of patients.

“Large RCTs are necessary to investigate the efficacy of glutamine for induction of remission in Crohn’s Disease,”​ they stated.

The paper concluded that enteral nutrition had shown promise in children, but not adults.

“Our current knowledge on the therapeutic benefit of dietary and enteral interventions needs to be strengthened by future well-designed RCTs in large cohorts of patients,”​ they added.


Source: Current Opinion in Biotechnology

Volume 44​, April 2017, Pages 69–73

“Dietary and enteral interventions for Crohn's disease”

Authors: Takayuki Yamamoto​, et al.

Probiota Asia 2017​ 

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The Probiota series is growing, and in October 2017, Singapore will host the first ever Probiota Asia event. Building on the success of the annual global Probiota and Probiota Americas events, Probiota Asia will focus exclusively on this high growth market and the challenges it faces.

Save the date: 11-13 October 2017

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