Probiotics, Prebiotics and Antibiotics in the Treatment of Inflammatory Bowel Disease

The rationale for using probiotics, prebiotics, and antibiotics in inflammatory bowel diseases (IBD) is based on convincing evidence that intestinal bacteria are implicated in the pathogenesis of these diseases. Probiotics are “living organisms, which upon ingestion in certain numbers, exert health benefits beyond inherent basic nutrition. Several mechanisms have been proposed to account for the action of probiotics. VSL#3, a highly concentrated cocktail of probiotics has been shown to be effective in the prevention of pouchitis onset and relapses. Results on the use of probiotics in UC are promising, both in terms of the prevention of relapses and the treatment of mildto-moderate attacks. Results in Crohn’s disease are not yet clear because of conflicting data and the limited number of well-performed studies. Prebiotics are dietary substances, usually nondigestible carbohydrates, which beneficially affect the host by selectively stimulating the growth and activity of protective commensal enteric bacteria. Evidence supporting the use of these nutriceuticals in IBD is still limited. Antibiotics have an essential role in treating the septic complications of Crohn’s disease, including intrabdominal and perianal abscesses and perianal fistulae. The use of antibiotics in UC is not supported by the available studies while their use in pouchitis is largely justified although proper controlled trials have not been conducted.