Should I take a probiotic for my IBD?

Research summary of a recently published paper: Efficacy and safety of probiotics in IBD:

An overview of systematic reviews and updated meta-analysis of randomized controlled trials


Background

There is a growing body of evidence showing that the microbiome has an involvement in IBD. However, there is a lack of knowledge on manipulating the microbiome in IBD particularly through the use of probiotics.


What was studied?

Whether taking probiotics increases the odds of achieving remission and/or decreases the odds of relapse/flare in the IBD.


Who was studied?

A total of 3,745 participants with Crohns Disease and Ulcerative Colitis.


What did they do?

This study was a meta-analysis of 45 randomised control trials.

Lets break that down:

meta-analysis - this is where researchers combine the results from multiple studies, 45 in this case, to reach a conclusion. It is considered the highest/best form of evidence.

randomised controlled trials - these trials are generally considered a reliable form of evidence where participants are put in the treatment or control group at random which again helps increase the reliability of results. They are then either given the treatment (in this case probiotics) or a placebo (a fake treatment) if the trial is placebo-controlled, or no treatment if they are just a control or comparison group. Again this increases the reliability of the results.


Results

  • Probiotics had a significant effect in inducing clinical remission in UC. A subgroup analysis suggested that combining 5-ASA (mesalazine) and probiotics may be beneficial for inducing remission in UC. Likewise, probiotics decreased the odds of clinical recurrence in UC and in relapsing pouchitis.

  • Probiotics lacked significant effect in CD.

  • Probiotics are safe.


Takeaways

Probiotics may be helpful for UC and pouchitis but not Crohns.

If you’d like to try a probiotic:

  • the type of probiotic matters. Always choose a brand/strain that has actually been proven to help otherwise you’re wasting your money: The most commonly used probiotic supplements in these clinical trails were the “De Simone Formulation” aka Vivomixx/Visbiome and Escherichia coli Nissle 1917. Single strains of Lactobacillus (e.g., Lactobacillus rhamnosus, Lactobacillus johnsonii) were also frequently used.

  • Always check with your IBD team before trying any supplements to ensure they are safe for you.


Limitations

Its important to note that the overall certainty of the evidence, using an assessment tool for these kind of pooled data studies, was low. This suggests that the true effect of taking probiotics might be markedly different from the estimated effect due to various reasons including how the individual studies were conducted so we could do with some even better designed studies to improve this.


Reference

Estevinho MM, Yuan Y, Rodríguez-Lago I, Sousa-Pimenta M, Dias CC, Barreiro-de Acosta M, Jairath V, Magro FEfficacy and safety of probiotics in IBD: An overview of systematic reviews and updated meta-analysis of randomized controlled trials.United European Gastroenterol J.(2024 Aug 6)


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