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

The rationale for using probiotics, prebiotics, and antibiotics ininflammatory bowel diseases (IBD) is based on convincing evidencethat intestinal bacteria are implicated in the pathogenesis of thesediseases. Probiotics are “living organisms, which upon ingestion incertain numbers, exert health benefits beyond inherent basic nutrition.Several mechanisms have been proposed to account for the actionof probiotics. VSL#3, a highly concentrated cocktail of probioticshas been shown to be effective in the prevention of pouchitis onsetand 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 clearbecause of conflicting data and the limited number of well-performedstudies. Prebiotics are dietary substances, usually nondigestiblecarbohydrates, which beneficially affect the host by selectivelystimulating the growth and activity of protective commensal entericbacteria. Evidence supporting the use of these nutriceuticals in IBDis still limited. Antibiotics have an essential role in treating the septiccomplications of Crohn’s disease, including intrabdominal andperianal abscesses and perianal fistulae. The use of antibiotics in UCis not supported by the available studies while their use in pouchitisis largely justified although proper controlled trials have not beenconducted.