Conclusions

Many clinical and experimental observations do suggest an involvement of the intestinal microflora in the pathogenesis and in the perpetuation of IBD. Pro-biotics may provide a simple and attractive way to prevent or treat IBD, and patients find the probiotic concept appealing because it is safe, non-toxic and natural. A highly concentrated cocktail of probiotics (VSL#3) is effective in the prevention of pouchitis onset and relapses. Results in ulcerative colitis are promising both in prevention of relapses and treatment of mild to moderate attacks. Results in Crohn's disease are not yet clear because of conflicting data and the limited number of well-performed studies.

It is important to select a well-characterised probi-otic preparation; in fact viability and survival of bacteria in many available preparations are unproven. It should be remembered that the beneficial effect of one probiotic preparation does not imply the efficacy of other preparations containing different bacterial strains, because each individual probiotic strain has unique biological properties. There is the need to improve our knowledge on the composition of enteric flora or "the neglected organ" and of the intestinal physiology and its relationship with the luminal ecosystem.

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