Crohns Disease

Results with probiotics in Crohn's disease are conflicting. In a small pilot study, treatment with capsules containing E. coli Nissle 1917 was compared to the administration of placebo in maintenance of steroid-induced remission of colonic CD. Twelve patients were treated with E. coli Nissle 1917 and 11 with placebo; at the end of the treatment period (12 weeks) relapse rates were 33% in the E. coli group and 63% in the placebo group, but unfortunately, because of the very small number of patients treated this difference did not reach statistical significance

In a small comparative open study, the association of Saccharomyces boulardii 1 g/day plus mesalamine 2 g/day was significantly superior to mesalamine 3 g/day in maintenance of remission in a 6-month trial

[32]. Prantera et al. have reported no benefit for Lac-tobacillus GG in preventing post-operative recurrence [33] in 1-year double-blind placebo-controlled trial. Additionally, more recently the same strain was shown not to be superior to placebo as an adjunct to standard treatment in the maintenance of medically induced remission in children [34].

We carried-out a single-blind study to compare a sequential antibiotic-probiotic treatment with mesalazine in the prevention of the post-operative recurrence of CD; 40 patients within 1 week after curative surgery were randomised to receive a high dose of rifaximin, a non-absorbable wide spectrum antibiotic, for 3 months followed by VSL#3 6 g per day for 9 months or mesalazine 4 g per day for 12 months. Patients were assessed clinically and endoscopically at 3 and 12 months; the combined antibiotic-probiot-ic treatment determined a significant lower incidence of severe endoscopic recurrence both at 3 and 12 months (10% and 20% vs. 40% and 40%, respectively; p<0.01) [35].

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