Introduction

The rationale for using probiotics in inflammatory bowel disease (IBD) is based on convincing evidence implicating intestinal bacteria in their pathogenesis. The distal ileum and the colon are the areas with the highest bacterial concentrations and represent the sites of inflammation in IBD; similarly pouchitis, the non-specific inflammation of the ileal reservoir after ileo-anal anastomosis, appears to be associated with bacterial overgrowth and dysbiosis. Enteric bacteria or their products have been found within the inflamed mucosa of patients with Crohn's disease (CD) [1].

There is evidence of a loss of immunologic tolerance to commensal bacteria in patients with IBD [2, 3]. Patients with CD respond consistently to diversion of the faecal stream, with immediate recurrence of inflammation after restoration of intestinal continuity [4] or infusion of luminal content into the bypassed ileum [5], and pouchitis does not occur before the ileostomy closure.

Patients with IBD have altered composition of enteric flora with increase of aggressive bacteria such as Bacterioides, adherent/invasive Escherichia coli, Enterococci, and decrease of protective Lactobacillus and Bifidobacterium species [6]. However, the most compelling evidence is derived from animal models; despite great diversity in genetic defects and immunopathology, a consistent feature of many transgenic and knockout mutant murine models of colitis is dependency on the presence of normal enteric flora for full expression of inflammation [7]. All these observations have suggested the possibility of preventing or treating IBD by manipulating intestinal microflora and increasing evidence supports the potential therapeutic role of probiotics in IBD [8].

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