A possible pathogenesis of IBD includes mucosal inflammation secondary to abnormal immune response against resident bacteria. The intestinal environment is a persisting stimulus in normal subjects. In CD patients, normal intestinal bacteria in genetically predisposed subjects or altered intestinal flora may induce and amplify gut inflammation. Therefore, manipulation of intestinal bacterial flora is the rationale for the use of antibiotics. In the last decade, probiotics (living micro-organisms with a beneficial effect on the host), prebiotics (dietary components that induce the growth of beneficial bacteria) and synbiotics (both the previous) have been used in the treatment of CD. Despite the lack of randomised clinical trials demonstrating efficacy of this therapeutic approach to CD patients, a number of review articles have been published during the last years outlining its efficacy in the treatment of IBD [191-193]. Based on experimental evidence, many strains are tested for maintenance of remission in CD patients.
Single-strain probiotics (Lactobacillus GG) at different dosages is not effective to maintain remission in patients suffering from CD [194-196]. Probiotics containing miscellaneous strains at high dosage may be theoretically more effective than a single strain in the treatment of CD, probably due to a synergic effect. Recently, VSL#3, containing three strains of Bifidobacterium (B. longum, B. infantis, B. breve), four strains of Lactobacillus (L. acidophilus, L. casei, L. delbrueckii, L. plantarum) and one strain of Streptococcus salivarius subsp. thermophilus has been proposed in the treatment of IBD. The postulated pathogenic mechanism of VSL#3 is induction of tis-sutal levels of the anti-inflammatory cytokine IL-10
and a greater expression of intestinal mucin, preventing adhesion of pathological Escherichia coli strains. Efficacy of VSL#3 is being tested in a doubleblind randomised trial for maintenance of remission in recurrent chronic pouchitis.
Results of randomised double-blind clinical trials are being awaited in order to make definitive conclusions on the use of probiotics in CD patients.
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