High dose probiotic and prebiotic cotherapy for remission induction of active Crohn's disease

Abstract

Background: Clinical trials of probiotic treatment for Crohn's disease (CD) have yielded conflicting results. This study assessed the clinical usefulness of combined probiotic and prebiotic therapy in the treatment of active CD.

Method: Ten active CD outpatients without history of operation for CD were enrolled. Their mean (±SD) age was 27 ± 7 years and the main symptoms presented were diarrhea and abdominal pain. Patients' initial therapeutic regimen of aminosalicylates and prednisolone failed to achieve remission. Patients were thus initiated on a synbiotic therapy, consisting of both probiotics (75 billion colony forming units [CFU] daily) and prebiotics (psyllium 9.9 g daily). Probiotics mainly comprised Bifidobacterium and Lactobacillus. Patients were free to adjust their intake of probiotics or prebiotics throughout the trial. Crohn's disease activity index (CDAI), International Organization for the Study of Inflammatory Bowel Disease (IOIBD) score and blood sample variables were evaluated and compared before and after the trial.

Results: The duration of the trial was 13.0 ± 4.5 months. By the end of therapy, each patient had taken a 45 ± 24 billion CFU daily probiotic dose, with six patients taking an additional 7.9 ± 3.6 g daily psyllium dose. Seven patients had improved clinical symptoms following combined probiotic and prebiotic therapy. Both CDAI and IOIBD scores were significantly reduced after therapy (255–136, P = 0.009; 3.5–2.1, P = 0.03, respectively). Six patients had a complete response, one had a partial response, and three were non-responders. Two patients were able to discontinue their prednisolone therapy, while four patients decreased their intake. There were no adverse events.

Conclusion: High-dose probiotic and prebiotic cotherapy can be safely and effectively used for the treatment of active CD.