Modulation of microbiota as treatment for intestinal inflammatory disorders: An uptodate

Table 1 Mechanisms of probiotics

Increase in barrier function

Maintenance of epithelial tight junctions integrity

Increase mucin production (Globet cells)

Increase in trefoil factors and defensins production (Paneth Cells)

Modulation of immune response

Increase secretory IgA

Production of anti-inflammatory cytokines and inhibition of pro-inflammatory cytokines

Promotion tolerogenic dendritic cells and regulatory T cells

Enhance of natural killer activity

Antagonism of pathogens

Direct killing of bacteria

Reduction of pathogen adherence

Inhibition of pathogenic bacteria growth by antimicrobial and antitoxin compound production (i.e., SCFA, bacteriocins and microcins)

Production of substances

Production of enzymatic activities and/or beneficial metabolites to the host

Promotion pain relief in visceral hyperalgesia

SCFA: Short chain fatty acids.

Table 2 Role of probiotics in inflammatory bowel diseases

Ref.	No. (intervention/control)	Probiotic	Control	Results
Remission induction in UC
Kato et al[68]	20 (10/10)	B. breve, B. bifidum, L. acidophilus + 5ASA/SASP	Placebo	slight ↑
Tursi et al[69]	90 (30/60)	VSL#3 + balsalazide	Balsalazide alone	↑
			5ASA
Miele et al[70]	29 (14/15)	VSL#3	Placebo	↑
Sood et al[71]	147 (77/70)	VSL#3	Placebo	↑
Matthes et al[72]	57 (46/11)	E. coli Nissle 1917	Placebo	↑
Tursi et al[73]	144 (71/73)	VSL#3	Placebo	↑
Maintenance of remission
Kruis et al[74]	103 (50/53)	E. coli Nissle 1917	5ASA	Similar efficacy
Kruis et al[75]	327 (162/165)	E. coli Nissle 1917	5ASA	Similar efficacy
Zocco et al[76]	187 (127/60)	Lactobacillus GG	5ASA	Similar efficacy (LGG more effective than 5ASA alone in prolonging relapse free time)
		Lactobacillus GG + 5ASA
Miele et al[70]	29 (14/15)	VSL#3	Placebo	↑
Wildt et al[77]	32 (20/12)	L. acidophilus La5, B. animalis subs P. lactis BB-12	Placebo	Similar effect
Maintenance of remission in Pouchitis
Gionchetti et al[78]	40 (crossover)	VSL#3	Placebo	↑
Gionchetti et al[79]	40 (20/20)	VSL#3	Placebo	↑
Mimura et al[80]	36 (20/16)	VSL#3	Placebo	↑
Maintenance of remission in CD
Prantera et al[81]	45 (23/22)	Lactobacillus GG	Placebo	Similar effect
Bousvaros et al[82]	75 (39/36)	Lactobacillus GG	placebo	Similar effect
Raju et al[83]	90 (43/47)	L. johnsonii	placebo	Similar effect
Van Gossum et al[84]	70 (34/36)	L. johnsonii	placebo	Similar effect
Induction of remission in CD
Steed et al[85]	24 (13/11)	B. longum, Synergy 1 + conventional therapy	Placebo + conventional therapy	Similar effect

All article are randomized controlled trials. 5ASA: Mesalazine; UC: Ulcerative colitis; CD: Crohn’s disease.

Table 3 Role of probiotics in irritable bowel syndrome

Ref.	Diagnostic criteria	No. participant	Probiotic	Time (wk)	Results (vs placebo)
O’Sullivan et al[147]	Rome	25	Lactobacillus GG	20	No difference
Nobaek et al[148]	Rome	60	L. plantarum	4	↓ pain and flatulence
Kim et al[149]	Rome II	25	VSL#3	8	↓ bloating
O’Mahony et al[150]	Rome II	80	L. salivarius UCC4331, B. infantis 35624	8	↓ symptoms and pro-inflammatory cytokines (only for B. infantis)
Kajarder et al[151]	Rome/Rome II	103	Mixture of L. rhamnosus GG, L. rhamnosus LC705, B. breve Bb99, P. freudenreichii	24	↓ symptoms
Kim et al[152]	Rome II	48	VSL#3	8	↓ flatulence
Niv et al[153]	Rome II	54	L. reuteri ATCC55730	24	No difference
Whorwell et al[154]	Rome II	362	B. infantis 35624	4	↓ symptoms (only at dose of 1 × 108 CFU)
Guyonnet et al[155]	Rome II (C-IBS)	274	B. animalis DN173010	4	↑ QoL and bloating score
Kajander et al[156]	Rome II	86	L. rhamnosus GG, L. rhamnosus Lc705, P. freudenreichii sp P. Shermanii JS, B. animalis sp P. lactis Bb-12	20	↓ bloating and abdominal pain
Zeng et al[157]	Rome II (D-IBS)	29	S. thermophilus, L. bulgaricus, B. longum	4	↓intestinal permeability and symptoms
Drouault-Holowazcz et al[158]	Rome II	100	B. longum LA101, L. acidophilus LA102, Lactocuccus lactis LA103, S. thermophilus LA104	4	↑ QoL
					↓ flatulence, pain and bloating
Sinn et al[159]	Roma III	40	L. acidophilus SDC 2012, 2013	4	↓ symptoms
Simrén et al[160]	Rome II	74	L. paracasei F19, L. acidophilus La5, B. lactis Bb-12	8	No difference
Søndergaard et al[161]	Rome II	52	L. paracasei F19, L. acidophilus La5, B. lactis Bb-12	8	No difference
Guglielmetti et al[162]	Rome III	122	B. bifidum MIMBb75	4	↓ symptoms ↑ QoL
Ducrotté et al[163]	Rome III (D-IBS)	214	L. plantarum 299v	4	↓ pain and bloating
Kruis et al[164]	Rome II (D-IBS)	120	E. coli Nissle 1917	12	No difference
Ki Cha et al[165]	Roma III (D-IBS)	50	L. acidophilus, L. plantarum, L. rhamnosus, B. breve, B. lactis, B. longum, S.thermophilus	8	↑ QoL
Dapoigny et al[166]	Rome III	50	L. caseirhamnosus	4	↓ symptoms
Roberts et al[167]	Rome III	179	B. lactis CNCMI-2494	12	No difference
Shavatehi et al[168]	Rome II	160	Lactobacillus, Bifidobacterium strains and Streptococcus thermophiles	2	No difference
Yoon et al[169]	Rome III	80	L. acidophilus, L. rhamnosus, B. breve, B. actis, B. longum, S.thermophilus	4	↓ symptoms
Pineton de Chambrun et al[170]	Rome III	179	S. cerevisiae	8	↓ pain and discomfort

All the studies are randomized controlled trials vs placebo. QoL: Quality of life.