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FRANCESCO CAPPELLO

Probiotics, prebiotics and symbiotics in inflammatory bowel diseases: state-of-the-art and new insights

  • Autori: Tomasello, G.; Cappello, F.; Leone, A.; Cottone, M.; Bellavia, M.; Rossi, F.; Facella, T.; Damiani, P.; Zeenny, M.; Damiani, F.; Abbruzzo, A.; Damiano, G.; Palumbo, V.; Cocchi, M.; Jurjus, A.; Spinelli, G.; LO MONTE, A.; Raimondo, D.; Sinagra, E.
  • Anno di pubblicazione: 2013
  • Tipologia: Articolo in rivista (Articolo in rivista)

Abstract

Inflammatory bowel disease (IBD) consists of two distinct clinical forms, ulcerative colitis (UC) and Crohn s disease (CD), with unknown aetiology, which nevertheless are considered to share almost identical pathophysiological backgrounds. Up to date, a full coherent mechanistic explanation for IBD is still lacking, but people start to realize that the pathogenesis of IBD involves four fundamental components: the environment, gut microbiota, the immune system and the genome. As a consequence, IBD development might be due to an altered immune response and a disrupted mechanism of host tolerance to the non-pathogenic resident microbiota, leading to an elevated inflammatory response. Considering the available data arising from the scientific literature, here reviewed, in CD, a benefit of probiotics remains unproven; in UC, a benefit of probiotics remains unproven, even if E. coli Nissle 1917seems promising in maintaining remission and it could be considered an alternative in patients intolerant or resistant to 5-ASA preparations; in pouchitis, small controlled trials suggest a benefit from VSL no. 3 in the primary and secondary prevention of pouchitis; in IBD-associated conditions, a benefit of probiotics remains unproven. However, well-designed randomized control clinical trials are necessary to understand the undoubted role of these agents in the management of gut physiology in health and disease.

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