Prophylaxis of Pouchitis Onset with Probiotic Therapy

Clinical Study Highlight

Prophylaxis of pouchitis onset with probiotic therapy: a double-blind, placebo-controlled trial.

Gastroenterology 2003 May; 124:1202-9

Gionchetti P, Rizzello F, Helwig U, Venturi A, Lammers KM, Brigidi P, Vitali B, Poggioli G, Miglioli M, Campieri M. 2003.

Summary and comments by Mary Ellen Sanders, Ph.D.

An emerging field of study is the ability of probiotics to down-regulate intestinal inflammation. Several research groups are investigating strain-specific effects in animal models of colitis, and human studies are underway with patients suffering from Crohn’s disease, ulcerative colitis and pouchitis. The European Union is funding a large, multicenter study through its PROGID project (part of the PROEUHEALTH cluster) on probiotics as therapeutics for IBD and other chronic gut disorders.

One research effort, headed by Dr. Gionchetti from the Department of Internal Medicine at the University of Bologna in Italy, has been especially active in studying probiotics and their impact on pouchitis and inflammatory bowel disease. A study published in the May issue of Gastroenterology reports results from a double-blind, placebo-controlled trial of 40 patients. These patients had all undergone surgery for ulcerative colitis to remove their colon and form an ileal pouch connected to the anus. The resulting ileal pouch serves as the fecal reservoir. Inflammation of this ileal pouch, or pouchitis, is the most common long-term complication from this surgery. Because of the role of bacterial colonization in the etiology of this complication and the short-term effectiveness of antibiotics in treating pouchitis, probiotic bacteria were hypothesized to play a role in preventing the onset of acute pouchitis. The effectiveness of the probiotic test product in reducing recurrence of inflammation in patients with ulcerative colitis and reducing postoperative recurrence of Crohn’s disease was documented in previous studies.

The probiotic preparation studied was the commercially available VSL#3 product, which is a blend of 8 lactobacilli and bifidobacteria and delivers 300 billion viable bacteria per gram. Three grams of the probiotic preparation (900 billion probiotic bacteria per day) or a placebo were administered to patients immediately after ileostomy closure. Patients were assessed after 1, 3, 6, 9, and 12 months. Two of the 20 patients (10%) treated with VSL#3 had an episode of acute pouchitis compared with 8 of the 20 patients (40%) treated with placebo. This statistically significant improvement demonstrated that the probiotic product, VSL#3, is an effective treatment for the prevention of the onset of acute pouchitis and improves the quality of life in patients with ileal pouch-anal anastomosis.