Treatment for ulcerative colitis
The treatment for ulcerative colitis includes medications from the aminosalicylates family (such as Raphasal, Salofalk, Pentasa, and Azacol), steroids, immunomodulators (like Imuran or its derivative Purinethol), TNF inhibitors (such as Remicade and Humira), and in recent years, newer biologic drugs, including Entyvio, Stelara, Xeljanz, and Zeposia. Each of these medications has the potential to cause undesirable side effects, with varying degrees for each drug. Therefore, there is a constant search for new treatments that are highly effective with minimal side effects. Aminosalicylates are indeed very safe and effective in treating ulcerative colitis, but not all patients respond well to them.
Numerous pieces of evidence from laboratory animal studies, epidemiological research, and findings from blood tests of patients indicate a clear link between gut bacteria and inflammation in inflammatory bowel diseases. This is not surprising considering that the number of bacteria in the intestine is ten times greater than the number of cells in the human body. Their presence is crucial for the immune system's balance and the production of essential metabolites.
Probiotic bacteria
Probiotic factors are defined as microorganisms that have a positive effect on humans by altering the gut's bacterial composition (the flora). Probiotic bacteria have been found to be effective in treating and preventing diseases such as viral gastroenteritis in children or diarrhea caused by antibiotic use. They might also play a role in preventing and treating conditions like allergies and infantile colic. Prebiotic factors are defined as food supplements that have a positive effect achieved by enriching gut bacteria. They usually consist of non-absorbable carbohydrates that provide food for colon bacteria, such as oligofructose (FOS) and oligogalactose (GOS). Laboratory animals with colitis treated with probiotics showed improvement in inflammation compared to those not exposed to the supplement.
VSL #3 Research
VSL #3 is a probiotic supplement with a high concentration that contains 8 live strains of bacteria. A study was conducted to evaluate the supplement's ability to induce remission in ulcerative colitis. Previous studies produced conflicting results, but most of them were small-scale studies. This new research was a double-blind, placebo-controlled trial conducted at three centers in northern India between 2005 and 2007. The study included patients with active ulcerative colitis over the age of 18 with mild to moderate disease. Patients who had colitis confined to the rectum, evidence of severe disease, infections, steroid use, antibiotic use, or were pregnant were excluded from the study. Out of 147 participants, 84 patients completed the study until week 12. 17 patients from the probiotic group withdrew from the study due to the worsening of their condition, while 18 patients from the placebo group withdrew. By week 12, approximately 43% of patients in the VSL #3 group achieved remission compared to 16% in the placebo group. No serious side effects were reported, but 18% of participants in the VSL #3 group reported bloating and altered taste.
Limitations of this study include a high number of patients lost to follow-up, additional treatment with aminosalicylates that most patients in the VSL #3 group received (making it difficult to determine the specific benefit), and the study's conduct in India only (local effects on the disease). However, since this study, three similar studies on ulcerative colitis (two in children) were published in 2009-2010, showing similar results with VSL #3. Other small studies also indicated potential benefits for specific strains of probiotics such as A. coli and yeast (Saccharomyces boulardii, not available in Israel).
To summarize,
Probiotic supplements are dietary supplements consisting of live microorganisms that have a positive effect on humans by improving the microbial balance in the digestive system and enhancing the local immune response. The results of this research suggest that probiotics may aid in achieving remission in active ulcerative colitis of mild to moderate severity.
It is essential to remember that not all probiotic supplements are the same, and only those proven in clinical trials should be used. The majority of similar studies in Crohn's disease did not yield positive results; therefore, there is currently no place to recommend this treatment for non-colitis inflammation (i.e., non-ulcerative colitis).
The probiotic preparation, VSL#3, induces remission in patients with mild-to-moderately active ulcerative colitis. Clin Gastroenterol Hepatol 2009; 7: 1202-1209. Am J Gastroenterol 2010 June Inflamm Bowel Dis 2009; 15: 760-768 Am J Gastroenterol 2009; 104: 437-443