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Synbiotic Therapy (Bifidobacterium longum/Synergy 1) Initiates Resolution of Inflammation in Patients with Active Ulcerative Colitis, a Randomized Controlled Pilot Trial

Microbiology and Gut Biology Group, University of Dundee, Ninewells Hospital Medical School, Dundee DD1 9SY, UK.
Gut (Impact Factor: 13.32). 03/2005; 54(2):242-9. DOI: 10.1136/gut.2004.044834
Source: PubMed

ABSTRACT Ulcerative colitis (UC) is an acute and chronic inflammatory disease of the large bowel with unknown aetiology. The immune response against normal commensal microorganisms is believed to drive inflammatory processes associated with UC. Therefore, modulation of bacterial communities on the gut mucosa, through the use of probiotics and prebiotics, may be used to modify the disease state.
A synbiotic was developed for use in UC patients combining a probiotic, Bifidobacterium longum, isolated from healthy rectal epithelium, and a prebiotic (Synergy 1), a preferential inulin-oligofructose growth substrate for the probiotic strain. Treatment was employed in a double blinded randomised controlled trial using 18 patients with active UC for a period of one month. Clinical status was scored and rectal biopsies were collected before and after treatment, and transcription levels of epithelium related immune markers were measured.
Sigmoidoscopy scores (scale 0-6) were reduced in the test group (start 4.5 (1.4), end 3.1 (2.5)) compared with placebo (start 2.6 (2.1), end 3.2 (2.2)) (p=0.06). mRNA levels for human beta defensins 2, 3, and 4, which are strongly upregulated in active UC, were significantly reduced in the test group after treatment (p=0.016, 0.038, and 0.008, respectively). Tumour necrosis factor alpha and interleukin 1alpha, which are inflammatory cytokines that drive inflammation and induce defensin expression, were also significantly reduced after treatment (p=0.018 and 0.023, respectively). Biopsies in the test group had reduced inflammation and regeneration of epithelial tissue.
Short term synbiotic treatment of active UC resulted in improvement of the full clinical appearance of chronic inflammation in patients receiving this therapy.

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    • "Probiotics are described as live micro-organisms applied in adequate amounts for beneficial use in order to strengthen the ordinary defence system and protect the gastrointestinal epithelium against pathogenic bacteria. Probiotics have been used successfully in cases of infant diarrhoea, food allergies, ulcerative colitis, colonic cancer, Crohn's disease and inflammatory bowel disease (Furrie et al., 2005; Steed et al., 2010; Rijkers et al., 2011; Quigley, 2012). The positive effects of probiotics on gastrointestinal diseases had motivated the investigation into the possible influence of micro-organisms on Barrett's transformation. "
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    • "Probiotics are described as live micro-organisms applied in adequate amounts for beneficial use in order to strengthen the ordinary defence system and protect the gastrointestinal epithelium against pathogenic bacteria. Probiotics have been used successfully in cases of infant diarrhoea, food allergies, ulcerative colitis, colonic cancer, Crohn's disease and inflammatory bowel disease (Furrie et al., 2005; Steed et al., 2010; Rijkers et al., 2011; Quigley, 2012). The positive effects of probiotics on gastrointestinal diseases had motivated the investigation into the possible influence of micro-organisms on Barrett's transformation. "
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    • "Sporadical reports on the use of synbiotics in UC are also available. The combination of B. longum and Sinergy 1 (a inulinoligofructose substrate ) was evaluated in patients with active UC as an adjunct to medical treatment in a small randomized, placebo-controlled trial, showing a trend (P = 0.06) of benefit over placebo in improving clinical activity index (Furrie et al., 2005). Another randomized controlled trial, carried out in UC patients in remission or with mildly active disease concomitantly on standard therapy, showed the superiority of a combination of B. longum and psyllium over the probiotic or the prebiotic alone in terms of IBD-related quality of life scores or reduction of serum C-reactive protein, respectively (Fujimori et al., 2009). "
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