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Probiotics PouchitisPouchitis is a common condition that occurs with people who have an ileal pouch anal anastomosis (IPAA.) Probiotics are known to have an anti-inflammatory effect in patients with inflammatory bowel disease. It is believed they regulate mucosal immune response through reductions in proinflammatory cytokines.1 Several different probiotics are giving useful results in the various trials that have taken place over the last few years with VSL3 being the star performer at this stage. Probiotic pouchitis list
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This probiotic for pouchitis has proven over a number of studies to be highly effective. You can read more about VSL3 and pouchitis here.
It is a mix of 8 different probiotics.
Lactobacillus GG - another probiotics pouchitis helper
This probiotic's full handle is Lactobacillus rhamnosus GG but it is often abbreviated down to LGG or simply called Culturelle
When LGG was given post-operatively to prevent pouchitis it decreased the risk for 3 years2. In this study, 117 patients were consecutively studied between 1989 and 2001 and all episodes of pouchitis were analyzed. 39 patients took a fermented product containing Lactobacillus rhamnosus GG; 78 patients did not take this product. First episodes of pouchitis was less frequent (cumulative risk at 3 years, 7% verse 29%) in the group that took L rhamnosus GG.
The doctors in that study recommended a dosage of 1010 to 2010 (ten to twenty billion) bacteria a day to delay the onset of pouchitis.
However, when Lactobacillus GG was tried as a probiotic treatment for acute active pouchitis it was not successful3. This was, admittedly, a very small trial. Ten patients with a history of pouchitis and endoscopic inflammation were given LGG and ten similar patients were given a placebo. It did change the pouch intestinal flora (increased the ratio of faecal lactobacilli to facecal anerobes) but only 40% of patients were colonized with LGG.
The doctors conclusion was that it "changed the pouch intestinal bacterial flora but was ineffective as primary therapy for a clinical or endoscopic response."
Lactobacillus acidophilus and Bifidobacterium lactis
These two probiotics for pouchitis are in the commercially available product Cultura which contains the strains Lactobacillus acidophilus LA-5 and Bifidobacterium lactis BB-12. The aim of this study was to assess mucosal inflammation and blood flow response in patients with a J-configurated ileal pouch anal anastomosis (IPAA.) Doctors used the Pouchitis Disease Activity Index (PDAI) to compare results in 41 patients with ulcerative colitis and 10 patients with familial adenomatous polyposis (FAP) when given 500 mls of Cultura for 4 weeks.The histological score did not change in either group.
However, the PDAI decreased in both groups from a level considered as indicative of pouchitis to a level considered as not active pouchitis.4
Other results were:
- LDF measurements did not change during the 4 weeks of taking Cultura
- in the UC group, mucosal perfusion was significantly reduced in the distal part of the pouch (compared to the proximal part)
- perfusion levels were higher in the FAP patients compared to the UC group
- Calprotectin levels did not change much during the 4 weeks in either group
REFERENCES
1. Pronio A, Montesani C, Butteroni C, Vecchione S, Mumolo G, Vestri A, Vitolo D, Boirivant M. Probiotic administration in patients with ileal pouch-anal anastomosis for ulcerative colitis is associated with expansion of mucosal regulatory cells. Inflamm Bowel Dis. 2008 May;14(5):662-8.
2. Gosselink MP, Schouten WR, van Lieshout LM, Hop WC, Laman JD, Ruseler-van Embden JG. Delay of the first onset of pouchitis by oral intake of the probiotic strain Lactobacillus rhamnosus GG. Dis Colon Rectum. 2004 Jun;47(6):876-84. Epub 2004 Apr 19.
3. J. Kuisma, S. Mentula, H. Jarvinen, A. Kahri, M. Saxelin, M. Farkkila. Effect of Lactobacillus rhamnosus GG on ileal pouch inflammation and microbial flora. Alimentary Pharmacology & Therapeutics, Volume 17 Issue 4 Page 509-515, February 2003.
4. Laake KO, Line PD, Grzyb K, Aamodt G, Aabakken L, Røset A, Hvinden AB, Bakka A, Eide J, Bjørneklett A, Vatn MH. Assessment of mucosal inflammation and blood flow in response to four weeks' intervention with probiotics in patients operated with a J-configurated ileal-pouch-anal-anastomosis (IPAA). Scand J Gastroenterol. 2004 Dec;39(12):1228-35.
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GoodBug Says
Remember -
A true probiotic will always have the strain specified.
So the wording on the label will be the bacteria name, eg Lactobacillus rhamnosus, followed by the strain, eg GG.
It's those few letters or numbers at the end that make all the difference.
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