Battling bacteria

Probiotics show promise in some colitis sufferers

While we’ve all been hit with a bad case of diarrhea and severe cramping after eating something that we probably shouldn’t have, imagine having to live with these debilitating symptoms in a prolonged and recurrent manner for years or even decades. Such is the plight of those often young individuals affected by inflammatory bowel disease, commonly known as IBD. This edition of HealthWatch looks at new research suggesting that replacing the bad bacteria in the colon with the good shows promise for at least one form of this condition.

What is IBD?

IBD encompasses two main diseases, ulcerative colitis (UC) and Crohn’s disease. However, there are important differences between the two conditions. Crohn’s disease can show up in any portion of the digestive tract from the rectum up to the esophagus, while ulcerative colitis is limited to the colon. IBD is a chronic disease that typically causes inflammation and pain in the intestines, but especially the colon. The degree of inflammation varies between individuals but is characterized by intestinal bleeding, diarrhea, abdominal bloating, pain, weight loss, and sometimes fever. IBD does not remain static over time. People experience flare-ups and then periods of relative calm.

How prevalent is IBD?

Twenty to 30 per cent of IBD cases occur in people under age 20. The overall incidence in Canada is among the highest worldwide. There are currently more than 200,000 Canadians living with the condition, of which 112,000 people have Crohn’s and 88,000 suffer from ulcerative colitis. What’s more, the numbers have increased, possibly due to environmental factors that may affect the immune system. In addition, recent increased awareness among physicians and the public may be leading to more patients being diagnosed and at an earlier age.

What causes IBD?

There isn’t one universal cause for IBD; rather, several elements come into play, including genetic factors. When it comes to flare-ups, certain harmful types of bacteria such as c. difficile may contribute by triggering an immune system response that leads to intestinal inflammation. It has also been hypothesized that certain drugs – such as non-steroidal anti-inflammatories (NSAIDs) and antibiotics – along with previous infections and acute stress can trigger IBD flare-ups; however, the research on this is controversial and the evidence is weak.

How does a doctor arrive at a diagnosis? Why might diagnosis be delayed?

IBD is one of those conditions in medicine that is not black or white. One of the grey areas is diagnosis, which may be delayed due to the fact that symptoms can point to other conditions, such as bowel infections. For this reason, a doctor may arrive at a diagnosis of IBD in part by elimination of other causes. Ultimately, a sigmoidoscopy or colonoscopy may be performed to view the lining of the colon and do a biopsy.

Treatment

Current treatment for IBD focuses on suppressing or at least modulating a person’s immune system response. Medication typically consists of aminosalicylates – aspirin-like drugs – steroids, immunosuppressants, and biologics – drugs that specifically target one’s immune system.

The study

Sood A, Midha V, Makharia GK, Ahuja V, Singal D, Goswami P, Tandon RK. The probiotic preparation, VSL#3 induces remission in patients with mild-to-moderately active ulcerative colitis. Clin Gastroenterol Hepatol. Jul 21, 2009.

Why was this study undertaken?

While cortisone and other immunosuppressant drugs are the focus of treatment, they are potentially risky, with both immediate and long-term side effects. Specifically, given what is believed about the causes of flare-ups, the idea has been that by restoring the balance between bad and good bacteria, patients with flare-ups settle down more quickly; and by keeping the good bacteria in charge, the likelihood of a relapse drops significantly.

So what happened in this study?

In this randomized, placebo controlled study of 154 adults with mild to moderate ulcerative colitis, half received a daily regimen of a probiotic called VSL#3 and the other half received a placebo powder of similar appearance. Probiotics are “good” bacteria that survive the stomach and make their way down to the colon; VSL#3 is a mixture of eight strains and was provided at a daily dose of 3,600 billion bacteria in sachets of powder to be taken twice a day mixed in either water or yogourt.

What were the findings?

The results were quite promising and pretty consistent with the other research in this area, often conducted in children. One third of the group that was given the probiotic experienced a greater than 50 per cent improvement in their symptoms in addition to other measures of how active their UC was; only 10 per cent of the placebo group got that much better. The benefits were sustained to the 12-week mark and thus appeared to promote remission. Of note, one third of the patients in the probiotic group found that their symptoms were getting worse and did not complete the study although almost half of the placebo group felt the same way and failed to get to the end.

Should UC sufferers take probiotics?

This study, supported by the makers of VL#3, requires confirmation in larger government-sponsored trials before being advocated for widespread use. On the other hand, these supplements appear to be genuinely helpful for some UC sufferers and, while not cheap, are likely to be safe, so there’s probably no harm in giving them a try. VL#3 can be ordered online and might be reimbursed by some insurance companies.

n The Crohn’s and Colitis Foundation of Canada is sponsoring the All that Glitters Gala at the Montreal Museum of Fine Arts on Thursday, Oct. 15, 2009, at 5:30 p.m. Tickets are available by calling the CCFC at 514-342-0666.


The material provided in HealthWatch is designed for general educational purposes only and does not pertain to individual cases. It should not replace necessary medical consultations with your own doctor or medical professional.

This article is a reprint of http://www.montrealgazette.com/health/HealthWatch+Battling+bacteria/1962642/story.html The time or date displayed reflects when an article was added to Google News. Sept 4 , 2009‎