Probiotics
A Role for Probiotics in Pediatric Inflammatory Bowel Disease— Is there Evidence to Support It?
Jean-François Turcotte, MD and Hien Q Huynh, MBBS, FRACP, FRCPC Division of Pediatric Gastroenterology and Nutrition, Stollery Children’s Hospital, University of Alberta, Edmonton
Abstract
Therapeutic options for inflammatory bowel disease have grown rapidly. In recent years, probiotics as a treatment option for these diseases have also been studied. Data in children are still scarce. No evidence supports the role of probiotics in Crohn’s disease while some studies show a possible benefit in ulcerative colitis. However, current data are not sufficient to recommend the use of probiotics as induction or maintenance therapy in pediatric inflammatory bowel disease. Further studies are needed to evaluate the role of probiotics in children affected by inflammatory bowel disease, and even more so for ulcerative colitis as there seems to be a real potential for therapy in this particular condition.
Keywords Crohn’s disease, inflammatory bowel disease, probiotics, therapy, ulcerative colitis
Disclosure: The authors have no conflicts of interest to declare. Received: September 22, 2010 Accepted: October 18, 2010 Citation: US Gastroenterology & Hepatology Review, 2010;6:54–7 Correspondence: Hien Q Huynh, MBBS, FRACP, FRCPC, Associate Professor, Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Aberhart Centre Room 9219, 11402 University Ave NW, Edmonton, AB T6G 2J3, Canada. E:
Hien.Huynh@
ualberta.ca
Probiotics are defined by the World Health Organization (WHO) as “live micro-organisms which when administered in adequate amounts confer a health benefit on the host.”1
concentration of bacteria are the colon and the distal ileum. These areas are also the ones mostly affected in IBD patients.5
A reduction in Many studies have been conducted in
both children and adults regarding the use of probiotics as a potential treatment for numerous diseases, including inflammatory bowel disease (IBD). The rationale behind their potential effect is linked to the presumed dysregulation of immune responses to commensal bacteria in IBD patients.
Inflammatory Bowel Disease—A Complex Mechanism of Disease
The exact mechanism behind the development of IBD is still not well understood. Genetics plays a role; several inflammatory pathways regulated through specific genes have been associated with both Crohn’s disease (CD) and ulcerative colitis (UC). Genome-wide association (GWA) studies are considerably improving our understanding of genetic susceptibility to IBD.2
relatives is known to be higher.3
Furthermore, the risk of IBD among first-degree Some environmental triggers, such
as smoking, are considered to have an impact on the disease. But the one area where research has greatly evolved is in the concept of intestinal immunity. The intestinal microbiome, consisting of all micro-organisms that live in the intestinal tract, seems to play a major role in gastrointestinal health.2
The interleukin-10 (IL-10) gene-deficient mouse has been shown to develop colitis when exposed to commensal bacteria while no colitis has been observed in germ-free mice.4
These findings support the role of
an abnormal or dysregulated immune response to commensal bacteria in the pathogenesis of IBD. In humans, the two sites with the highest
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bifidobacteria and lactobacillus has also been described in patients with IBD, while both bacteria are recognized as beneficial to the gut.6
Highlighting Differences Between Pediatric Patients and Adults with Inflammatory Bowel Disease
IBD comprises two main entities: CD and UC. About 25% of cases are diagnosed in children.7
Some specific characteristics of these conditions
are unique to children. First, a higher percentage of children with CD have colonic involvement. Second, more children with UC present with a pancolitis at diagnosis compared with adults.7
Severity in pediatric CD
is also a concern, as a young age at diagnosis is considered to be a marker of severity. Children are also less likely to have been exposed to environmental triggers, such as smoking. These patterns of disease have to be taken into account when dealing with pediatric IBD patients. Potentially, children with IBD may respond to probiotics differently to adults. Also, concerns for both growth and puberty constitute features that characterize pediatric management of IBD. We also have to consider that there are far fewer studies regarding the use and safety of drugs in children. Moreover, the advances we have made in the medical management of IBD have come with some adverse effects. Newer and more potent agents have been known to induce some significant risks, including malignancies.8
Therefore, efforts have been made to find safer
therapies with good clinical outcome. Moreover, studies have reported that the use of complementary medicine is common among pediatric
© TOUCH BRIEFINGS 2010
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