Prebiotics are ineffective in treatment of Crohn’s disease:

Wednesday, 02 February 2011 17:09

Nutrition News

results of a double-blind placebo-controlled study

Inflammatory bowel diseases (IBD), and in particular Crohn’s disease (CD), are characterized  by uncontrolled attack by the immune system  of commensal intestinal bacteria  which,  in  normal circumstances, are tolerated.  During the course of CD, modification in the composition of this gut flora has also frequently been observed, a phenomenon known as dysbiosis.  During this period, the concentration of bacteria beneficial  for intestinal homeostasis (such as bifidobacteria) decreases, enabling less beneficial bacterial species to proliferate.

Prebiotics can be defined as undigestible fermentable food components (sugars) which are beneficial to the organism by selectively stimulating growth and/or activity of one or several bacterial species in the colon.  The most frequently encountered natural prebiotics   in food are fructose polymers known as inulin and fructo-oligosaccharides (FOS).  In healthy individuals, it was demonstrated that prebiotics are capable of increasing the concentration of beneficial  bacteria in humans, and especially   bifidobacteria.  Based on these observations, a group of British scientists attempted to test the impact of FOS in patients with CD  in the hope of re-establishing intestinal homeostasis via modulation of bifidobacteria, thus obtaining clinical improvement.

Unfortunately, results of this clinical study turned out to be negative.  FOS were not clinically  effective in treatment of moderate episodes of CD.  No significant differences  in improvement of symptoms  or  clinical expression of the disease were found between patients receiving FOS and those given a placebo.

However, these results do not rule out the use of prebiotics in treatment of IBD.  Indeed, since a growing number of  patients are seeking non-pharmacological therapeutic strategies, the role of prebiotics might lie in maintaining   remission stages of the disease rather than in inducing remission itself.  This research track should be explored in the near future.

References

Randomised, double-blind, placebo-controlled trial of fructo-oligosaccharides in active Crohn’s disease. Benjamin, JL et al., Gut (Online first, published on January 24, 2011).