Probiotics' role in Crohn's and Ulcerative colitis
Not all microorganisms are harmful to human health. There are some live microorganisms that can be used for health benefits, as they can fight against harmful microorganisms, and these are called probiotics. Probiotics can be found in various natural and artificial products, such as yogurt, cheese, fermented food, and dietary supplements.
The use of probiotics for the treatment of Inflammatory Bowel Disease (IBD), more specifically Crohn’s and Ulcerative Colitis (UC), have been proven for several decades, but the latest Chinese research claimed them as unsafe for these diseases because they may act as bacteria-host and can lead to harmful side effects. Therefore, it is necessary to dig more into the use of live microorganisms in the form of natural probiotics for bowel diseases (1).
Line of Action of Probiotics for IBD
Probiotics work in a way that they act as a barrier for the microorganisms at the outer layer of the tissues so that foreign or harmful microorganisms cannot enter the tissue. This comprises a distinct process that includes tightening the epithelial layer so that a barrier could be formed, binding of probiotics microorganisms in the intestine, inhibiting foreign pathogens from entering the tissue, producing anti-microorganisms that can fight against the foreign pathogens, and modulating the immune system. This line of action is utilized for the treatment of IBD as it can fight against the microorganisms causing IBD (2).
Inflammatory bowel diseases Crohn's and ulcerative colitis are caused by pathogens' adhesion in the intestinal mucosa resulting in the inflammation of the gastrointestinal tract, that needs to be treated through various medicinal interventions. Probiotics can be very helpful as Part of Crohn's and Ulcerative colitis natural treatment. They can effectively lower inflammation as they inhibit microbial growth causing inflammation in the bowel. As probiotics increase the epithelial tight junctions and permeability resulting in a higher immune response in the intestines. And the increased number of mucosal immunity as they secrete the antimicrobial agents (3).
Effectiveness of Probiotics for Crohn’s Disease
Crohn’s disease is the inflammation in one or more parts of the gastrointestinal tract due to the pathogenic adhesions at all layers of the intestinal tissue i.e., from the superficial to the deepest layer of the intestinal mucosa. Probiotics are most effective to strengthen the mucosal layer that has been weakened in Crohn’s disease due to microbial adhesion (1).
It inhibits the pathogenic adhesion in the intestinal mucosa hence, reducing the inflammation in the gastrointestinal tract. Therefore, another research from 2018 stated that the effectiveness of probiotics should not be challenged rather than counting their side effects (4).
Effectiveness of Probiotics on Ulcerative Colitis
Ulcerative Colitis (UC) involves the inflammation in the superficial layer of the intestinal mucosa as the UC pathogens can adhere only to this layer. Probiotics stimulate the mucosal immune system preventing the luminal bacteria to reach the outer layer of the intestine. Hence, a study from 2019 claimed that probiotics can be used as a medicinal intervention for changing the mucosal consistency and adherence patterns of the bacteria due to which it is widely used to treat UC (2).
On the other hand, a recent study raised a concern regarding the impact of probiotics on the mucosal linings, and irregulating the bacteria present in the intestine increases the inflammation in the IBD (1).
Concerns raised in the latest research
Live microorganisms can modify or mutate themselves hence, can act as hosts to the inflammation-causing bacteria. Although research from 2017 suggested that probiotics can act as bacterial hosts to certain types of bacteria which include campylobacter, enterococcus, and clostridium difficile whereas they inhibit other types of bacteria such as bifidobacteria, Escherichia coli, lactobacilli, etc (5). As it is known that the inflammation in IBD is caused by Clostridium difficile, Escherichia coli, and Listeria monocytogenes, therefore it is unsafe to administer probiotics before diagnosing the type of microorganism.
On the other hand, another study from 2021 published another research to highlight the challenging factors related to the administration of probiotics for the treatment of IBD. It included external factors, gut survival, antibiotic interaction, dose, effectiveness, and safety issues (6).
1. External factors – Probiotics are sensitive to heat, oxygen, and moisture due to which their line of action can be altered and can be harmful instead of effective.
2. Gut survival – Not all probiotics can tolerate bile and stomach acids while adhering to the mucosal lining. Therefore, the intensity of the inflammation and chemical evaluation of the gastrointestinal tract should be considered before administering the probiotics.
3. Antibiotic interaction – There is a risk of decreased antibiotic potency due to the increased pathogenic resistance while interacting with the live microorganisms in the probiotics.
4. Dosage – The dose of probiotics and the intervals in between the subsequent doses should be specific to the pathogenic strain because every probiotic acts differently when modulating the immune system fighting against pathogens.
5. Effectiveness – The effectiveness of the probiotics is a challenging factor because the probiotics’ half-life is transient and dependent on the type of pathogens.
6. Safety – Probiotics for the treatment of IBD are not safe for children and adults with a weakened immune system.
Although the concerns regarding the use of probiotics for IBD are considered health-related risks that cannot be tolerable but good care and understanding of the use and administration of probiotics can reduce the risks.
It is genuinely understandable that the effectiveness and advantages of probiotics for the treatment of IBD are well-practiced by health practitioners for many ages, but these concerns should be addressed before administering probiotics for IBD.
References
[1]: Derwa, Y., Gracie, D. J., Hamlin, P. J., & Ford, A. C. (2017). Systematic review with meta‐analysis: the efficacy of probiotics in inflammatory bowel disease. Alimentary pharmacology & therapeutics, 46(4), 389-400.
[2]: Coqueiro, A. Y., Raizel, R., Bonvini, A., Tirapegui, J., & Rogero, M. M. (2019). Probiotics for inflammatory bowel diseases: a promising adjuvant treatment. International journal of food sciences and nutrition, 70(1), 20-29.
[3]: Shen, Z. H., Zhu, C. X., Quan, Y. S., Yang, Z. Y., Wu, S., Luo, W. W., ... & Wang, X. Y. (2018). Relationship between intestinal microbiota and ulcerative colitis: Mechanisms and clinical application of probiotics and fecal microbiota transplantation. World journal of gastroenterology, 24(1), 5.
[4]: Lee, Y. Y., Leow, A. H. R., Chai, P. F., Raja Ali, R. A., Lee, W. S., & Goh, K. L. (2021). Use of probiotics in clinical practice with special reference to diarrheal diseases: A position statement of the Malaysian Society of Gastroenterology and Hepatology. JGH Open, 5(1), 11-19.
[5]: Jia, K., Tong, X., Wang, R., & Song, X. (2018). The clinical effects of probiotics for inflammatory bowel disease: A meta-analysis. Medicine, 97(51).
[6]: Vrakas, S., Mountzouris, K. C., Michalopoulos, G., Karamanolis, G., Papatheodoridis, G., Tzathas, C., & Gazouli, M. (2017). Intestinal bacteria composition and translocation of bacteria in inflammatory bowel disease. PLoS One, 12(1), e0170034.