Table 4.
Prebiotics and synbiotics for IBD (Randomized trials)
| Author, year | Disease activity |
Case /Control |
Base Therapy | Agent (s) | Therapy duration |
Outcomes, therapy vs control | PMID |
|---|---|---|---|---|---|---|---|
| Prebiotics | |||||||
| Ulcerative colitis | |||||||
| Hallert, 1991 | inactive | 16/13 | Psyllium | 4 m | Improve symptoms | 1654592 | |
| Ejderhamn, 1992 | inactive, child | 10/10 | Sulfa | Wheat bran vs psyllium | 6 m | Reduce total bile acid and modified composition | 1360699 |
| Fernandez-Banares, 1999 | inactive | 35/37/30 | Psyllium vs 5-ASA vs combined | 12 m | Equivalent relapse rate (40%, 35%, 30%) Increase butyrate | 10022641 | |
| Hallert, 2003 | inactive | 22/10 | Wheat bran | 3 m | Increase butyrate | 12769445 | |
| Hanai, 2004 | inactive | 22/37 | GBF | 12 m | Improve remission period and tapering steroid | 15067363 | |
| Hafer, 2007 | active | 7/7 | 5-ASA, steroid, immunosuppress ant or antibiotics | Lactulose | 4 m | NS on clinical, endoscopic scores Improve QOL | 17784949 |
| Casellas, 2007 | active | 10/9 | 5-ASA | Oligofructose-enriched inulin | 2 w | Improve fecal calprotectin, symptoms | 17439507 |
| Fujimori, 2009 | inactive, mild | 40/40/40 | 5-ASA, steroid | Psyllium vs Bifidobacterium longum vs synbiotics | 4 w | NS on clinical, endoscopic scores Improve QOL | 19201576 |
| Faghfoori, 2011 | inactive | 21/20 | Standard drugs | GBF | 2 m | Improve inflammatory cytokines | 21367884 |
| Faghfoori, 2014 | inactive | 23/23 | Standard drugs | GBF | 2 m | Improve CRP, symptoms | 25097845 |
| James, 2015 | inactive | 7/7 | 5-ASA, steroid, thiopurine | Inulin-type fructans etc. | 17 d | Tend to normalise gut transit, but does not increase the proportion of carbohydrate fermented, nor increase short-chain fatty acids | 25037189 |
| Pouchitis | |||||||
| Alles, 1997 | inactive | Crossover 15 | Steroid | Fructo-oligosaccharide (FOS) or resistant starch | 7 d | Resistant starch increases butyrate FOS reduced isobutyrate and isovalerate excretion | 9356550 |
| Meijer, 2000 | active | Crossover 20 | Inulin | 3 w | NS (increase butyrate, not significant, correlated with disease activity | 11052521 | |
| Welters, 2002 | active | Crossover 20 | Inulin | 3 w | Improve endoscopic and histological scores | 12004211 | |
| Crohn’s disease | |||||||
| Heaton, 1979 (retro) | active | 22/32 | Steroid, AZA, or sulfa | Fiber-rich, unrefined-carbohydrate diet | 4.3 y | Improve hospital admission (fewer and shoter: 111 d vs 533 d), surgical rate (5% vs 16%) | 519185 |
| Jones, 1985 | inactive | 10/10 | Fiber-rich, unrefined-carbohydrate diet | 6 m | Improve relapse rate (0% vs 70%) and ESR | 2862371 | |
| Levenstein, 1985 | inactive, active | 28/30 | Normal diet vs fiber-restricted diet | 29 m | Fiber-restriction does not improve outcome (symptoms, need for surgery or hospitalization) | 2996991 | |
| Hafer, 2007 | active | 8/9 | 5-ASA, steroid, immunosuppress ant or antibiotics | Lacturose | 4 m | NS | 17784949 |
| Benjamin, 2011 | active | 54/49 | Fructo-oligosaccharide | 4 w | NS (clinical response: 22% vs 39%) Reduce IL-6+ DC, increase IL-10+ DC | 21262918 | |
| Brotherton, 2011 | inactive | 4/3 | Wheat bran | 4 w | Improve QOL | 24871666 | |
| Joossens, 2012 | inactive, active | 34/33 | Oligofructose-enriched inulin | 4 w | Improve disease activity | 21749983 | |
| De Preter, 2013 | inactive, active | 25/20 | Oligofructose-enriched inulin | 4 w | Improve clinical diseaese activity Increase acetaldehyde and butyrate | 23303175 | |
| Synbiotics (Probiotics + Prebiotics) | |||||||
| Ulcerative colitis | |||||||
| Furrie, 2005 | active | 8/8 | Bifidobacterium longum + fructo-oligosaccharide/inulin | 4 w | Improve endoscopic score (P=0.06) and b-defencin (P<0.05), TNF-α (P=0.018), IL-1 (P=0.023) | 15647189 | |
| Fujimori, 2009 | inactive, mild | 40/40/40 | 5-ASA, steroid | Psyllium/Bifidobacterium longum /synbiotics | 4 w | Improve QOL and CRP | 19201576 |
| Ishikawa, 2011 | inactive, active | 21/20 | Bifidobacterium breve Yakult + galacto-oligosaccharide | 2 w | Improve endoscopic score | 21525768 | |
| Crohn’s disease | |||||||
| Chermesh, 2007 | inactive | 20/10 | Pediacoccus pentoseceus, Lactobacillus raffinolactis, L. paracasei subsp. paracasei 19, L. plantarum 2362 and beta-glucans, inulin, pectin, resistant starch | 24 m | NS | 17211699 | |
| Steed, 2010 | active | 13/11 | Bifidobacterium longum + fructo-oligosaccharide/inulin | 6 m | Improve remission rate (62% vs 45%), clinial and histological scores and inflammatory cytokines | 20735782 | |
IBD: inflammatory bowel disease, PMID: PubMed identifier, NS: no statistically significant difference in disease activity, AZA; azathioprine, sulfa: salazosulfapyridine, 5-ASA: 5-aminosalicylic acid, DC: dendritic cell, QOL: quality of life, ESR: erythrocyte sedimentation rate, GBF: germinated barley foodstuff, CRP: C-reactive protein, CDAI: Crohn’s disease activity index.