Probiotic use in IBD: Yay or nay?

Using the probiotic Escherichia coli Nissle 1917 (EcN) as add-on therapy for patients with mild-to-moderate ulcerative colitis (UC) helps induce disease remission and preserve quality of life (QoL) in these patients, according to studies presented at CCC 2022.

The double-blind, multicentre trial randomized 133 adults (mean age 46 years) with mild-to-moderate UC to receive once-daily EcN or placebo in a 1:1 ratio for 8 weeks.

At 4 weeks, significantly more patients who took EcN showed clinical response compared with those on placebo (39.7 percent vs 21.7 percent; p=0.04). 

The rate of endoscopic remission at 8 weeks was also higher in the EcN group than the placebo group (46.4 percent vs 27.1 percent; p=0.03).

Although there was no increase in IBDQ scores with EcN vs placebo (51.5 percent for both), significantly fewer EcN-treated patients reported a drop in their IBDQ score than those on placebo (1.7 percent vs 13.3 percent) — indicating that the health-related QoL was better preserved with EcN. The difference between the two groups remained significant regardless of whether it was an intention-to-treat analysis (p=0.02) or per-protocol analysis (p=0.03). 

“EcN is safe and effective in preventing the exacerbation of IBDQ scores and achieving clinical responses and endoscopic remissions in patients with mild-to-moderate UC,” the researchers concluded.

Flip side of probiotics?

While specific probiotic such as EcN is beneficial for patients with UC, consumption of probiotics in general has been associated with brain fog in patients with inflammatory bowel disease (IBD).

In another cross-sectional study of 66 adult patients (mean age 44 years, 53 percent female) with IBD (39.4 percent with UC and 60.6 percent with Crohn’s disease), the patients were categorized based on whether they had a history of probiotic use or not. Patients who did not have pre-existing psychiatric illness or were not currently taking any opioid medications were included and assessed on symptoms of brain fog using a questionnaire.

About one-third of the patients reported taking probiotics as dietary supplement (31.8 percent) — of which 67 percent had taken probiotics for more than 1 year.

“There is a high prevalence of probiotic consumption in patients with IBD in clinical practice, whether by a physician or not,” the researchers pointed out.

Overall, probiotic consumption appeared to be associated with brain fog, although this was not statistically significant (p=0.080).

However, when the analysis was restricted to male patients, the association between probiotics and brain fog became significant (p=0.004), so was the association among Caucasian patients (p=0.044).

In addition, the longer the duration of probiotic use, the more likely the patients were to have brain fog (p=0.038).

“Future prospective studies are warranted to examine causal relationship between probiotics and IBD-associated brain fog to guide prescription of probiotic supplements for IBD,” suggested the researchers.