Use of Probiotics to Treat Inflammatory Bowel Disease (IBD)

The inflammatory bowel diseases (IBD) include Crohn’s disease, ulcerative colitis, and indeterminate colitis. These conditions are lifelong, chronic diseases that cause inflammation in the digestive tract and other effects on other body systems. IBD is managed on an individual basis, with medications, lifestyle changes, and diet.

One potential treatment that often gets discussed is probiotics. Probiotics are bacteria that are found in some foods (like yogurt, kefir, kimchi, and kombucha) and are also made into supplements. They are the beneficial types of bacteria that live in the human digestive tract, helping it to function well.

What’s not well understood is if probiotics may help certain medical conditions and then which types of bacteria should be used. For IBD, it may seem as though taking probiotics to treat the disease makes sense.

However, the American Gastroenterological Association (AGA) has recently issued guidelines about whether or not probiotics should be used to treat IBD and other digestive conditions. In most cases, there doesn’t seem to be good evidence to recommend probiotics for treating IBD.

Probiotics for Crohn’s Disease

The AGA doesn’t recommend probiotics for treating Crohn’s disease outside of use in a clinical trial. They cite the limitations of the studies that have been done so far. Studies have been small and have used different strains of probiotics. These types of issues make it challenging to make any conclusions about how probiotics may affect Crohn’s disease. 

The AGA found 12 studies that looked at the use of probiotics to treat Crohn’s disease. One of these studies was trying to get patients into remission. The other 11 were studying the use of probiotics as a maintenance treatment.

Some of the studies compared the use of probiotics to the medication mesalamine, even though mesalamine has not been shown to be effective for treating Crohn’s disease.

In the end, the AGA concluded that the evidence for the use of probiotics to treat Crohn’s disease in children and in adults was poor. They call for better studies to be done in case there are certain patients with Crohn’s disease who might benefit from treatment with probiotics.

Probiotics for Ulcerative Colitis

The AGA doesn’t recommend probiotics for treating ulcerative colitis outside of use in a clinical trial. As with Crohn’s disease, the limitations in the type of studies that have been done so far are the main factor in this decision.

The AGA found 11 studies done using probiotics for treating ulcerative colitis. They used various different strains of probiotics, which makes comparing these studies difficult.

There were four studies that compared the use of probiotics with the medications mesalamine or balsalazide. A few of the studies allowed co-therapy with steroids and one was done with the use of probiotic enemas in children.

While the evidence was considered “low,” the AGA does indicate that for some of the studies, the benefit was “uncertain.” There was one study that showed a “potential for benefit.” This appears to be in contrast to Crohn’s disease, where there doesn’t seem to be much indication that probiotics might be beneficial.

Probiotics for Pouchitis in a J-Pouch

Pouchitis is a condition that can occur in people who live with an ileal pouch–anal anastomosis (IPAA), also called a j-pouch. This surgery is used to treat ulcerative colitis, although it may also be used for Crohn’s disease in certain rare circumstances.

It is not well understood why pouchitis happens, and there are theories that there could be several different causes and types of pouchitis. In most cases, pouchitis is treated with the use of one or more antibiotics. In some cases, pouchitis may become chronic and other medications might be used.

However, there are studies into how probiotics may be used to both prevent and to treat pouchitis with probiotics. In one study, 3 grams per day of the combination probiotic called VSL#3 was given to 40 patients. VSL#3 is a proprietary blend that contains several species of probiotics, including Lactobacillus, Bifidobacterium, Streptococcus salivarius, and Thermophilus.

After a year, the patients in the study who received the VSL#3 had a 10% rate of pouchitis. The patients that received a placebo had a 40% rate of pouchitis.

However, a similar study that included 31 patients didn’t show any difference in the rate of pouchitis between the group that received the VSL#3 and the group that did not.

A different strain of bacteria, Clostridium butyricum MIYAIR, was tried in another study of 17 patients in Japan. What the researchers saw was that the j-pouch patients who took the probiotic had fewer bouts of pouchitis (one patient versus four with placebo).

In their guidelines, the AGA recommends that if a probiotic is used for adults and children with pouchitis, that it is a combination of strains. The strains included are L paracasei subspecies paracasei, L plantarum, L acidophilus, L delbrueckii subsp bulgaricus, B longum subspecies longum, B breve, B longum subsp infantis, and S salivarius subspecies thermophilus.

The guidelines also note that this formulation is expensive for patients because it is often not covered by insurance. Because the evidence supporting the use of these probiotics is still considered “very low,” it’s also considered reasonable for patients with j-pouch to opt to not take any probiotics.

The upshot for people who have a j-pouch due to IBD is that the use of probiotics comes down to shared decision making with the healthcare team and the patient. There’s not a lot of strong evidence that probiotics will help prevent pouchitis.

For some, probiotics might be found, through trial and error, to be useful in trying to prevent pouchitis or in recovering quicker from a bout of pouchitis. For others, the cost of the types of probiotics that have been shown to work in these clinical trials might not be worth it for preventing pouchitis in the long run.

Is There Harm in Taking a Probiotic?

People who live with IBD might wonder what harm there could be in taking a probiotic. For one thing, it might be expensive. For another, it might not help.

While in some cases, probiotics might not have any adverse side effects, for some people it could lead to bloating, gas, or diarrhea. Sometimes these effects will go away over time and with continued use of the probiotic.

Another potential harm is the cost: in some cases probiotics can be quite expensive. If they’re not giving any benefit, that is a problem, especially for people who already have high medical costs.

What’s less well understood is if a probiotic might be used instead of receiving a treatment for IBD that has been proven to work in clinical trials. The harm would be in taking probiotics that might not have an effect and in forgoing other treatment.

A Word From Verywell

IBD is complex and with the evidence that is available right now, it doesn’t look like taking a probiotic is a long-term strategy for treating the disease and preventing complications. Even so, IBD is also highly individualized and it’s important to discuss all treatment decisions, including probiotics, with a healthcare team that includes a gastroenterologist.