Benefits of Probiotics in Managing Ulcerative Colitis

How Inflammation Develops in Ulcerative Colitis

Ulcerative colitis is a chronic type of bowel disease that can relapse. It causes sores (ulcers) in the lining of the large intestine. The cause is unknown, but it may be related to a problem in how the immune system responds to antigens. Ulcerative colitis occurs mainly in the colon, where many bacteria live. It is characterized by inflammation of the colon, increased permeability of the colon lining, and an abnormally high number of leukocytes (white blood cells) in the colon. Normal intestinal bacteria comprises around 400 different species of bacteria, which are most concentrated in the colon. Intestinal bacteria can produce harmful toxins, like Gram-negative bacterial endotoxin, and harmful enzymes, like β-glucuronidase and tryptophanase, which produce carcinogenic agents. These toxins can interact with cells on the surface of the intestine and cause inflammation. This inflammation can activate the immune system and lead to more inflammation.

Probiotics as an Alternative to Traditional Medicine 

Medical treatment of ulcerative colitis relies on reducing inflammation with drugs. However, these drugs have side effects and can disturb the quality of life. A new option is to use antibiotics to remove bacteria that contribute to inflammation. However, this treatment has had limited success in the past.

Probiotic bacteria that could resolve inflammation can be used as an alternative to traditional medicines. Probiotics are safe live microorganisms that improve disturbances in the indigenous microflora, boost the development of microflora, have anti-diabetic and anti-hyperlipidemic effects, inhibit carcinogenesis, have anticolitic effects, and induce activation of the host’s immune system.

This study aimed to show the probable therapeutic effect of probiotics in patients with UC and to evaluate their impact on the inflammatory mediators like myeloperoxidase (MPO), interleukin-6 (IL-6), and calprotectin, and the activation of the protein nuclear factor-kappaB (NF-κB), which initiate and regulate the cells’ immune response to infection.

The Study Method on Probiotics for Ulcerative Colitis

30 patients newly diagnosed with mild to moderate UC were randomly classified into two groups: the sulfasalazine group, who received 2400 milligrams per deciliter (mg/d) with starch as placebo; and the probiotic group, who received 2400 mg/d of sulfasalazine with probiotic. Inflammatory markers were evaluated before and after eight weeks of treatment with probiotics (Lactobacillus delbruekii and Lactobacillus fermentum).Tissue samples for biopsy were obtained from inflamed colonic mucosa, the moist inner lining of the colon, for its MPO and IL-6 content and the expression of NF-kappaB p65 and tumor necrosis factor (TNF)-alpha proteins. Stool samples were taken for calprotectin content.

Another group of ten healthy volunteers joined in as the control group.

The Results

The colonic concentration of IL-6, expression of TNF-alpha and NF-kappaB p65, and leukocyte recruitment from those in the probiotic group significantly lessened the inflammation as reflected in a decrease in colonic MPO activity and the calprotectin level compared with the sulfasalazine and control groups.

The Conclusion

Oral supplementation with probiotics could help maintain remission and prevent relapse of ulcerative colitis.


Effect of Probiotics on Pro-Inflammatory Cytokines and NF-kappaB Activation in Ulcerative Colitis

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