One Year, Randomised, Double Blind, Placebo Controlled Trial of Probiotics, Bifidobacterium Infantis 35624 or Lactobacillus Salivarius UCC118, as Food Supplements for Maintenance of Remission in Crohn's Disease and Ulcerative Colitis

There is a growing body of evidence that the enteric bacterial flora contribute to the pathogenesis of inflammatory bowel disease (IBD; Crohn's disease and Ulcerative Colitis) (Targan S and Shanahan F Inflammatory Bowel Disease: From Bench to Bedside, Williams and Wilkins 1994).

It has recently been found that patients suffering active Crohn's disease have significantly less recoverable bifidobacteria in their faeces compared to healthy individuals. This reduction in bifidobacteria numbers was observed to be directly correlated with decreased levels of B-D-galactosidase production and activity (Favier C et al. Dig Dis Sci 1997;42:817-822). B-D-galactosidase is an enzyme produced by bifidobacteria. These results support suggestions proposed in other studies (Bartram HP et al. Am J Clin Nutr 1994;59:428-432) that strains of bifidobacteria may play important roles in maintaining a balanced healthy intestinal microflora.

In Crohn's disease, there is extensive clinical evidence indicating the importance of the continuity of the faecal stream in disease recurrence.

Ingestion of bifidobacteria can improve gastrointestinal transit. In elderly individuals, mild constipation can be at least partially corrected through the consumption of milk fermented by bifidobacteria (Seki M et al. Nutr Food 1978;4:379-387). In addition, colonic transit times of women were significantly accelerated in the sigmoid colon following consumption of a milk fermented by bifidobacteria sp. and yoghurt cultures (Grimaud JC et al. Gastroenterol Clin Biol 1993;17:A127), but not by traditional yoghurt cultures alone (Grimaud JC et al. Les bact_ries lactiques, 1994;406).

Several genetically engineered 'knock out' and transgenic animal models of IBD have been reported in which the role of the enteric flora has been directly demonstrated by comparing animals raised in germ free versus conventional facilities. For example, the gastrointestinal Crohn's-like inflammation that occurs in interleukin-10 (IL-10) deficient mice is attenuated when the animals are kept in a germ free environment and becomes more pronounced and widespread when they are switched to conventional facilities. (Kuhn R et al. Cell 1993;75:263-274).