Table of Contents
Introduction
Mayo clinic (2017) describes inflammatory Bowel Disease (IBD) as a collective term that describes disorders that entail chronic inflammation of the digestive tract (“Inflammatory bowel disease (IBD) – Symptoms and causes – Mayo Clinic,” 2017; Carter, Lobo, & Travis, 2004; McFarland, 2008). It also describes two types of IBD, which include Ulcerative colitis (UC) and Crohn’s disease (CD). Ulcerative colitis causes long-lasting sores or ulcers in the inner lining of the large intestines, while Crohn’s disease causes inflammation of the entire lining of the digestive tract that spread deep into the tissues affected.
Treatment of IBD aims at reducing the triggers of symptoms and signs of the IBD. Treatment may involve surgery, anti-inflammatory drug therapy, nutritional approach, and alternative medicine (“Inflammatory bowel disease (IBD) – Diagnosis and treatment – Mayo Clinic,” 2017). The primary concern of this study is the alternative medication particularly the use of Probiotic approach and prebiotic therapies. Mayo Clinic notes that although the probiotic and prebiotic have been used to treat IBD, its efficiency and safety is not well documented. Therefore, this study critically analyzes the studies investigating prebiotics and probiotics in people with inflammatory bowel disease with the aim of giving precise impacts or effects of using prebiotics to patients with IBD. This paper is significant because it will address the concerns of many, including Mayo clinic who note that the results and impacts of probiotics and prebiotics are not precise, neither is it properly documented. Also, anybody willing to use prebiotics and probiotics to treat IBD will understand what will be the benefits, and what the limitations if any would be to the user encounter in the process.
Definitions
Probiotics
Ghouri (2014) describes probiotics as microorganisms ingested individually or in combination with other organisms with the aim of making the intestinal microbiota normalize and also hope that the host organisms will improve the intestinal barrier function. Precisely, The International Scientific Association for Probiotics and Prebiotics (ISAPP) define probiotics as “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host (Hill et al., 2014, p. 507). The general benefits of probiotics include improved digestion, reduced cold and flu, stronger immune system, destruction of candida, improved health and healing from leaky gut syndrome (“Probiotics Benefits, Foods, and Supplements – Dr. Axe”, 2017).
Prebiotics
On the other hand, Macfarlane, Macfarlane, and Cummings (2006) define prebiotic as a non-digestible food substance that when ingested, it benefits the host by stimulating the growth of beneficial bacteria in the colon thus promoting the health of the host. Nonetheless, on August 2017, ISAPP reviewed the definition of prebiotics to mean, “A substrate that is selectively utilized by host microorganisms conferring a health benefit “(Gibson, 2017, p. 493). As of 2017, only two food carbohydrates qualify to be referred to as prebiotics, and they are galacto-oligosaccharides and inulin-type prebiotics (Guarino et al., 2017).
The inulin-type prebiotics contains beta2-1) fructosyl-fructose glycosidic bonds, which are responsible for the element’s physiological properties and their unique structure. In humans, they are resistant to the digestion in small intestines, meaning that they reach the colon while still intact. In the colon, bacteria ferment them thus becoming good agents for making the probiotics to grow (Guarino et al., 2017). They are readily available in food such as garlic, wheat, chicory root, and in cereals but have relatively low quantities.
The benefits of prebiotics according to Macfarlane, Macfarlane, & Cummings (2006) are that the prebiotics such as inulin and its derivatives are relatively cheap yet very beneficial health-wise because they promote healthy activities of gut microbiota. Also, prebiotics can improve organoleptic properties of dairy products and fat-based spreads thus increasing their utilization in the body (Leroy & De Vuyst, 2004). Finally, the researchers explain that prebiotics can be used as an alternative to probiotics which are difficult to use in some food and they have the potential to prevent diarrhea.
Prebiotics and Probiotic in IBD Patients
Having defined prebiotics, Macfarlane, Macfarlane, and Cummings (2006) decided to investigate the published evidence about the effects of prebiotics to the function of the gut and its role in the health conditions of humans. The researcher was addressing the question of whether prebiotics had similar effects in health improvement as that of probiotics. Also, to find evidence that prebiotics, just like probiotics are cheaper, have less side effects and risks, and that they are easier to incorporate in a human’s diet than probiotics.
Therefore, Macfarlane, Macfarlane, and Cummings (2006) conducted a literature review to identify clinical studies for the study. They found out that there are three types of prebiotics namely galacto-oligalsacharrides, oligofructose, and lactulose, and that the three increased the quantities of lactobacillus and bifidobacteria. In return, the bacteria, particularly bifidobacteria had an altering effect to the balance of the large bowel microbiota (Klaenhammer, 2007; Roy, 2005). They explain that these carbohydrates ferment in the tract thus producing intestinal gas and short-chain fatty acids even though the effect on the bowel behavior is relatively small. However, in a clinical context, the researchers say that randomized –controlled trial of prebiotics are few in humans. However, tests of the same to animals indicated that prebiotics had an anti-inflammatory effect on bowels that had an inflammatory illness. They also suggest that prebiotics enhanced better calcium absorption. Macfarlane, Macfarlane, and Cummings (2006), therefore, concluded that it was still early days for prebiotics, and its research is not exhaustive. The claim that the literature is not thorough concurs with Guandalini (2014) who says that probiotics and prebiotics is a promising field in research in the future because by then, there was little evidence of their effects to patients with IBD. Nonetheless, Macfarlane, Macfarlane, and Cummings (2006) conclude that the research available can be used to make definite conclusions that prebiotics can bring direct and better health outcomes safely and cheaply.
Ghouri (2014) carried out research to determine whether probiotics, prebiotics, and synbiotic are effective methods of managing IBD. They chose to use a systematic review of randomized trials of previous researchers on prebiotics, probiotics, and symbiotics use. They, therefore, identified 14 studies whose trials involve patients with CD and 21 with patients with UC, and five trials that were conducted to patients of pouchitis. After comparing probiotics to placebo, the researchers found no significant difference in the outcomes of clinical procedures. Also, they found out that adding probiotic to traditional drugs of treating UC improved the induction of remission rates. Also, in the treatment of pouchitis, probiotics exhibited some efficacy, particularly after antibiotic-induced remission. Therefore, there is evidence that probiotics can be used for induction and maintenance of remissions for patients with pouchitis and UC (Ghouri, 2014; Whelan and Quigley, 2013; Sood et al., 2009). Nonetheless, Ghouri (2014) note that there are insufficient data and information that would expressly make them recommend the use of probiotics particularly in the CD. Although Ghouri (2014) findings are positive on UC only, Plaza-Díaz (2017) finds supplementation of probiotics has the potential of being tolerated, efficient, and safe for both CD and UC patients.
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Evidence of Benefits from Randomized Controlled Trials
Segarra et al. (2016) decided to carry out a randomized and controlled clinical trial of the use of Prebiotic supplements to the treatment of IBD. Since the researchers wanted to use prebiotic as a supplement, they combined it with Oral chondroitin sulfate combined with a hydrolyzed diet which was administered it to dogs. They were addressing the problem that recent therapeutic actions of IBD are characterized by severe side effects, and so they needed to find out a treatment procedure without side effects. They, therefore, developed the therapy as described above and administered to 27 dogs for 180 days with some dogs getting the supplement and other grouped as placebo.
After the dogs completed the treatment, it was apparent that the group that took the supplement exhibited a significant decrease in histologic score. Also, the team that had supplement had higher serum cholesterol levels than the group in placebo. There were no any side effects during and after the 180 days trial on dogs (Segarra et al., 2016). Thus, the researchers concluded that administering a combination of prebiotic supplement with hydrolyzed diet had no side effects, and it reduced the impact of IBD activity.
Scientific Evidence of Probiotic and IBD
Martinez, Bedani, and Saad (2015) also sought scientific evidence of the benefits of dietary prebiotics and probiotics. The researchers were addressing the issues that although consumers of prebiotic and probiotic products regard the product highly and in fact pay highly for the commodities, health organizations had laid numerous claims about restricting the consumption of probiotics and prebiotics in large quantities. They, therefore, set out to find out the core health benefits of the two dietary elements by reviewing the literature.
Among the health areas that the researcher discussed are the effects of prebiotics and probiotics on the IBD. They report that the studies were conflicting in the sense that some; indicated improvement of health outcome to IBD patients, while some reviews stated that there was no effect. Also, Martinez, Bedani, and Saad (2015) noted that although prebiotics and probiotic did not have a general improvement in health outcome, a specific symptom of IBD improved while other symptoms did not change. Nonetheless, the researcher agrees with Ghouri (2014) and Trop (2014) about the lack of sufficient studies to make conclusive findings based the literature. In fact, Martinez, Bedani, and Saad (2015) say that studies, particularly on CD and UC, are scarce and not so encouraging.
Wang, Geier, and Howarth (2016) noted that chemotherapy treatment is a cancer treatment that has the potential of damaging the gut. After the damage, it causes lesions, whose effects and symptoms resemble the IBD symptoms and complications. The researchers explain that the sores from the chemotherapy negatively disrupt the actions of intestinal microbiota thus increasing chances of harmful effects of pathogenic micro bacteria such as Clostridia while reducing the effects of useful bacteria such as bifidobacteria and lactobacilli. Having studied that prebiotics may have a good impact on the gut, the researchers sought whether prebiotics would as well heal bowel inflammation resulting from chemotherapy effects.
Just like other researchers discussed above, Wang, Geier, and Howarth (2016) decided to make their findings through analysis of the literature. They make three conclusions of the literature analysis. First, they found out that prebiotics has the potential as an anti-inflammatory to inflammation regardless of the cause of the inflammation. Second, prebiotics act as modulators, which mean that they modulate or regulate the availability of useful bacteria at the expense of pathogenic bacteria (Wang, Geier and Howarth, 2016). Finally, prebiotics demonstrated efficacy as growth promoter thus being agents of good health. These findings relate with findings by Iannitti & Palmieri (2010), who find that prebiotics therapy has the potential to reduce the effects of post-operative complications. Therefore, prebiotics is promising candidates for the likely agents of treating chemotherapy-induced mucositis, inflammation, or any other post treatment complications related to therapeutic operations..
Further, options for treating IBD is notoriously inadequate or characterized by severe and severe side effects (McFarland, 2008; Guandalini, 2014). Therefore, Guandalini (2014) was concerned about whether there is an alternative treatment method for the condition that would reduce the side effects. The researcher considered the use of probiotics as a method of treating IBD but emphasize to children. Most of the previous studies either dealt with animal or adults, but this research put the focus on children thus making it unique. The researcher, therefore, decided to give a concise update on the data that was present relating to the treatment of IBD in young children.
Guandalini (2014) found out that a particular trial on the use of probiotics to treat UC in children, only 1 of 12 children under a controlled trial exhibited efficacy in inducing and maintaining remission. Also, IBD patients who benefit much from the use of probiotics are the patients with predominant diarrhea. Furthermore, low doses of probiotics had improved outcomes, but high doses were counterproductive. Nonetheless, Guandalini (2014) says that several controlled trial had promising results particularly in reducing abdominal pain. About prebiotics and IBD, few trials exist, and the ones that exist give mixed results (Guandalini, 2014). Also, the probiotics in humans with IBD were scarce, and again the available ones had mixed results. In the literature, no any research had successfully conducted the effects of probiotic in Chron’s disease. Thus, the field has a long way to go and a promising ground for future researchers.
The Role of Probiotics in Preventing IBD
Saez-Lara et al. (2015) set out research to determine whether probiotics can be used to avoid IBD. Also, they were also addressing its role in treating IBD. They, however, put a focus on specific probiotic, which are lactic acid bacteria and bifidobacteria. They were concerned on results of human only with no regards to trials of an animal model.
The researchers conducted a review of PubMed databases, to pull out studies that had human trial and results of the same to make their findings. They found out that in humans, the use of the probiotics had positive effects in treating and maintaining UC patients, while in CD, no clear evidence or trial showed effective treatment of improved health outcome. Also, using probiotics was seen to improve symptoms of IBD. Nonetheless, about the use of probiotics to prevent IBD, there were much more studies needed to understand whether it was possible for probiotics to prevent the illness.
Improving the Gut Health
A healthy gut is prone to many infections including the inflammation. Thus, Tuohy (2003) discuss the action of prebiotics in maintaining a healthy gut. The researcher first notes the critical role of Butyrate in maintaining remission in patients with IBD through enhancing mucosal cell proliferation. Therefore, using dietary fibers and prebiotics has been investigated to find out whether they promote the production of butyrate (Tuohy, 2003). The results are that the fibers and prebiotics enhance the development of functional food that targets IBD explicitly. The researchers conclude by noting that probiotic inulin increases colonic butyrate which in return reduces inflammation severity in animal models. In humans, Wasilewski et al. (2015) explain that probiotics modify gut-associated lymphoid cells as a mechanism for maintaining a healthy gut and prevention or treatment of IBD. Besides, according to Spiller (2008), probiotics promotes gut barrier function, block pathogen binding, decrease visceral hypersensitivity culminating from inflammation, and regulate the gut inflammatory response. All these are elements that improve gut health thus minimizing risks of inflammatory Bowel disease.
Mechanisms of Probiotic Action and Implications in IBD
Vanderpool, Yan, and Polk (2008) Note that abnormal interaction between gut microorganisms and the host is the cause of the adverse effects such as IBD. It has been noted that patients with IBD have increased the level of harmful bacteria and decreased the level of beneficial bacteria. Therefore manipulating the intestinal bacteria is among the critical methods of treating the adverse effects. Probiotics manipulate using two utilization actions which are through probiotic-derived antibacterial substances and Competitive Inhibition of Pathogen and Toxin Adherence to the Intestinal Epithelium (Vanderpool, Yan, and Polk, 2008, p. 1587). Below is a discussion of the two actions.
Probiotic-derived Antibacterial Substances
According to Vanderpool, Yan, and Polk (2008) probiotics have a direct antibacterial effect on the disease-causing organism by producing antibacterial substances that include acids and bacteriocins. The probiotic-derived antibacterial microorganisms can work individually or synergistically to block pathogens from growing and are known as antimicrobial peptides such as Lactococcus lactis. The peptides work by targeting lipid II component, a substance found in the wall of a cell membrane. The mechanisms within which they destroy the pathogen is by forming pores in the cytoplasm membrane of the pathogens, particularly the sensitive ones (Vanderpool, Yan, and Polk, 2008). Also, they interfere with critical enzymatic activities of the cell thus destroying it. Moreover, it produces bacterial like substances that are poisonous and toxic to harmful bacteria including Gram-positive and Gram Negative bacteria. Once they target that particular component of a pathogen, the pathogen is rendered inactive and cannot cause disease.
Competitive Inhibition of Pathogen and Toxin Adherence to the Intestinal Epithelium
Under this action, Vanderpool, Yan, and Polk (2008) explain that probiotics decrease the adhesion potential of both the pathogens and their toxins. This means that even though the pathogens are present in the gut, probiotics make it hard for them to attach to the intestinal epithelium. The lactobacilli bacteria can easily compete and win the battle of connecting themselves to the wall, regardless of whether the pathogens had attached themselves earlier before the probiotic treatment. Vanderpool, Yan, and Polk (2008) conclude by noting that probiotics action is in two ways, which are the production of antibacterial products. The second action is by blocking carbohydrates cites that pathogens use for binding on the intestinal walls, thus making the intestinal microbial environment inappropriate for the pathogen to survive or to do their harmful works.
Disadvantages of Using Probiotics in IBD
There are limitations associated with the use of probiotics. To begin with, although they are expensive, the health benefits are still minimal (Jaret, 2017). IBD patients cannot use probiotics and prebiotics exclusively and expect better health outcomes. Patients can only use them as supplements, making them even more expensive yet the potential health benefit is small.
Also, they have side effects which if not controlled may be severe. Some of the side effects include bloating and diarrhea (Harbolic, 2017). They may also cause infection in the gut particularly to people with other health conditions such as IBD. Guandalini (2014) Says that low doses of probiotics had improved outcomes but high doses were counterproductive.
Conclusion
After analyzing the literature, it is apparent that most research conquers on several things. First, there is no doubt that prebiotics and probiotics have a positive relationship with the treatment of IBD in many ways as discussed. Among them is that probiotics decrease the adhesion potential of both the pathogens and their toxins. Second, probiotics have an altering effect on the balance of the large bowel microbiota. Third, probiotic inulin increases colonic butyrate which in return reduces inflammation severity in animal models. Fifth, probiotics reduce specific symptoms of IBD such as diarrhea. Fifth, probiotics can be used for induction and maintenance of remissions for patients with pouchitis and UC diseases. Sixth, Probiotics and prebiotics promote gut health through reducing harmful microorganisms. Nonetheless, the limitations are that they can only be used as supplements, meaning that they cannot be used independently to treat IBD. Also, they have side effects which include diarrhea and bloating. However, most of the researchers, who used a metanalysis and literature review, agree that the literature and clinical trials available are not sufficient enough to warrant a clinically significant finding. Also, the few literature that had randomized controlled trials had mixed results and are controversial (Wasilewski et al., 2015). This means that with further research, there will be many more roles and limitations of prebiotics and probiotics in treating IBD. Therefore, there is an importance of carrying out new research that is large enough so that the results will not only be statistically significant but clinically significant as well. The next study should put more emphasis on the human model rather than an animal model, and use a considerable sample size.
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