Probiotics are effective in increasing remission rates in adults with ulcerative colitis, but not in maintaining remission. Probiotics should begin at the onset of an exacerbation of ulcerative colitis, and we suggest continuing for one to two weeks after the resolution of symptoms. A meta-analysis of 23 RCTs with 1,763 adults found that probiotics significantly increased remission rates in patients with active ulcerative colitis compared to placebo (ARR %3D 12.3%; NNT %3D. Some probiotic combinations were superior to individual strains in this analysis, but no specific combination was superior to another.
The limitations of the evidence included that available studies used different patient populations, probiotic formulations, treatment durations, and concomitant therapies. The review included 12 trials in which probiotics were used to induce or maintain remission in 689 children and adults with Crohn's disease, as well as 17 trials that examined various probiotic formulations to induce or maintain remission in 1673 children and adults with ulcerative colitis. Commercial products that contain both prebiotic sugars and probiotic organisms are often referred to as synbiotics. A meta-analysis of 63 RCTs with 11,811 children and adults comparing probiotics with placebo or without treatment reported a significant reduction in the risk of antibiotic-associated diarrhea (NNT %3D) 1.A more precise use of the term “probiotic” will be useful to guide physicians and consumers in differentiating the various products on the market.
There is substantial confusion in the regulation of probiotics, in many cases because regulators are trying to apply schemes to probiotic foods and supplements that were initially designed to facilitate pharmaceutical development. Most published meta-analyses have shown that probiotics slightly reduce symptoms of atopic dermatitis in infants and children. However, some case reports did not confirm that the specific strain of probiotics used was the cause of the infection. The panel determined that this definition remains relevant and useful for scientists and regulators to define the broad category of probiotics.
The authors concluded that although probiotics may be modestly beneficial for ulcerative colitis, they should not be used routinely. The panel concluded that the overall benefit of maintaining a healthy digestive tract was reinforced by evidence collected on a large number of different probiotic strains representing commonly studied species. At least 60 reports have been published since 1966 of fungemia associated with the use of probiotics containing the yeast Saccharomyces cervisiae. Probiotics normally exert their effects in the gastrointestinal tract, where they can influence the gut microbiota.