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P622 Efficacy of probiotics in inflammatory bowel disease: systematic review and meta-analysis

Derwa Y.1, Gracie D.J.*1,2, Hamlin P.J.1, Ford A.C.1,2

1St. James's University Hospital, Leeds Gastroenterology Institute, Leeds, United Kingdom 2University of Leeds, LIBACS, Leeds, United Kingdom

Background

Ulcerative colitis (UC) and Crohn's disease (CD) are inflammatory bowel diseases (IBD). Evidence implicates disturbances of the gastrointestinal microbiota in their pathogenesis. We performed a systematic review and meta-analysis to examine the efficacy of probiotics in IBD.

Methods

MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (up to November 2016). Eligible randomised controlled trials (RCTs) recruited adults with UC or CD, and compared probiotics with 5-aminosalicylates (5-ASAs) or placebo. Dichotomous symptom data were pooled to obtain a relative risk (RR) of failure to achieve remission in active IBD, or RR of relapse of disease activity in quiescent IBD, with 95% confidence intervals (CIs).

Results

The search identified 12,251 citations. Twenty-two RCTs were eligible. There was no benefit of probiotics over placebo in inducing remission in active UC (RR of failure to achieve remission = 0.86; 95% CI 0.68–1.08).

Figure 1. Forest plot of randomised controlled trials reporting the efficacy of probiotics versus placebo in inducing remission in active UC, or in preventing relapse in quiescent UC.

However, when only trials of VSL#3 were considered there appeared to be a benefit (RR =0.74; 95% CI 0.63–0.87). Probiotics appeared equivalent to 5-ASAs in preventing UC relapse (RR =1.02 (95% CI 0.85 to 1.23).

Figure 2. Forest plot of randomised controlled trials reporting the efficacy of probiotics versus 5-aminosalicylates in Inducing remission in active UC, or in preventing relapse in quiescent UC.

There was no benefit of probiotics in inducing remission of active CD, in preventing relapse of quiescent CD, or in preventing endoscopic or clinical relapse of CD after surgically induced remission.

Figure 3. Forest plot of randomised controlled trials reporting the efficacy of probiotics versus placebo in inducing remission in active CD, or in preventing relapse in quiescent CD.

Conclusion

VSL#3 appears to be effective in inducing remission in active UC, and probiotics may be as effective as 5-ASAs in preventing relapse of quiescent UC. However, the efficacy of probiotics in CD remains uncertain, and more evidence from RCTs is required before their utility is known.