Effect of Lactobacillus rhamnosus GG on ileal pouch inflammation and microbial flora.
BACKGROUND
Preliminary trials of probiotics in preventing recurrent chronic pouchitis have been encouraging.


OBJECTIVE
To investigate the efficacy of Lactobacillus GG supplementation as primary therapy for ileal pouch inflammation, and its effect on the microbial flora.


METHODS
Twenty patients, with a previous history of pouchitis and endoscopic inflammation, were recruited for a prospective, randomized, double-blind, placebo-controlled trial of Lactobacillus GG supplementation (10 LGG, 10 placebo) in two gelatine capsules [(0.5-1) x 10(10) colony-forming units/capsule] b.d. for 3 months. Quantitative bacterial culture of fresh faecal samples and biopsies taken from the pouch and afferent limb was performed before and after supplementation.


RESULTS
Lactobacillus GG supplementation changed the pouch intestinal flora by increasing the ratio of total faecal lactobacilli to total faecal anaerobes (P = 0.03) and enhancing the frequency of lactobacilli-positive cultures in the pouch and afferent limb mucosal biopsy samples. However, only 40% of patients were colonized with Lactobacillus GG. No differences were observed between the groups with regard to the mean pouchitis disease activity index or the total anaerobes or aerobes of faecal or tissue biopsy samples.


CONCLUSIONS
A single-strain probiotic bacterium supplement of Lactobacillus GG changed the pouch intestinal bacterial flora, but was ineffective as primary therapy for a clinical or endoscopic response. More clinical trials are needed to evaluate the right placement and dosage of probiotics within a treatment regimen for pouchitis.
Kuisma
J
J
Department of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland. juha.kuisma@hus.fi
Mentula
S
S
Jarvinen
H
H
Kahri
A
A
Saxelin
M
M
Farkkila
M
M
D000328:Adult; D001647:Bile Acids and Salts / Q000032:analysis; D002908:Chronic Disease; D004311:Double-Blind Method; D005243:Feces / Q000737:chemistry / Q000382:microbiology; D005260:Female; D006801:Humans; D007778:Lactobacillus / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D019449:Pouchitis / Q000382:microbiology / Q000628:therapy*; D011446:Prospective Studies; D012008:Recurrence
D001647:Bile Acids and Salts