title: High dose probiotic and prebiotic cotherapy for remission induction of active Crohn's disease.
abstract: BACKGROUND
  Clinical trials of probiotic treatment for Crohn's disease (CD) have yielded conflicting results. This study assessed the clinical usefulness of combined probiotic and prebiotic therapy in the treatment of active CD.
  
  
  METHODS
  Ten active CD outpatients without history of operation for CD were enrolled. Their mean (+/-SD) age was 27 +/- 7 years and the main symptoms presented were diarrhea and abdominal pain. Patients' initial therapeutic regimen of aminosalicylates and prednisolone failed to achieve remission. Patients were thus initiated on a synbiotic therapy, consisting of both probiotics (75 billion colony forming units [CFU] daily) and prebiotics (psyllium 9.9 g daily). Probiotics mainly comprised Bifidobacterium and Lactobacillus. Patients were free to adjust their intake of probiotics or prebiotics throughout the trial. Crohn's disease activity index (CDAI), International Organization for the Study of Inflammatory Bowel Disease (IOIBD) score and blood sample variables were evaluated and compared before and after the trial.
  
  
  RESULTS
  The duration of the trial was 13.0 +/- 4.5 months. By the end of therapy, each patient had taken a 45 +/- 24 billion CFU daily probiotic dose, with six patients taking an additional 7.9 +/- 3.6 g daily psyllium dose. Seven patients had improved clinical symptoms following combined probiotic and prebiotic therapy. Both CDAI and IOIBD scores were significantly reduced after therapy (255-136, P = 0.009; 3.5-2.1, P = 0.03, respectively). Six patients had a complete response, one had a partial response, and three were non-responders. Two patients were able to discontinue their prednisolone therapy, while four patients decreased their intake. There were no adverse events.
  
  
  CONCLUSIONS
  High-dose probiotic and prebiotic cotherapy can be safely and effectively used for the treatment of active CD.
authors: Third Department of Internal Medicine, Nippon Medical School, Tokyo, Japan. s-fugimori@nms.ac.jp
authors: Shunji
authors: S
authors: Fujimori
authors: Atsushi
authors: A
authors: Tatsuguchi
authors: Katya
authors: K
authors: Gudis
authors: Teruyuki
authors: T
authors: Kishida
authors: Keigo
authors: K
authors: Mitsui
authors: Akihito
authors: A
authors: Ehara
authors: Tsuyoshi
authors: T
authors: Kobayashi
authors: Yoshihisa
authors: Y
authors: Sekita
authors: Tsuguhiko
authors: T
authors: Seo
authors: Choitsu
authors: C
authors: Sakamoto
mesh_terms: D000328:Adult; D001644:Bifidobacterium; D002400:Cathartics / Q000008:administration & dosage*; D003424:Crohn Disease / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D007778:Lactobacillus; D008297:Male; D019936:Probiotics / Q000008:administration & dosage*; D011620:Psyllium / Q000008:administration & dosage*; D012074:Remission Induction
chemical_list: D002400:Cathartics; D011620:Psyllium