title: Effect of probiotics on inducing remission and maintaining therapy in ulcerative colitis, Crohn's disease, and pouchitis: meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Whether probiotics are beneficial at all stages of treatment in inflammatory bowel disease or superior to placebo remains controversial.
  
  
  METHODS
  Two reviewers independently selected randomized controlled trials comparing probiotics with controls in inflammatory bowel disease and extracted data related to remission/response rates, relapse rates, and adverse events. Subanalyses were also performed.
  
  
  RESULTS
  Twenty-three randomized controlled trials with a total of 1763 participants met the inclusion criteria. From the meta-analysis, probiotics significantly increase the remission rates in patients with active ulcerative colitis (UC) (P = 0.01, risk ratio [RR] = 1.51). The remission rates were significantly higher in patients with active UC treated with probiotics than placebo (P < 0.0001, RR = 1.80). Unfortunately, subgroup analysis found that only VSL#3 significantly increased the remission rates compared with controls in patients with active UC (P = 0.004, RR = 1.74). Interestingly, VSL#3 (P < 0.00001, RR = 0.18) also significantly reduced the clinical relapse rates for maintaining remission in patients with pouchitis. No significantly different adverse events were detected between probiotics and controls in the treatment of UC (P = 0.94, RR = 0.99) or CD (P = 0.33, RR = 0.87).
  
  
  CONCLUSIONS
  Administration of probiotics results in additional benefit in inducing remission of patients with UC. VSL#3 are beneficial for maintaining remission in patients with pouchitis. And, probiotics can provide the similar effect as 5-aminosalicylic acid on maintaining remission of UC, although no additional adverse events presented.
authors.affiliation: *Department of Gastroenterology, Renji Hospital, Shanghai Jiao-Tong University, School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China; †Department of Medicine, University of Chicago, Chicago, Illinois; and ‡Committee on Immunology, Department of Pathology, University of Chicago, Chicago, Illinois.
authors.forename: Jun
authors.initials: J
authors.lastname: Shen
authors.forename: Zhi-Xiang
authors.initials: ZX
authors.lastname: Zuo
authors.forename: Ai-Ping
authors.initials: AP
authors.lastname: Mao
mesh_terms: D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D006801:Humans; D060046:Maintenance Chemotherapy; D019449:Pouchitis / Q000188:drug therapy*; D019936:Probiotics / Q000627:therapeutic use*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction