Probiotic enema may help pediatric UC patients
MedWire News: Children with ulcerative colitis (UC) may benefit from intestinal microbiota manipulation, suggest the results of a study of Lactobacillus reuteri enema.
"Probiotics are live microorganisms that in adequate amounts confer a healthy benefit to the host," explain Laura Stronati (Italian National Agency for New Technologies, Energy and Sustainable Economic Development, Rome) and co-workers.
"They change gut microbial species composition and diversity, increase mucosal barrier function, and elicit a variety of responses from intestinal immune cells due to interactions between surface-bound or secreted ligands and membrane receptors."
The research examined the impact of probiotic therapy on the rectal mucosa of children with mild to moderate UC. Forty patients, aged a median of 7.2 years, were randomly assigned to receive an evening enema of L. reuteri ATCC55730 (1010 CFU) or placebo for 8 weeks, in addition to oral mesalazine therapy.
Overall, 31 patients, aged a median of 13 years, completed the study.
Patients who received the probiotic enema showed a significantly greater improvement than controls in their Mayo score for clinical and endoscopic markers of stool frequency, bleeding, disease activity, and mucosal appearance.
Specifically, the Mayo score fell from 8.6 at baseline to 3.2 after 8 weeks in patients given the probiotic versus 8.7 at baseline and 7.1 at the study end in controls.
The probiotic enema was also associated with a significant decrease in rectal histology score, not seen in controls.
Patients and controls did not significantly differ in cytokine mucosal expression at baseline. However, by the end of the study, patients given the probiotic enema showed a significant increase in levels of interleukin (IL)-10 from baseline, as well as a significant decrease in IL-1 β, IL-8, and tumor necrosis factor α. No such changes were found in the controls.
"Our data document the efficacy of rectal infusion of L. reuteri ATCC 55730 in improving mucosal inflammation in children with distal active UC as well as in changing the mucosal expression levels of some cytokines involved in the mechanisms of [inflammatory bowel disease]," report Stronati et al in the journal Alimentary Pharmacology and Therapeutics.
"It remains to be proved if this strain given on a long-term basis is able to maintain such effectiveness and if its oral administration is more comfortable for patients, is as effective as rectal infusion."
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By Lynda Williams