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Probiotics, Prebiotics, and Antibiotics in Medical Management of Inflammatory Bowel Disease

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Crohn's Disease and Ulcerative Colitis

Abstract

The rationale for using probiotics, prebiotics, and antibiotics is based on convincing evidence that implicates intestinal bacteria in the pathogenesis of these diseases.

Probiotics are “living organisms,” which upon ingestion in certain numbers exert health benefits beyond inherent basic nutrition. Several mechanisms have been proposed to account for the action of probiotics. These include antagonistic activity against pathogenic bacteria, either by inhibition of adherence and translocation, or by production of antibacterial substances such as antimicrobial peptides and hydrogen peroxide. Probiotics also stimulate mucosal defense, both at the level of immune and epithelial function. Encouraging results have been obtained with probiotic therapy in experimental colitis. VSL#3, a highly concentrated cocktail of probiotics has been shown to be effective in the prevention of pouchitis onset and relapses. Results on the use of probiotics in UC are promising, both in terms of the prevention of relapses and the treatment of mild-to-moderate attacks. Results in Crohn’s disease (CD) are not yet clear because of conflicting data and the limited number of well-performed studies.

Prebiotics are dietary substances, usually nondigestible carbohydrates, which beneficially affect the host by selectively stimulating the growth and activity of protective commensal enteric bacteria. Evidence supporting the use of these nutriceuticals in IBD is still limited.

The use of antibiotics in UC is not supported by the available studies. Antibiotics have an essential role in treating the septic complications of CD, including intrabdominal and perianal abscesses and perianal fistulae.

The use of antibiotics in pouchitis is largely justified although proper controlled trials have not been conducted.

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References

  1. Guarner F, Casellas F, Borruel N, et al. Role of microecology in chronic inflammatory bowel diseases. Eur J Clin Nutr. 2002;56:S34–8.

    PubMed  Google Scholar 

  2. Neut C, Bulois P, Desreumaux P, et al. Changes in the bacterial flora of the neoterminal ileum after ileocolonic resection for Crohn’s disease. Am J Gastroenterol. 2002;97:939–46.

    PubMed  Google Scholar 

  3. Manichanh C, Rigottier-Gois L, Bonnaud E, et al. Reduced diversity of faecal microbiota in Crohn’s disease revealed by a metagenomic approach. Gut. 2006;55:205–11.

    PubMed  CAS  Google Scholar 

  4. Sokol H, Seksik P, Furet JP, et al. Low counts of fecalibacterium pausnitzii in colitis microbiota. Inflamm Bowel Dis. 2009;15:1183–9.

    PubMed  CAS  Google Scholar 

  5. Sokol H, Pigneur B, Watterlot L, et al. Fecalibacterium prausnitzii is an anti-inflammatory commensal bacterium identified by gut microbiota analysis of Crohn’ disease patients. Proc Natl Acad Sci USA. 2008;105:16731–6.

    PubMed  CAS  Google Scholar 

  6. Duchmann R, Kaiser I, Hermann E, et al. Tolerance exist towards resident intestinal flora but is broken in active inflammatory bowel disease (IBD). Clin Exp Immunol. 1995;102:445–7.

    Google Scholar 

  7. Janowitz HD, Croen EC, Sachar DB. The role of the faecal stream in Crohn’s disease: An historical and analytic perspective. Inflamm Bowel Dis. 1998;4:29–39.

    PubMed  CAS  Google Scholar 

  8. D’Haens GR, Geboes K, Peeters M, et al. Early lesions of recurrent Crohn’s disease caused by infusion of intestinal contents in excluded ileum. Gastroenterology. 1998;114:771–4.

    Google Scholar 

  9. Abdelrazeq AS, Kadiyil N, Botterill ID, et al. Predictors for acute and chronic pouchitis following restorative proctocolectomy for ulcerative colitis. Colorectal Dis. 2007;10:805–13.

    PubMed  Google Scholar 

  10. Sartor RB. Insights into the pathogenesis of inflammatory bowel disease provided by new rodent models of spontaneous colitis. Inflamm Bowel Dis. 1995;1:64–75.

    Google Scholar 

  11. Campieri M, Gionchetti P. Probiotics in inflammatory bowel disease: new insight to pathogenesis or a possible therapeutic alternative? Gastroenterology. 1999;116:1246–9.

    PubMed  CAS  Google Scholar 

  12. Metchnikoff E. The Prolongation of Life: Optimistic Studies. London: William Heinemann; 1907. p. 161–83.

    Google Scholar 

  13. Schaafsma G. State of the art concerning probiotic strains in milk products. IDF Nutr Newsl. 1996;5:23–4.

    Google Scholar 

  14. Lee YK, Salminen S. The coming age of probiotics. Trends Food Sci Tech. 1995;6:241–5.

    Google Scholar 

  15. Ng SC, Hart AL, Kamm MA, et al. Mechanism of action of probiotics: recent advances. Inflamm Bowel Dis. 2009;15:300–10.

    PubMed  CAS  Google Scholar 

  16. Fabia R, Ar’rajab A, Johansson ML, et al. The effect of exogenous administration of Lactobacillus reuterii R2LC and oat fiber on acetic acid-induced colitis in the rat. Scand J Gastroenterol. 1993;28:155–62.

    PubMed  CAS  Google Scholar 

  17. Mao Y, Nobaek S, Kasravi B, et al. The effects of Lactobacillus strains and oat fibre on methotrexate-induced enterocolitis in rats. Gastroenterology. 1996;111:334–44.

    PubMed  CAS  Google Scholar 

  18. Madsen KL, Tavernini MM, Doyle JSG, et al. Lactobacillus sp prevents development of enterocolitis in interleukin-10 gene-deficient mice. Gastroenterology. 1999;116:1107–14.

    PubMed  CAS  Google Scholar 

  19. Schultz M, Veltkamp C, Dieleman LA, et al. Lactobacillus plantarum 299V in the treatment and prevention of spontaneous colitis in interleukin-10 deficient mice. Inflamm Bowel Dis. 2002;8:71–80.

    PubMed  Google Scholar 

  20. O’Mahony L, Feeney M, O’Halloran S, et al. Probiotic impact on microbial flora, inflammation and tumour development in IL-10 knockout mice. Aliment Pharmacol Ther. 2001;15:1219–25.

    PubMed  Google Scholar 

  21. McCarthy J, O’Mahony L, O’Callaghan L, et al. Double-blind, placebo-controlled trial of two probiotic strains in interleukin 10 knockout mice and mechanistic link with cytokine balance. Gut. 2003;52:975–80.

    PubMed  CAS  Google Scholar 

  22. Shibolet O, Karmeli F, Eliakim R, et al. Variable response to probiotics in two models of experimental colitis in rats. Inflamm Bowel Dis. 2002;8:399–408.

    PubMed  Google Scholar 

  23. Madsen K, Cornish A, Soper P, et al. Probiotic bacteria enhance murine and human intestinal epithelial barrier function. Gastroenterology. 2001;121:580–91.

    PubMed  CAS  Google Scholar 

  24. Pagnini C, Saeed R, Bamias G, et al. Probiotics promotes gut health through stimulation of epithelial innate immunity. Proc Natl Acad Sci USA. 2010;107:454–9.

    PubMed  CAS  Google Scholar 

  25. Kruis W, Schuts E, Fric P, et al. Double-blind comparison of an oral Escherichia coli preparation and mesalazine in maintaining remission of ulcerative colitis. Aliment Pharmacol Ther. 1997;11:853–8.

    PubMed  CAS  Google Scholar 

  26. Rembacken BJ, Snelling AM, Hawkey P, et al. Non pathogenic Escherichia coli vs mesalazine for the treatment of ulcerative colitis: a randomised trial. Lancet. 1999;354:635–9.

    PubMed  CAS  Google Scholar 

  27. Kruis W, Fric P, Pokrotnieks J, et al. Maintaining remission of ulcerative colitis with Escherichia Coli Nissle 1917 is as effective as with standard mesalazine. Gut. 2004;53:1673–23.

    Google Scholar 

  28. Matthes H, Krummenerl T, Giensch M, et al. Clinical trial: probiotic treatment of acute distal ulcerative colitis with rectally administered Escherichia coli Nislle 1917 (EcN). BMC Compl Alternative Med. 2010;10:13–20.

    Google Scholar 

  29. Ishikawa H, Akedo I, Umesaki Y, et al. Randomized, controlled trial of the effect of bifidobacteria-fermented milk on ulcerative colitis. J Am Coll Nutr. 2003;22:56–63.

    PubMed  Google Scholar 

  30. Guslandi M, Giollo P, Testoni PA. A pilot trial of Saccharomyces boulardii in ulcerative colitis. Eur J Gastroenterol Hepatol. 2003;15:697–8.

    PubMed  Google Scholar 

  31. Venturi A, Gionchetti P, Rizzello F, et al. Impact on the faecal flora composition of a new probiotic preparation. Preliminary data on maintenance treatment of patients with ulcerative colitis (UC) intolerant or allergic to 5-aminosalicylic acid (5 ASA). Aliment Pharmacol Ther. 1999;13:1103–8.

    PubMed  CAS  Google Scholar 

  32. Bibiloni R, Fedorak RN, Tannock GW, et al. VSL#3 probiotic mixture induces remission in patients with active ulcerative colitis. Am J Gastroenterol. 2005;100:1539–46.

    PubMed  Google Scholar 

  33. Sood A, Midha V, Makharia GK, et al. The probiotic preparation, VSL#3 induces remission in patients with mild-to-moderately active ulcerative colitis. Clin Gastroenterol Hepatol. 2009;7:1202–9.

    PubMed  Google Scholar 

  34. Tursi A, Brandimarte G, Papa A, et al. Treatment of relapsing mild-to-moderate ulcerative colitis with the probiotic VSL#3 as adjunctive to a standard pharmaceutical treatment: a double-blind, randomized, placebo-controlled study. Am J Gastroenterol. 2010;105(10):2218–27. doi:10.1038/ajg.2010.218.

    PubMed  Google Scholar 

  35. Miele E, Pascarella F, Riannetti E, et al. Effect of a probiotic preparation (VSL#3) on induction and maintenance of remission in children with ulcerative colitis. Am J Gastroenterol. 2009;104:437–43.

    PubMed  CAS  Google Scholar 

  36. Huynh HQ, deBruin J, Guan L, et al. Probiotic preparation VSL#3 induces remission in children with mild to moderate acute ulcerative colitis: a pilot study. Inflamm Bowel Dis. 2009;15:760–8.

    PubMed  Google Scholar 

  37. Pardi DS, D’Haens G, Shen B, et al. Clinical guidelines for the management of pouchitis. Inflamm Bowel Dis. 2009;15:1424–31.

    PubMed  Google Scholar 

  38. Ruseler-van-Embden JGH, Schouten WR, van Lieshout LMC. Pouchitis: result of microbial imbalance? Gut. 1994;114(35):658–64.

    Google Scholar 

  39. Gionchetti P, Rizzello F, Venturi A, et al. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. Gastroenterology. 2000;119:305–9.

    PubMed  CAS  Google Scholar 

  40. Mimura T, Rizzello F, Helwig U, et al. Once daily high dose probiotic therapy for maintaining remission in recurrent or refractory pouchitis. Gut. 2004;53:108–14.

    PubMed  CAS  Google Scholar 

  41. Ulisse S, Gionchetti P, D’Alò S, et al. Increased expression of cytokines, inducible nitric oxide synthase and matrix metalloproteinases in pouchitis: effects of probiotic treatment (VSL#3). Gastroenterology. 2001;96:2691–9.

    CAS  Google Scholar 

  42. Kuisma J, Mentula S, Kahri A, et al. Effect of Lactobacillus rhamnosus GG on ileal pouch inflammation and microbial flora. Aliment Pharmacol Ther. 2003;17:509–15.

    PubMed  CAS  Google Scholar 

  43. Shen B, Brzezinski A, Fazio VW, et al. Maintenance therapy with a probiotic in antibiotic-dependent pouchitis: experience in clinical practice. Aliment Pharmacol Ther. 2005;22:721–8.

    PubMed  CAS  Google Scholar 

  44. Gionchetti P, Rizzello F, Helvig U, et al. Prophylaxis of pouchitis onset with probiotic therapy: a double-blind placebo controlled trial. Gastroenterology. 2003;124:1202–9.

    PubMed  Google Scholar 

  45. Gionchetti P, Rizzello F, Morselli C, et al. High-dose probiotics for the treatment of active pouchitis. Dis Colon Rectum. 2007;50:2075–82.

    PubMed  Google Scholar 

  46. Biancone L, Michetti P, Travis S, et al. European evidence-based Consensus in the management of ulcerative colitis: special situations. J Crohns Colitis. 2008;2:63–92.

    PubMed  Google Scholar 

  47. Malchow HA. Crohn’s disease and Escherichia coli. A new approach in therapy to maintain remission of colonic Crohn’s disease? J Clin Gastroenterol. 1997;25:653–8.

    PubMed  CAS  Google Scholar 

  48. Guslandi M, Mezzi G, Sorghi M, et al. Saccharomyces boulardii in maintenance treatment of Crohn’s disease. Dig Dis Sci. 2000;45:1462–4.

    PubMed  CAS  Google Scholar 

  49. Prantera C, Scribano ML, Falasco G, et al. Ineffectiveness of probiotics in preventing recurrence after curative resection for Crohn’s disease: a randomised controlled trial with Lactobacillus GG. Gut. 2002;51:405–9.

    PubMed  CAS  Google Scholar 

  50. Bousvaros A, Guandalini S, Baldassano RN, et al. A randomized, double-blind trial of Lactobacillus GG versus placebo in addition to standard maintenance therapy for children with Crohn’s disease. Inflamm Bowel Dis. 2005;11:833–9.

    PubMed  Google Scholar 

  51. Marteau P, Lemann M, Seksik P, et al. Ineffectiveness of Lactobacillus johnsonii LA1 for prophylaxis of post-operative recurrence in Crohn’s disease: a randomized, double-blind, placebo-controlled GETAID trial. Gut. 2006;55:842–7.

    PubMed  CAS  Google Scholar 

  52. Van Gossum A, Dewit O, Louis E, et al. Multicenter, randomized-controlled clinical trial (Lactobacillus Johnsonii LA1) on early endoscopic recurrenmce of Crohn’s disease after ileo-caecal resection. Inflamm Bowel Dis. 2007;13:135–42.

    PubMed  Google Scholar 

  53. Campieri M, Rizzello F, Venturi A, et al. Combination of antibiotic and probiotic treatment is efficacious in prophylaxis of post-operative recurrence of Crohn’s disease: a randomised controlled study vs mesalazine. Gastroenterology. 2000;118:A781.

    Google Scholar 

  54. Willert RP, Peddi KK, Ombiga J, et al. Randomised, double-blinded, placebo-controlled study of VSL#3 versus placebo in the maintenance of remission in Crohn’s disease. Gastroenterology. 2010;138 Suppl 1:T1235.

    Google Scholar 

  55. Gibson GR, Roberfroid MB. Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. J Nutr. 1995;125:1401–12.

    PubMed  CAS  Google Scholar 

  56. Jacobasch G, Schmiedl D, Kruschewski M, et al. Dietary resistant starch and chronic inflammatory bowel diseases. Int J Colorectal Dis. 1999;14:201–11.

    PubMed  CAS  Google Scholar 

  57. Madsen KL, Doyle JS, Jewell LD, et al. Lactobacillus species prevent colitis in interleukin 10 gene-deficient mice. Gastroenterology. 1999;116:1107–14.

    PubMed  CAS  Google Scholar 

  58. Videla S, Vilaseca J, Antolin M, et al. Dietary inulin improves distal colitis induced by dextran sodium sulphate in the rat. Am J Gastroenterol. 2001;96:1486–93.

    PubMed  CAS  Google Scholar 

  59. Araki Y, Andoh A, Koyama S, et al. Effects of germinated barley foodstuff on microflora and short chain fatty acid production in dextran sulfate sodium-induced colitis in rats. Biosci Biotechnol Biochem. 2000;64:1794–800.

    PubMed  CAS  Google Scholar 

  60. Cherbut C, Michel C, Lecannu G. The prebiotic characteristics of fructo-oligasaccharides are necessary for necessary for reduction of TNBS-induced colitis in rats. J Nutr. 2003;90:75–85.

    Google Scholar 

  61. Moreau NM, Martin LI, Toquet CS, et al. Restoration of the integrity of rat caeco-colonic mucosa by resistant starch, but not by fructo-oligosaccharides, in dextran sulfate sodium-induced experimental colitis. Br J Nutr. 2003;90:75–85.

    PubMed  CAS  Google Scholar 

  62. Hoentjen F, Zhang X, Tannock GW et al. The prebiotic combination inulin and fructo-oligosaccharides prevents colitisin HLA-B27 transgenic rats. Gastroenterology 2011 (In press).

    Google Scholar 

  63. Hallert C, Kaldma M, Petersson BG. Ispaghula husk may relieve gastrointestinal symptoms in ulcerative colitis in remission. Scand J Gastroenterol. 1991;26:747–50.

    PubMed  CAS  Google Scholar 

  64. Fernandez-Banares F, Hinojosa J. Sanchez-Lombrana et al. Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Am J Gastroenterol. 1999;94:427–33.

    PubMed  CAS  Google Scholar 

  65. Mitsuyama K, Toyonaga A, Sata M. Intestinal microflora as a therapeutic target in inflammatory bowel disease. J Gastroenterol. 2002;37 Suppl 14:73–7.

    PubMed  Google Scholar 

  66. Kanauchi O, Mitsuyama K, Homma T, et al. Treatment of ulcerative colitis by feeding with germinated barley foodstuff: First report of a multicenter open control trial. J Gastroenterol. 2002;37:67–72.

    PubMed  CAS  Google Scholar 

  67. Kanauchi O, Mitsuyama K, Homma T, et al. Treatment of ulcerative colitis patients by long-term administration of germinated barley foodstuff: multicenter open trial. Int J Mol Med. 2003;12:701–4.

    PubMed  CAS  Google Scholar 

  68. Lindsay JO, Whelan K, Stagg AJ, et al. Clinical, microbiological, and immunological effects of fructo-oligosaccharide in patients with Crohn’s disease. Gut. 2006;55:348–55.

    PubMed  CAS  Google Scholar 

  69. Casellas F, Borruel N, Torrejon A, et al. Oral oligofructose–enriched inulin supplementation in acute ulcerative colitis is weel tolerated and associated with lowered fecal calprotectin. Aliment Pharmacol Ther. 2007;25:1061–7.

    PubMed  CAS  Google Scholar 

  70. Rath HC, Schultz M, Freitag R, Dieleman LA, Li F, Linde HJ, et al. Different subsets of enteric bacteria induce and perpetuate experimental colitis in rats and mice. Infect Immun. 2001;69:2277–85.

    PubMed  CAS  Google Scholar 

  71. Madsen KL, Doyle JS, Tavernini MM, Jewell LD, Rennie RP, Fedorak RN. Antibiotic therapy attenuates colitis in interleukin 10 gene-deficient mice. Gastroenterology. 2000;118:1094–55.

    PubMed  CAS  Google Scholar 

  72. Hoentjen F, Harmsen HJ, Braat H, Torrice CD, Mann BA, Sartor RB, et al. Antibiotics with a selective aerobic or anaerobic spectrum have different therapeutic activities in various regions of the colon in interleukin-10 gene deficient mice. Gut. 2003;52:1721–7.

    PubMed  CAS  Google Scholar 

  73. Fiorucci S, Distrutti E, Mencarelli A, Barbanti M, Palazzini E, Morelli A. Inhibition of intestinal bacterial translocation with rifaximin modulates lamina propria monocytic cells reactivity and protects against inflammation in a rodent model of colitis. Digestion. 2002;66:246–56.

    PubMed  CAS  Google Scholar 

  74. Bamias G, Marini M, Moskaluk CA, Odashima M, Ross WG, Rivera-Nieves J, et al. Down-regulation of intestinal lymphocyte activation and Th1 cytokine production by antibiotic therapy in a murine model of Crohn’s disease. J Immunol. 2002;169:5308–14.

    PubMed  Google Scholar 

  75. Yamada T, Deitch E, Specian RD, Perry MA, Sartor RB, Grisham MB. Mechanisms of acute and chronic intestinal inflammation induced by indomethacin. Inflammation. 1993;17:641–62.

    PubMed  CAS  Google Scholar 

  76. Onderdonk AB, Hermos JA, Dzink JL, Bartlett JG. Protective effect of metronidazole in experimental ulcerative colitis. Gastroenterology. 1978;74:521–6.

    PubMed  CAS  Google Scholar 

  77. Videla S, Villaseca J, Guarner F, Salas A, Treserra F, Crespo E, et al. Role of intestinal microflora in chronic inflammation and ulceration of the rat colon. Gut. 1994;35:1090–7.

    PubMed  CAS  Google Scholar 

  78. Dieleman LA, Goerres M, Arends A, Sprengers D, Torrice C, Hoentjen J, et al. Lactobacillus GG prevents recurrence of colitis in HLA-B27 transgenic rats after antibiotic treatment. Gut. 2003;52:370–6.

    PubMed  CAS  Google Scholar 

  79. Dickinson RJ, O’Connor HJ, Pinder I, Hamilton I, Johnston D, Axon AT. Double-blind controlled trial of oral vancomycin as adjunctive treatment in acute exacerbations of idiopathic colitis. Gut. 1985;26:1380–4.

    PubMed  CAS  Google Scholar 

  80. Chapman RW, Selby WS, Jewell DP. Controlled trial of intravenous metronidazole as adjunct to corticosteroids in severe ulcerative colitis. Gut. 1986;27:1210–2.

    PubMed  CAS  Google Scholar 

  81. Burke DA, Axon ATR, Clayden SA, Dixon MF, Johnston D, Lacey RW. The efficacy of tobramycin in the treatment of ulcerative colitis. Aliment Pharmacol Ther. 1990;4:123–9.

    PubMed  CAS  Google Scholar 

  82. Mantzaris GJ, Hatzis A, Kontogiannis P, Triadaphyllou G. Intravenous tobramycin and metronidazole as an adjunct to corticosteroids in acute, severe ulcerative colitis. Am J Gastroenterol. 1994;89:43–6.

    PubMed  CAS  Google Scholar 

  83. Mantzaris GJ, Archavlis E, Christoforidis P, Kourtessas D, Amberiadis P, Florakis N, et al. A prospective randomised controlled trial of oral ciprofloxacin in acute ulcerative colitis. Am J Gastroenterol. 1997;92:454–6.

    PubMed  CAS  Google Scholar 

  84. Mantzaris GJ, Petraki K, Archavlis E, Amberiadis P, Kourtessas D, Christoforidis P, et al. A prospective randomised controlled trial of intravenous ciprofloxacin as an adjunct to corticosteroids in acute, severe ulcerative colitis. Scand J Gastroenterol. 2001;36:971–4.

    PubMed  CAS  Google Scholar 

  85. Turunen UM, Farkkila MA, Hakala K, Seppala K, Sivonen A, Ogren M, et al. Long-term treatment of ulcerative colitis with ciprofloxacin: a prospective, double-blind, placebo-controlled study. Gastroenterology. 1998;115:1072–8.

    PubMed  CAS  Google Scholar 

  86. Gionchetti P, Rizzello F, Ferrieri A, Venturi A, Brignola C, Ferretti M, et al. Rifaximin in patients with moderate or severe ulcerative colitis refractory to steroid-treatment: a double-blind, placebo-controlled trial. Dig Dis Sci. 1999;44:1220–1.

    PubMed  CAS  Google Scholar 

  87. Blichfeldt P, Blomhoff JP, Myhre E, Gjone E. Metronidazole in Crohn’s disease. A double-blind cross-over clinical trial. Scand J Gastroenterol. 1978;13:123–7.

    PubMed  CAS  Google Scholar 

  88. Ursing B, Alm T, Barany F, Bergelin I, Ganrot-Norlin K, Hoevels J, et al. A comparative study of metronidazole and sulfasalazine for active Crohn’s disease: the cooperative Crohn’s disease study in Sweden. II results. Gastroenterology. 1982;83:550–62.

    PubMed  CAS  Google Scholar 

  89. Ambrose NS, Allan RN, Keighley MR, Burdon DW, Youngs D, Lennard-Jones JE. Antibiotic therapy for treatment in relapse of intestinal Crohn’s disease. A prospective randomized study. Dis Colon Rectum. 1985;28:81–5.

    PubMed  CAS  Google Scholar 

  90. Sutherland LR, Singleton J, Sessions J, Hanauer S, Krawitt E, Rankin G, et al. Double Blind, placebo controlled trial of metronidazole in Crohn’s disease. Gut. 1991;32:1071–5.

    PubMed  CAS  Google Scholar 

  91. Prantera C, Zannoni F, Scribano ML, Berto E, Andreoli A, Kohn A, et al. An antibiotic regimen for the treatment of active Crohn’s disease: a randomized controlled clinical trial of metronidazole plus ciprofloxacin. Am J Gastroenterol. 1996;91:328–32.

    PubMed  CAS  Google Scholar 

  92. Steinhart AH, Feagan BG, Wong CJ, Vandervoort M, Mikolainins S, Croitoru K, et al. Combined budesonide and antibiotic therapy for active Crohn’s disease: a randomized controlled trial. Gastroenterology. 2002;123:33–40.

    PubMed  CAS  Google Scholar 

  93. Colombel JF, Lemann M, Cassagnou M, Bouhnik Y, Duclols B, Dupas JL, et al. A controlled trial comparing ciprofloxacin with mesalazine for the treatment of active Crohn’s disease. Am J Gastroenterol. 1999;94:674–8.

    PubMed  CAS  Google Scholar 

  94. Arnold GL, Beaves MR, Prydun VO, Mook WJ. Preliminary study of ciprofloxacin in active Crohn’s disease. Inflamm Bowel Dis. 2002;8:10–5.

    PubMed  Google Scholar 

  95. Shafran I, Dondelinger PJ, Johnson LK, et al. Efficacy and tolerability of rifaximin, a nonabsorbed, gut-selective, oral antibiotic in the treatment of active Crohn’s disease: results of an open-label study. Am J Gastroenterol. 2003;98:S250.

    Google Scholar 

  96. Leiper K, Morris AI, Rhodes JM. Open label trial of oral clarithromycin in active Crohn’s disease. Aliment Pharmacol Ther. 2000;14:801–6.

    PubMed  CAS  Google Scholar 

  97. Dignass A, Van Assche G, Lindsay JO, et al. for the European Crohn’s and Colitis Organisation (ECCO). The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: current management. J Crohns Colitis. 2010;4:28–62.

    PubMed  CAS  Google Scholar 

  98. Rutgeerts P, Hiele M, Geboes K, Peeters M, Penninckx F, Aerts R, et al. Controlled trial of metronidazole treatment for prevention of Crohn’s recurrence after ileal resection. Gastroenterology. 1995;108:1617–21.

    PubMed  CAS  Google Scholar 

  99. Rutgeerts P, Van Assche G, D’Haens G, Baert F, Norman M, Aerden I, et al. Ornidazol for prophilaxis of postoperative Crohn’s disease: final results of a double-blind placebo controlled trial. Gastroenterology. 2002;122:A80.

    Google Scholar 

  100. Campieri M, Rizzello F, Venturi A, Poggioli G, Ugolini F, Helwig U, et al. Combination of antibiotic and probiotic treatment is efficacious in prophylaxis of post-operative recurrence of Crohn’s disease: a randomized controlled study vs mesalamine. Gastroenterology. 2000;118:A781.

    Google Scholar 

  101. Borgaonkar MR, MacIntosh DG, Fardy JM. A meta-analysis of antimycobacterial therapy for Crohn’s disease. Am J Gastroenterol. 2000;95:725–9.

    PubMed  CAS  Google Scholar 

  102. Schwartz DA, Pemberton JH, Sandborn WJ. Diagnosis and treatment of perianal fistulas in Crohn’s disease. Ann Intern Med. 2001;135:906–18.

    PubMed  CAS  Google Scholar 

  103. Bernstein LH, Frank MS, Brandt LJ, Boley SJ. Healing of perianal Crohn’s disease with metronidazole. Gastroenterology. 1980;79:357–65.

    PubMed  CAS  Google Scholar 

  104. Brandt LJ, Bernstein LH, Boley SJ. Metronidazole therapy for perianal Crohn’s disease: a follow-up study. Gastroenterology. 1982;83:383–7.

    PubMed  CAS  Google Scholar 

  105. Solomon MR, McLeod R. Combination ciprofloxacina and metronidazole in severe perianal Crohn’s disease. Can J Gastroenterol. 1993;7:571–3.

    Google Scholar 

  106. Sandborn WJ, Mc Leod R, Jewell DP. Medical therapy for induction and maintenance of remission in pouchitis. A systematic review. Inflamm Bowel Dis. 1999;5:33–9.

    PubMed  CAS  Google Scholar 

  107. Hurst RD, Molinari M, Chung P, Rubin M, Michelassi F. Prospective study of the incidence, timing and treatment of pouchitis in 104 consecutive patients after restorative proctocolectomy. Arch Surg. 1996;131:497–502.

    PubMed  CAS  Google Scholar 

  108. Madden M, McIntyre A, Nicholls RJ. Double- blind cross-over trial of metronidazole versus placebo in chronic unremitting pouchitis. Dig Dis Sci. 1994;39:1193–6.

    PubMed  CAS  Google Scholar 

  109. Shen B, Achkar JP, Lashner BA, Ormsby AH, Remzi FH, Brzenzinski A, et al. A randomized clinical trial of ciprofloxacin and metronidazole to treat acute pouchitis. Inflamm Bowel Dis. 2001;7:301–5.

    PubMed  CAS  Google Scholar 

  110. Gionchetti P, Rizzello F, Venturi A, Ugolini F, Rossi M, Brigidi P, et al. Antibiotic combination therapy in patients with chronic, treatment-resistant pouchitis. Aliment Pharmacol Ther. 1999;13:713–8.

    PubMed  CAS  Google Scholar 

  111. Mimura T, Rizzello F, Helwig U, Poggioli G, Schreiber S, Talbot IC, et al. Four week open-label trial of metronidazole and ciprofloxacin for the treatment of recurrent or refractory pouchitis. Aliment Pharmacol Ther. 2002;16:909–17.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Clinical Medicine and Gastroenterology, University of Bologna, Policlinico S. Orsola, Via Massarenti 9, 40138, Bologna, Italy

    Paolo Gionchetti MD & Fernando Rizzello

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  1. Paolo Gionchetti MD
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  2. Fernando Rizzello
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Correspondence to Paolo Gionchetti MD .

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  1. Medical School of the Humboldt Universit, Department of Medicine, Charité Medical Center, Virchow Hospita, Berlin, 13344, Germany

    Daniel C. Baumgart

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Gionchetti, P., Rizzello, F. (2012). Probiotics, Prebiotics, and Antibiotics in Medical Management of Inflammatory Bowel Disease. In: Baumgart, D. (eds) Crohn's Disease and Ulcerative Colitis. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-0998-4_43

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