Protective Bacteria Prevent Complication Following Ulcerative Colitis Surgery

BETHESDA, Md. -- Ulcerative colitis patients who have their colon surgically removed are significantly less likely to develop a post-surgical complication called pouchitis when treated with probiotics, "good bacteria," after surgery.

Of patients given a highly concentrated probiotics formulation after surgery, 10 percent developed pouchitis, while 40 percent of those on placebo developed the complication. These findings are reported in the May issue of Gastroenterology, the journal of the American Gastroenterological Association.

Probiotics are living bacteria that, when ingested in adequate amounts, exert health effects beyond inherent nutrition. In this case, probiotics may increase the concentration of protective bacteria in the intestines. In this randomized, double-blind, placebo-controlled study, patients received probiotic VSL#3 (1 packet/day) or placebo. Each packet contained 900 billion bacteria: four strains of Lactobacillus, three strains of Bifidobacterium, and one strain of Streptococcus salivarius.

"Probiotics not only prevented pouchitis, but also significantly lowered stool frequency and enhanced quality of life for patients after surgery," reports Paolo Gionchetti, MD, lead study author from the University of Bologna, Italy. "It's important to note that this particular concentration of bacteria strains was responsible for the positive effect. Recent studies have shown that other bacteria formulations don't have the same outcome."

The procedure that removes the large intestine, called ileal pouch-anal anastomosis or "pouch" surgery, is a popular measure to relieve ulcerative colitis without requiring patients to wear an external ostomy bag. After the large intestine is removed, the small intestine is connected to the rectum. On average, 37 percent of patients develop pouchitis in the year following surgery. Pouchitis is a syndrome characterized by increased stool frequency and fluidity, rectal bleeding, abdominal cramping, incontinence, and fever.

Attacks of pouchitis may be acute and intermittent or chronic and unremitting. After developing pouchitis, patients generally receive antibiotics with a positive response within a few days. Ten percent of patients will develop chronic pouchitis requiring continuous therapy. In an editorial accompanying Gionchetti's study, Jeffry A. Katz, MD commented on the role probiotics could play in treatment of pouchitis.

"As a chronic therapy, probiotics are safer than antibiotics," says Katz, associate professor of medicine at the University Hospitals of Cleveland. "For this reason alone, probiotics should become the choice for maintenance of remission in chronic pouchitis and for prevention of pouchitis in high-risk patients."

Ulcerative colitis is an inflammatory bowel disease, which affects about 500,000 Americans. Most cases are diagnosed before age 30, but the disease can occur at any age. It is a chronic disease with unknown cause, characterized by ulceration of the large intestine and rectum with bleeding, abscesses and inflammation, often causing anemia and electrolyte imbalance. The cause of ulcerative colitis remains unknown, but an immune disorder -- perhaps in response to a viral or bacterial infection -- and heredity may be contributing factors.

Source: American Gastroenterological Association