Efficacy of Probiotics in Reducing Relapse in Ulcerative Colitis: A Meta-Analysis of Controlled Trials

Wajih Ul Hassan; Meghna Somaraj; Airin Parvin Nipu; Najwa Nadeem; Aania Zahra; Bibi Mariam; Samreen Islam; Addan Farooq; Maham Shaikh

doi:10.70749/ijbr.v3i5.1297

Authors

Wajih Ul Hassan King Edward Medical University/ Mayo Hospital, Lahore, Punjab, Pakistan.
Meghna Somaraj Kasturba Medical College, Manipal, India.
Airin Parvin Nipu Mymensingh Medical College, Mymensingh, Bangladesh.
Najwa Nadeem Faisalabad Medical University, Faisalabad, Punjab, Pakistan.
Aania Zahra University of Health Sciences, Lahore, Punjab, Pakistan.
Bibi Mariam Liaquat University of Medical and Health Sciences, Sindh, Pakistan.
Samreen Islam Bahria Medical and Dental College, Karachi, Sindh, Pakistan.
Addan Farooq Bahria Medical and Dental College, Karachi, Sindh, Pakistan.
Maham Shaikh People’s Medical College Hospital, Nawabshah, Sindh, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i5.1297

Keywords:

Ulcerative Colitis, Probiotics, Relapse Prevention, Meta-analysis

Abstract

Background: Ulcerative colitis (UC) is a chronic inflammatory bowel disease marked by periods of remission and relapse. While mesalazine remains a standard maintenance therapy, long-term use may lead to adverse effects. Probiotics, known to modulate gut microbiota and reduce intestinal inflammation, have emerged as a potential adjunct or alternative treatment to prevent relapse in UC. Objective: This meta-analysis aimed to evaluate the efficacy of probiotics compared to mesalazine in maintaining remission and reducing relapse rates in UC patients. Methods: A systematic search of PubMed, Embase, Scopus, and Cochrane CENTRAL was conducted to identify randomized controlled trials (RCTs) from 1990 to 2023 that compared probiotics with mesalazine in adult UC patients. Studies were screened based on predefined inclusion criteria. Data were extracted and pooled risk ratios (RRs) were calculated using a random-effects model. Heterogeneity was assessed using I² statistics, and risk of bias was evaluated via the Cochrane RoB 2.0 tool. Results: Four RCTs involving 533 patients were included. Among them, 264 received probiotic therapy and 269 received mesalazine. The pooled RR for relapse was 0.97 (95% CI: 0.79–1.20; p = 0.80), indicating no statistically significant difference between groups. Subgroup analysis at 12-month follow-up showed similar outcomes (RR = 0.96; 95% CI: 0.77–1.19; p = 0.68). Heterogeneity was low (I² = 0%). Conclusion: Probiotic therapy demonstrates comparable efficacy to mesalazine in preventing relapse in UC patients. Given their favorable safety profile and patient acceptability, probiotics may serve as a viable maintenance strategy, warranting further large-scale studies to confirm long-term outcomes.

Downloads

Download data is not yet available.

References

Bernardi, F., Fanizzi, F., Parigi, T. L., Zilli, A., Allocca, M., Furfaro, F., Peyrin-Biroulet, L., Danese, S., & D’Amico, F. (2024). Role of Probiotics in the Management of Patients with Ulcerative Colitis and Pouchitis. Microorganisms, 13(1), 19.

https://doi.org/10.3390/microorganisms13010019

Rayyan, Y. M., Agraib, L. M., Alkhatib, B., Yamani, M. I., Abu-Sneineh, A. T., & Tayyem, R. F. (2023). Does probiotic supplementation improve quality of life in mild-to-moderately active ulcerative colitis patients in Jordan? A secondary outcome of the randomized, double-blind, placebo-controlled study. European Journal of Nutrition, 62(7), 3069–3077.

https://doi.org/10.1007/s00394-023-03207-8

Preidis, G. A., Weizman, A. V., Kashyap, P. C., & Morgan, R. L. (2020). AGA Technical Review on the Role of Probiotics in the Management of Gastrointestinal Disorders. Gastroenterology, 159(2), 708-738.e4.

https://doi.org/10.1053/j.gastro.2020.05.060

Naidoo, K., Gordon, M., Fagbemi, A. O., Thomas, A. G., & Akobeng, A. K. (2011). Probiotics for maintenance of remission in ulcerative colitis. Cochrane Library.

https://doi.org/10.1002/14651858.cd007443.pub2

Filidou, E., & Kolios, G. (2021). Probiotics in intestinal mucosal healing: a new therapy or an old friend? Pharmaceuticals, 14(11), 1181.

https://doi.org/10.3390/ph14111181

Huang, C., Hao, W., Wang, X., Zhou, R., & Lin, Q. (2023). Probiotics for the treatment of ulcerative colitis: a review of experimental research from 2018 to 2022. Frontiers in Microbiology, 14.

https://doi.org/10.3389/fmicb.2023.1211271

Fedorak, R. N. (2010, November 1). Probiotics in the management of ulcerative colitis.

https://pmc.ncbi.nlm.nih.gov/articles/PMC3033537/

Vakadaris, G., Stefanis, C., Giorgi, E., Brouvalis, M., Voidarou, C., Kourkoutas, Y., Tsigalou, C., & Bezirtzoglou, E. (2023). The role of probiotics in Inducing and Maintaining remission in Crohn’s Disease and ulcerative colitis: A Systematic Review of the literature. Biomedicines, 11(2), 494.

https://doi.org/10.3390/biomedicines11020494

National Center for Biotechnology Information. (2018). https://www.ncbi.nlm.nih.gov/

Estevinho, M. M., Yuan, Y., Rodríguez‐Lago, I., Sousa‐Pimenta, M., Dias, C. C., Acosta, M. B., Jairath, V., & Magro, F. (2024). Efficacy and safety of probiotics in IBD: An overview of systematic reviews and updated meta‐analysis of randomized controlled trials. United European Gastroenterology Journal, 12(7), 960–981.

https://doi.org/10.1002/ueg2.12636

Naidoo, K., Gordon, M., Fagbemi, A. O., Thomas, A. G., & Akobeng, A. K. (2011b). Probiotics for maintenance of remission in ulcerative colitis. Cochrane Library.

https://doi.org/10.1002/14651858.cd007443.pub2

Rembacken, B., Snelling, A., Hawkey, P., Chalmers, D., & Axon, A. (1999b). Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: a randomised trial. The Lancet, 354(9179), 635–639.

https://doi.org/10.1016/s0140-6736(98)06343-0

Kruis, W. (2004b). Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine. Gut, 53(11), 1617–1623.

https://doi.org/10.1136/gut.2003.037747

Dellon, E. S., Gonsalves, N., Abonia, J. P., Alexander, J. A., Arva, N. C., Atkins, D., Attwood, S. E., Auth, M. K., Bailey, D. D., Biederman, L., Blanchard, C., Bonis, P. A., Bose, P., Bredenoord, A. J., Chang, J. W., Chehade, M., Collins, M. H., Di Lorenzo, C., Dias, J. A., . . . Aceves, S. S. (2022). International Consensus Recommendations for Eosinophilic Gastrointestinal Disease Nomenclature. Clinical Gastroenterology and Hepatology, 20(11), 2474-2484.e3.

https://doi.org/10.1016/j.cgh.2022.02.017

Berinstein, J. A., Aintabi, D., & Higgins, P. D. (2023). In-hospital management of inflammatory bowel disease. Current Opinion in Gastroenterology, 39(4), 274–286.

https://doi.org/10.1097/mog.0000000000000953

Derwa, Y., Gracie, D. J., Hamlin, P. J., & Ford, A. C. (2017). Systematic review with meta-analysis: the efficacy of probiotics in inflammatory bowel disease. Alimentary Pharmacology & Therapeutics, 46(4), 389–400.

https://doi.org/10.1111/apt.14203

Iheozor-Ejiofor, Z., Kaur, L., Gordon, M., Baines, P. A., Sinopoulou, V., & Akobeng, A. K. (2020). Probiotics for maintenance of remission in ulcerative colitis. Cochrane Library.

https://doi.org/10.1002/14651858.cd007443.pub3

Rahimi R, Nikfar S, Rezaie A, et al. A meta-analysis of the benefit of probiotics in maintaining remission of human ulcerative colitis: evidence for prevention of disease relapse and maintenance of remission. 2008. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

https://www.ncbi.nlm.nih.gov/books/NBK76284/