J Microbial Biochem Technol Probiotics ISSN:1948-5948 JMBT, an open access journal Research Article Open Access Triantafillidis et al., J Microbial Biochem Technol 2011, S1 DOI: 10.4172/1948-5948.S1-005 Review Article Open Access *Corresponding author: Prof John K. Triantafllidis, Associated Professor “Gr. T. Popa” University of Medicine and Pharmacy, Iasi, Romania. Head, Department of Gastroenterology and Center for Infammatory Bowel Disease,“Saint Panteleimon” General Hospital, Nicea, Greece, Tel: (Greece)-6944432917; Fax: (Greece)-2105810970; E-mail: jktrian@gmail.com Received October 13, 2011; Accepted November 11, 2011; Published November 21, 2011 Citation: Triantafllidis JK, Georgopoulos F, Merikas E (2011) The Role of Pre- and Probiotics in the Treatment of Infammatory Bowel Disease. J Microbial Biochem Technol S1:005. doi:10.4172/1948-5948.S1-005 Copyright: © 2011 Triantafllidis JK, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Abstract Many patients with infammatory bowel disease use alteranative therapy, mainly probiotics and synbiotics, to manage this intestinal condition. Despite widespread use of these natural therapies by patients, health care providers may be unfamiliar with probiotics as a treatment modality. This review describes the rationale for use of probiotics in patients with active or inactive infammatory bowel disease, their mechanism(s) of action, and recent controlled clinical studies in which effcacy of probiotics, prebiotics and synbiotics in patients with active or inactive infammatory bowel disease has been explored. Certain probiotics, particularly E. coli Nissle 1917 and a multi-agent mixture VSL#3, may be beneft patients with UC or pouchitis, while LactoBacillus rhamnosus GG appears less useful. In general, probiotics show potential for therapeutic application mainly in pouchitis and to a lesser degree in UC, while their effects in maintenance therapy for CD have been much less promising. While there is suggestion of beneft when patients with ulcerative colitis use bacterial therapies small sample sizes and methodological weeknesses in study designs necessitate that additional studies must be conducted before probiotics and or synbiotics can be routinely recommended in clinical practice. The Role of Pre- and Probiotics in the Treatment of Inflammatory Bowel Disease John K. Triantafllidis*, Filippos Georgopoulos and Emmanuel Merikas Department of Gastroenterology and Center for infammatory Bowel Disease, “Saint Panteleimon” General Hospital, Nicea, Greece Introduction Te normal colonic microfora is intimately involved in the aetiology of infammatory bowel disease (IBD). Both ulcerative colitis (UC) and Crohn’s disease (CD) are quite ofen refractile to conventional treatment thus requiring the use of alternative therapies based for example on the use of probiotics, prebiotics or combination of the two (synbiotics). So far, most of the studies in this area have been performed using probiotics, and although an increasing interest on the use of synbiotics has been noticed recently, few randomised controlled trials have been conducted concerning both murine models of IBD and humans. Te available clinical and experimental data suggest that these functional foods can alter the composition of the colonic microbiota, and reduce infammatory processes in the gut mucosa, thus having the potential to induce disease remission especially in patients sufering from UC. In this review we will try to clarify the role of prebiotics, probiotics, and synbiotics on the clinical course of patients with IBD based on the results of the current literature. Defnitions Probiotics are live microorganisms that when ingested in adequate quantities, exert a health beneft to the host. Inactivated bacteria or bacteria derived factors can also have probiotic properties, and thus might be considered as probiotics. Te main probiotic preparations commercially available belong to a group of Gram-positive fermentative bacteria that are associated with the production of lactic acid from carbohydrates. Species of LactoBacillus, Lactococcus, Bifdobacterium and Streptococcus thermophilus are included in this group, being normal as well as important constituents of the human gastrointestinal microfora [1]. Potential probiotic roles probably share some other microbes including yeasts (Saccharomyces boulardii, Saccharomyces cerevisiae) and non-pathogenic strains of E. coli and Bacillus species. Prebiotics are dietary substances (mostly consisting of non-starch polysaccharides and oligosaccharides not or poorly digested by human enzymes) that benefts the host by selectively stimulating the growth and activity of indigenous probiotic bacteria. According to the International Scientifc Association for Probiotics and Prebiotics “a dietary prebiotic is a selectively fermented ingredient that results in specifc changes, in the composition and/or activity of the gastrointestinal microbiota, thus conferring beneft(s) upon host health [2].” Te majority of prebiotics includes fbres and carbohydrates, such as resistant starch, wheat bran, and inulin. Teir presence in the bowel lumen selectively enhances proliferation of certain probiotic bacteria, especially Bifdobacteria species. Tey also act as carbon and energy sources for bacteria growth in the large bowel, where they are fermented into short chain fatty acids, lactate, CO 2 , and H 2 formation being energy sources for the gut mucosa especially of the lef colon [3]. Synbiotics is a novel approach combining probiotics and prebiotics in an attempt to obtain synergistic efects of the two compounds by improvement of the probiotic colonisation or the metabolic efect. Although the number of microorganisms that must be ingested to obtain a benefcial efect is largely unknown, a probiotic should contain several billion microorganisms to increase the chance of adequate gut colonization [4]. It must be stressed however, that probiotic benefts associated with one strain do not necessarily hold true for other. Frequency of probiotic use by the patients with IBD Te most widely used probiotics are Saccharomyces boulardii J o u r n a l o f M i c ro b i a l & B i o c he mi c a l T e c h n o l o g y ISSN: 1948-5948 Journal of Microbial & Biochemical Technology