Article information
Resumen
Múltiples estudios del sistema inmunitario de pacientes con enfermedad inflamatoria intestinal (EII) han demostrado la existencia de un trastorno en la inmunidad de la mucosa, probablemente determinado genéticamente, que origina una inmunorreactividad exagerada contra elementos de la flora comensal. La estrategia básica del tratamiento de la EII ha estado dirigida a suprimir las respuestas inflamatorias y, salvo los estudios de tratamiento con antibióticos, se ha prestado poca atención a modificar la flora intestinal. La modificación de la flora intestinal mediante probióticos ofrece la oportunidad no sólo de actuar desde el punto de vista microbiológico, sino también desde el punto de vista inmunológico. La utilización de probióticos en la EII es desde el punto de vista fisiopatológico una buena alternativa terapéutica. Sin embargo, por el momento, los estudios con probióticos sólo han presentado resultados clínicos positivos en situaciones muy concretas. Los datos secundarios fisiopatológicos de los estudios clínicos sugieren un efecto beneficioso, aunque habrá que confirmarlo en estudios llevados a cabo con un mayor número de pacientes, o aplicando estrategias que consigan modificar de manera más eficaz la composición de la flora intestinal.
Multiple studies of the immune system in patients with inflammatory bowel disease (IBD) have demonstrated the presence of altered intestinal mucosal immunity, probably genetically determined, giving rise to increased immunoreactivity against elements of the commensal flora.
The basic strategy in the treatment of IBD is aimed at suppressing inflammatory responses. With the exception of studies of antibiotic therapy, little attention has been paid to modifying intestinal flora. Modification of intestinal flora through probiotics provides the possibility of acting microbiologically as well as immunologically. From the physiopathological point of view, the use of probiotics in IBD is a good therapeutic alternative.
However, at present, studies with probiotics have only yielded positive results in highly specific situations. Secondary physiopathological data from clinical trials suggest a beneficial effect. However, this effect should be confirmed either in studies with a larger number of patients or by applying strategies that more effectively modify the composition of intestinal flora.
Full text is only aviable in PDF
Bibliografía
[1.]
F. Shanahan.
Crohn's disease.
Lancet, 359 (2002), pp. 62-69
[2.]
F. Shanahan.
Inflammatory bowel disease: immunodiagnostics, immunotherapeutics, and ecotherapeutics.
Gastroenterology, 120 (2001), pp. 622-635
[4.]
Guarner F, Schaafsma G. Probiotics. Int J Food Microbiol. 998;39:237-8.
[6.]
F. Shanahan.
Probiotics and inflammatory bowel disease:is there a scientific rationale?.
Inflamm Bowel Dis, 6 (2000), pp. 107-115
[7.]
A.J. Stagg, A.L. Hart, S.C. Knight, M.A. Kamm.
Microbial-gut interactions in health and disease. Interactions between dendritic cells and bacteria in the regulation of intestinal immunity.
Best Pract Res Clin Gastroenterol, 18 (2004), pp. 255-270
[8.]
M. Allez, L. Mayer.
Regulatory T cells: peace keepers in the gut.
Inflamatory Bowel Diseases, 10 (2004), pp. 666-676
[9.]
M. Drakes, T. Blanchard, S. Czinn.
Bacterial probiotic modulation of dendritic cells.
Infection and Immunity, 72 (2004), pp. 3299-3309
[10.]
A.L. Hart, K. Lammers, P. Brigidi, B. Vitali, F. Rizzello, P. Gionchetti, et al.
Modulation of human dendritic cell phenotype and function by probiotic bacteria.
Gut, 53 (2004), pp. 1602-1609
[11.]
L. O’Mahony, L. O’Callaghan, J. McCarthy, D. Shilling, P. Scully, S. Sibartie, et al.
Differential cytokine response from dendritic cells to commensal and pathogenic bacteria in different lymphoid compartments in humans.
Am J Physiol Gastrointest Liver Physiol, 290 (2006), pp. 839-845
[12.]
N. Borruel, M. Carol, F. Casellas, M. Antolin, F. De Lara, E. Espin, et al.
Increased mucosal tumour necrosis factor alpha production in Crohn's disease can be downregulated ex vivo by probiotic bacteria.
Gut, 51 (2002), pp. 659-664
[13.]
N. Borruel, F. Casellas, M. Antolin, M. Llopis, M. Carol, E. Espiin, et al.
Effects of nonpathogenic bacteria on cytokine secretion by human intestinal mucosa.
Am J Gastroenterol, 98 (2003), pp. 865-870
[14.]
M. Carol, N. Borruel, M. Antolin, M. Llopis, F. Casellas, F. Guarner, et al.
Modulation of apoptosis in intestinal lymphocytes by a probiotic bacteria in Crohn's disease.
J Leukoc Biol, 79 (2006), pp. 917-922
[15.]
R. Fabia, A. Ar’Rajab, M.L. Johansssib, R. Willen, R. Andersson.
The effect of exogenous administration of Lactobacillus reuteri R2LC and oat fiber on acetic-acid induced colitis in the rat.
Scand J Gastroenterol, 28 (1993), pp. 155-162
[16.]
Y. Mao, S. Nobaeck, B. Kasravi, D. Adawi, U. Stenram, G. Molin, et al.
The effects of Lactobacillus strains and oat fiber on methotrexate-induced enterocolitis in rats.
Gastroenterology, 111 (1996), pp. 334-344
[17.]
R. Kuhn, J. Lohler, D. Rennick, K. Rajewsky, W. Muller.
Interleukin-10 deficient mice develop chronic enterocolitis.
Cell, 75 (1993), pp. 263-274
[18.]
R.K. Sellon, S.L. Tonkonogy, M. Schultz, L.A. Dieleman, W. Grenther, E. Balish, et al.
Resident enteric bacteria are necessary for development of spontaneous colitis and immune system activation in interleukin-10 deficient mice.
Infect Immun, 66 (1998), pp. 5224-5231
[19.]
K.L. Madsen, J.S. Doyle, M.M. Tavernini, L.D. Jewell, R.P. Rennie, R.N. Fedorak.
Antibiotic therapy attenuates colitis in interleukin 10 gene-deficient mice.
Gastroenterology, 118 (2000), pp. 1094-1105
[20.]
K.L. Madsen, J.S. Doyle, L.D. Jewell, M.M. Tavernini, R.N. Fedorak.
Lactobacillus species prevents colitis in Interleukin 10 gene-deficient mice.
Gastroenterology, 116 (1999), pp. 1107-1114
[21.]
K. Madsen, A. Cornish, P. Soper, C. McKaigney, H. Jijon, C. Yachimec, et al.
Probiotic bacteria enhance murine and human intestinal epithelial barrier function.
Gastroenterology, 121 (2001), pp. 580-591
[22.]
J. Mccarthy, O’Mahony, L. O’Callaghan, B. Sheil, E. Vaughan, N. Fitzsimons, et al.
Double blind, placebo controlled trial of two probiotics strains in interleukin 10 knockout mice and mechanistic link with cytokine balance.
Gut, 52 (2003), pp. 975-980
[23.]
O’Mahony, M. Feeney, S. O’Halloran, L. Murphy, B. Kiely, J. Fitzgibbon, et al.
Probiotic impact on microbial flora, inflammation and tumour development in IL-10 knockout mice.
Aliment Pharmacol Ther, 15 (2001), pp. 1219-1225
[24.]
A. Grabig, D. Paclik, C. Guzy, A. Dankof, D.C. Baumgart, J. Erckenbrecht, et al.
Escherichia coli strain Nissle 1917 ameliorates experimental colitis via toll-like receptor 2- and toll-like receptor 4-dependent pathways.
Infect Immun, 74 (2006), pp. 4075-4082
[25.]
M. Llopis, M. Antolin, F. Guarner, A. Salas, J.R. Malagelada, et al.
Mucosal colonisation with Lactobacillus casei mitigates barrier injury induced by exposure to trinitronbenzene sulphonic acid.
Gut, 54 (2005), pp. 955-959
[26.]
M. Schultz, C. Veltkamp, L.A. Dieleman, W.B. Grenther, P.B. Wyrick, S.L. Tonkonogy, et al.
Lactobacillus plantarum 299V in the treatment and prevention of spontaneous colitis in interleukin-10-deficient mice.
Inflamm Bowel Dis, 8 (2002), pp. 71-80
[27.]
L.A. Dieleman, M.S. Goerres, A. Arends, D. Sprengers, C. Torrice, F. Hoentjen, et al.
Lactobacillus GG prevents recurrence of colitis in HLA-B27 transgenic rats after antibiotic treatment.
Gut, 52 (2003), pp. 370-376
[28.]
L. Steidler, W. Hans, L. Schotte, S. Neirynck, F. Obermeier, W. Falk, et al.
Treatment of murine collitis by Lactococcus lactis secreting Interleukin-10.
Science, 289 (2000), pp. 1352-1355
[29.]
F. Shanahan.
Turbo probiotics for IBD.
Gastroenterology, 120 (2001), pp. 1297-1298
[30.]
D. Rachmilewitz, K. Katakura, F. Karmeli, T. Hayashi, C. Reinus, B. Rudensky, et al.
Toll-like receptor 9 signaling mediates the anti-inflammatory effects of probiotics in murine experimental colitis.
Gastroenterology, 126 (2004), pp. 520-528
[31.]
D. Rachmilewitz, F. Karmeli, K. Takabayashi, T. Hayashi, L. Leider-Trejo, J. Lee, et al.
Immunostimulatory DNA ameliorates experimental and spontaneous murine colitis.
Gastroenterology, 122 (2002), pp. 1428-1441
[32.]
F. Obermeier, N. Dunger, U. Strauch, N. Grunwlad, H. Herfarth, J. Schölmerich, et al.
Contrasting activity of cytosin-guanosin dinucleotide oligonucleotides in mice with experimental colitis.
Clin Exp Immunol, 134 (2003), pp. 217-224
[33.]
H. Jijon, J. Backer, H. Díaz, H. Yeung, D. Thiel, C. McKaigney, et al.
DNA from probiotic bacteria modulates murine and human epithelial and immune function.
Gastroenterology, 126 (2004), pp. 1358-1373
[34.]
G. Reid, F. Guarner, G. Gibson, T. Tompkins, H. Gill, I. Rowland, et al.
International Scientific Association for Probiotics and Prebiotics.
Gastroenterology, 127 (2004), pp. 366-367
[35.]
M. Guslandi, P. Giollo, P.A. Testoni.
A pilot trial of Saccharomyces boulardii in ulcerative colitis.
Eur J Gastroenterol Hepatol, 15 (2003), pp. 697-698
[36.]
W. Kruis, E. Schütz, P. Fric, B. Fixa, G. Judmaier, M. Stolte.
Double-blind comparison of an oral Escherichia coli preparation and mesalazine in maintaining remission of ulcerative colitis.
Aliment Pharmacol Ther, 11 (1997), pp. 853-858
[37.]
B.J. Rembacken, A.M. Snelling, P.M. Hawkey, D.M. Chalmers, A.T. Axon.
Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: a randomised trial.
Lancet, 354 (1999), pp. 635-639
[38.]
W. Kruis, P. Fric, J. Pokrotnieks, M. Lukás, B. Fixa, M. Kascák, et al.
Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine.
Gut, 53 (2004), pp. 1617-1623
[39.]
H. Ishikawa, I. Akedo, Y. Umesaki, R. Tanaka, A. Imaoka, T. Otani.
Randomized controlled trial of the effect of bifidobacteriafermented milk on ulcerative colitis.
J Am Coll Nutr, 22 (2003), pp. 56-63
[40.]
K. Kato, S. Mizuno, Y. Umesaki, Y. Ishii, M. Sugitani, A. Imaoka, et al.
Randomized placebo-controlled trial assessing the effect of bifidobacteria-fermented milk on active ulcerative colitis.
Aliment Pharmacol Ther, 20 (2004), pp. 1133-1141
[41.]
F. Shanahan, F. Guarner, A. Von Wright, T. Vilpponen-Salmela, D. O’Donoghue, B. Kiely, PROGID team of Investigators.
A one year, randomised, double-blind, placebo controlled trial of a lactobacillus or a bidifobacterium probiotic for maintenance of steroid-induced remission of ulcerative colitis.
Gastroenterology, 130 (2006), pp. 44A
[42.]
A. Venturi, P. Gionchetti, F. Rizzello, R. Johansson, E. Zucconi, P. Brigidi, et al.
Impact on the faecal flora by a new probiotic preparation: preliminary data on maintenance treatment of patients with ulcerative colitis.
Aliment Pharmacol Ther, 13 (1999), pp. 1103-1108
[43.]
R. Bibiloni, R.N. Fedorak, G.W. Tannock, K.L. Madsen, P. Gionchetti, M. Campieri, et al.
VSL#3 probiotic-mixture induces remission in patients with active ulcerative colitis.
Am J Gastroenterol, 100 (2005), pp. 1539-1546
[44.]
A. Tursi, G. Brandimarte, G.M. Giorgetti, G. Forti, M.E. Modeo, A. Gigliobianco.
Low-dose balsalazide plus a high-potency probiotic preparation is more effective than balsalazide alone or mesalazine in the treatment of acute mild-to-moderateulcerative colitis.
Med Sci Monit, 10 (2004), pp. 126-131
[45.]
M.A. Zocco, L.Z. Dal Verme, F. Cremonini, A.C. Piscaglia, E.C. Nista, M. Candelli, et al.
Efficacy of Lactobacillus GG in maintaining remission of ulcerative colitis.
Aliment Pharmacol Ther, 23 (2006), pp. 1567-1574
[46.]
M. Malin, H. Soumalainen, M. Saxelin, E. Isolauri.
Promotion of IgA immune response in patients with Crohn's disease by oral bacteriotherapy with Lactobacillus GG.
Ann Nutr Metab, 40 (1996), pp. 137-145
[47.]
P. Gupta, H. Andrew, B.S. Kirschner, S. Guandalini.
Is Lactobacillus GG helpful in children with Crohn's disease? Results of a preliminary, open-label study.
J Pediatr Gastroenterol Nutr, 31 (2000), pp. 453-457
[48.]
A. Bousvaros, S. Guandalini, R.N. Baldassano, C. Botelho, J. Evans, G.D. Ferry, 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, 11 (2005), pp. 833-839
[49.]
HA. Malchow.
Crohn's disease and Escherichia coli. A new approach in therapy to maintain remission of colonic Crohn's disease?.
J Clin Gastroenterol, 25 (1997), pp. 653-658
[50.]
M. Schultz, A. Timmer, H.H. Herfarth, R.B. Sartor, J.A. Vanderhoof, H.C. Rath.
Lactobacillus GG in inducing and maintaining remission of Crohn's disease.
BMC Gastroenterol, 4 (2004), pp. 5
[51.]
M. Guslandi, G. Mezzi, M. Sorghi, P.A. Testoni.
Saccharomyces boulardii in maintenance treatment of Crohn's disease.
Dig Dis Sci, 45 (2000), pp. 1462-1464
[51.]
C. Prantera, M.L. Scribano, A. Falasco, A. Andreoli, C. Luzi.
Ineffectiveness of probiotics in preventing recurrence after curative resection for Crohn's disease: a randomised controlled trial with Lactobacillus GG.
Gut, 51 (2002), pp. 405-409
[53.]
P. Marteau, M. Lemann, P. Seksik, D. Laharie, J.F. Colombel, Y. Bouhnik, et al.
Ineffectiveness of Lactobacillus johnsonii LA1 for prophylaxis of postoperative recurrence in Crohn's disease: a randomised, double blind, placebo controlled GETAID trial.
Gut, 55 (2006), pp. 842-847
[54.]
Van Gossum, O. Dewit, K. Geboes, et al.
A randomized placebocontrolled clinical trial of probiotics (1. Jonhsonii, La1) on early endoscopic recrrence of Crohn's disease (CD) after ileocaecal resection.
Gastroenterology, 128 (2005), pp. A17
[55.]
P. Gionchetti, F. Rizzello, A. Venturi, P. Brigidi, D. Matteuzzi, G. Bazzocchi, et al.
Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial.
Gastroenterology, 119 (2000), pp. 305-309
[56.]
T. Mimura, F. Rizzello, U. Helwig, G. Poggioli, S. Schreiber, I.C. Talbot, et al.
Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis.
Gut, 53 (2004), pp. 108-114
[57.]
P. Gionchetti, F. Rizzello, U. Helwig, A. Venturi, K.M. Lammers, P. Brigidi, et al.
Prophylaxis of puchitis onset with probiotic therapy: a double blind, placebo-controlled trial.
Gastroenterology, 124 (2003), pp. 1202-1209
[58.]
T. Kuhbacher, S.J. Ott, U. Helwig, T. Mimura, F. Rizzello, B. Kleessen, et al.
Bacterial and fungal microbiota in relation to probiotic therapy (VSL#3) in pouchitis.
Gut, 55 (2006), pp. 833-841
[59.]
S. Videla, J. Vilaseca, M. Antolín, A. García-Lafuente, F. Guarner, E. Crespo, et al.
Dietary inulin improves distal colitis induced by dextran sodium sulfate in the rat.
Am J Gastroenterol, 96 (2001), pp. 1486-1493
[60.]
M. Schultz, K. Munro, G.W. Tannock, I. Melchner, C. Gottl, H. Schwietz, et al.
Effects of feeding a probiotic preparation (SIM) containing inulin on the severity of colitis and on the composition of the intestinal microflora in HLA-B27 transgenic rats.
Clin Diagn Lab Immunol, 11 (2004), pp. 581-587
[61.]
E. Furrie, S. Macfarlane, A. Kennedy, J.H. Cummings, S.V. Walsh, D.A. O’neil.
Synbiotic therapy (Bifidobacterium longum/synergy 1) initiates resolution ofinflammation in patients with active ulcerative colitis: a randomised controlled pilot trial.
Gut, 54 (2005), pp. 242-249
[62.]
F. Casellas, N. Borruel, A. Torrejón, E. Varela, M. Antolín, F. Guarner, et al.
Prebiotic-improved response to mesalazine in mild ulcerative colitis.
Gut, 55 (2006), pp. 122A
Copyright © 2007. Elsevier España S.L.. Todos los derechos reservados
