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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.
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