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Probiotics for ulcerative colitis therapy
Vol. 95, No. 1, 2000 ISSN 0002-9270/00/$20.00 PII S0002-9270(99)00799-6
WHAT’S NEW IN GI EDITOR
Jon S. Thompson, M.D., F.A.C.S. GASTROENTEROLOGY
Randall E. Brand Rene´e L. Young John K. DiBaise Hemant K. Roy Timothy M. McCashland RADIOLOGY
Aurelio Matamoros, Jr. Jeff L. Fidler
PATHOLOGY
James L. Wisecarver
LIVER STUDY UNIT
Carol A. Casey PEDIATRIC GASTROENTEROLOGY
David R. Mack University of Nebraska Medical Center Omaha, Nebraska
Probiotics for Ulcerative Colitis Therapy Rembacken BJ, Snelling AM, Hawkey PM, et al. Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: A randomized trial. Lancet 1999;354: 635–9. Probiotics are usually defined as noninfectious live bacteria that offer benefit to the host and normally colonize the intestinal tract. They have generally been found to offer benefit in prevention and/or treatment of infectious diarrhea. The authors of this single center study randomized 116 adult patients with clinically and histologically active ulcerative colitis to receive either mesalazine or a nonpathogenic Escherichia coli strain. Additionally, all patients received oral gentamicin for 1 wk at entry to the study. Randomization was then stratified so that the two patient groups had equivalent numbers of participants with mild, moderate, and severe colitis. Patient groups were found to be similar for age, gender, disease duration, smoking, and clinical activity index. Treatment of colitis was similar for the severity of the colitis (i.e., hydrocortisone enemas for mild proctocolitis, prednisolone 30 mg/day for more extensive disease, and prednisolone 60 mg/day for severe colitis). Patients not in remission after 12 wk were excluded. Sigmoidoscopy was performed and if it confirmed quiescent disease, patients were then maintained on mesalazine 1.2 g/day or on two capsules of the Escherichia coli daily while enemas or prednisolone were tapered. The number of patients in the mesalazine group compared to the probiotic group was similar for: achieving remission [44 (75%) vs 39 (67%)], time to remission (44 days vs
42 days), duration of remission (206 days vs 221 days), and number of patients relapsing (73% vs 67%) during the maximum 12-month follow-up period. This study employed a low dose of mesalazine for the maintenance phase of ulcerative colitis therapy. Compared to low dose therapy, there was no difference in the relapse rate with the relapse high for both groups. It is not clear how probiotic agents offer benefit to the host, but likely the mechanism will be complex in nature and may include alterations of the mucosal immune system. In addition, interactions of probiotic agents with mucosal epithelial cells may enhance innate nonimmune protective mechanisms such as intestinal mucins. Cell culture studies have demonstrated that intestinal mucins are up-regulated by co-incubation with probiotics (Am J Physiol 1999;276:G941–G950). It is difficult from the design of this study to advocate the use of probiotic agents at this time; however, the results are provocative and a larger multicenter study with similar doses of mesalazine in the maintenance and induction phases will be of interest. D. R. Mack, M.D.
Should All Children With Helicobacter pylori Be Treated? Ganga-Zandzou PS, Michaud L, Vincent P, et al. Natural outcome of Helicobacter pylori infection in asymptomatic children: A two-year follow-up study. Pediatrics 1999;104: 216 –21. Although current recommendations do not include treating asymptomatic children infected with Helicobacter
WHAT’S NEW IN GI
THE AMERICAN JOURNAL OF GASTROENTEROLOGY © 2000 by Am. Coll. of Gastroenterology Published by Elsevier Science Inc.
WHAT’S NEW IN GI EDITOR
Jon S. Thompson, M.D., F.A.C.S. GASTROENTEROLOGY
Randall E. Brand Rene´e L. Young John K. DiBaise Hemant K. Roy Timothy M. McCashland RADIOLOGY
Aurelio Matamoros, Jr. Jeff L. Fidler
PATHOLOGY
James L. Wisecarver
LIVER STUDY UNIT
Carol A. Casey PEDIATRIC GASTROENTEROLOGY
David R. Mack University of Nebraska Medical Center Omaha, Nebraska
Probiotics for Ulcerative Colitis Therapy Rembacken BJ, Snelling AM, Hawkey PM, et al. Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: A randomized trial. Lancet 1999;354: 635–9. Probiotics are usually defined as noninfectious live bacteria that offer benefit to the host and normally colonize the intestinal tract. They have generally been found to offer benefit in prevention and/or treatment of infectious diarrhea. The authors of this single center study randomized 116 adult patients with clinically and histologically active ulcerative colitis to receive either mesalazine or a nonpathogenic Escherichia coli strain. Additionally, all patients received oral gentamicin for 1 wk at entry to the study. Randomization was then stratified so that the two patient groups had equivalent numbers of participants with mild, moderate, and severe colitis. Patient groups were found to be similar for age, gender, disease duration, smoking, and clinical activity index. Treatment of colitis was similar for the severity of the colitis (i.e., hydrocortisone enemas for mild proctocolitis, prednisolone 30 mg/day for more extensive disease, and prednisolone 60 mg/day for severe colitis). Patients not in remission after 12 wk were excluded. Sigmoidoscopy was performed and if it confirmed quiescent disease, patients were then maintained on mesalazine 1.2 g/day or on two capsules of the Escherichia coli daily while enemas or prednisolone were tapered. The number of patients in the mesalazine group compared to the probiotic group was similar for: achieving remission [44 (75%) vs 39 (67%)], time to remission (44 days vs
42 days), duration of remission (206 days vs 221 days), and number of patients relapsing (73% vs 67%) during the maximum 12-month follow-up period. This study employed a low dose of mesalazine for the maintenance phase of ulcerative colitis therapy. Compared to low dose therapy, there was no difference in the relapse rate with the relapse high for both groups. It is not clear how probiotic agents offer benefit to the host, but likely the mechanism will be complex in nature and may include alterations of the mucosal immune system. In addition, interactions of probiotic agents with mucosal epithelial cells may enhance innate nonimmune protective mechanisms such as intestinal mucins. Cell culture studies have demonstrated that intestinal mucins are up-regulated by co-incubation with probiotics (Am J Physiol 1999;276:G941–G950). It is difficult from the design of this study to advocate the use of probiotic agents at this time; however, the results are provocative and a larger multicenter study with similar doses of mesalazine in the maintenance and induction phases will be of interest. D. R. Mack, M.D.
Should All Children With Helicobacter pylori Be Treated? Ganga-Zandzou PS, Michaud L, Vincent P, et al. Natural outcome of Helicobacter pylori infection in asymptomatic children: A two-year follow-up study. Pediatrics 1999;104: 216 –21. Although current recommendations do not include treating asymptomatic children infected with Helicobacter
WHAT’S NEW IN GI
THE AMERICAN JOURNAL OF GASTROENTEROLOGY © 2000 by Am. Coll. of Gastroenterology Published by Elsevier Science Inc.