[Probiotics and prebiotics in inflammatory bowel disease]

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.