Clinical utility of probiotics in inflammatory bowel disease

Many patients with inflammatory bowel disease (IBD) use probiotics 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 IBD, the history behind current research directions, and recent controlled clinical studies in which efficacy of probiotics has been explored in patients with IBD. Emphasis is placed upon critical analysis of study designs for investigations that used lactic acid-producing bacteria or Saccharomyces boulardii in management of Crohn's disease or ulcerative colitis. While there is suggestion of benefit when patients with ulcerative colitis use bacterial therapies and when patients with Crohn's disease use S boulardii, small sample sizes and methodological flaws in study designs necessitate that additional investigations be conducted before probiotics can be routinely recommended in clinical practice.