[Probiotics have a limited role in the treatment of inflammatory bowel disease]

Probiotics are frequently prescribed for the treatment of inflammatory bowel disease (IBD). However, supporting evidence for the use of probiotics in IBD is scarce. Most studies are limited by design or do not show that probiotic treatment is effective. Only a few randomised controlled trials have demonstrated any beneficial effect of probiotic use in IBD; namely, the use of VSL#3 in patients with pouchitis and ulcerative colitis. So far, the efficacy of probiotics in the treatment of Crohn's disease has not been clearly demonstrated. Furthermore, issues pertaining to their mechanisms of action, dosages and dosing intervals, safety, and health insurance coverage are currently unresolved. Given the limited body of evidence of their efficacy from controlled trials and the many unanswered questions on probiotic treatment, we recommend following the evidence obtained from well-designed randomised controlled trials and only prescribing probiotic treatment (e.g. VSL #3) for the prevention of pouchitis and the treatment of patients with mildly active ulcerative colitis.