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Evidence summaries

Probiotics Versus Mesalazine or Placebo for Maintenance of Remission in Ulcerative Colitis

There is insufficient evidence to make conclusions about the efficacy of probiotics compared to mesalazine or placebo for maintenance of remission in ulcerative colitis. Level of evidence: "D"

The quality of evidence is downgraded by study quality (incomplete outcome data, lack of blinding and unclear allocation concealment).

Summary

A Cochrane review [Abstract] 1 included 3 studies with a total of 587 subjects to assess the effectiveness of probiotics for maintenance of remission in ulcerative colitis. The studies ranged in length from 3 to 12 months.

Three trials (n=555) compared probiotics to mesalazine. There was no statistically significant difference between probiotics and mesalazine. Relapse was reported in 40.1% of patients in the probiotics group compared to 34.1% of patients in the mesalazine group (OR 1.33; 95% CI 0.94 to 1.90; I2 = 11%). Adverse events were reported in two studies (n=430). Twenty-six per cent of patients in the probiotics group experienced at least one adverse event compared to 24% of patients in the mesalazine group (OR 1.21; 95% CI 0.80 to 1.84; I2 =27%). Adverse events reported include diarrhea, mucous secretion, bloody stools, abdominal pain, flatulence and distension, nausea and vomiting and headache.

A small placebo controlled trial (n = 32) found no statistically significant difference in efficacy. Seventy-five per cent of probiotic patients relapsed at one year compared to 92% of placebo patients (OR 0.27; 95% CI 0.03 to 2.68).

Clinical comments

Note

Date of latest search:

    References

    • Naidoo K, Gordon M, Fagbemi AO et al. Probiotics for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev 2011;12:CD007443. [PubMed]

Primary/Secondary Keywords