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Effect of Probiotics on Inducing Remission and Maintaining Therapy in Ulcerative Colitis, Crohn's Disease, and Pouchitis: Meta-analysis of Randomized Controlled Trials

Shen, Jun MD, PhD*; Zuo, Zhi-Xiang PhD; Mao, Ai-Ping PhD

doi: 10.1097/
Original Clinical Articles

Background: Whether probiotics are beneficial at all stages of treatment in inflammatory bowel disease or superior to placebo remains controversial.

Methods: Two reviewers independently selected randomized controlled trials comparing probiotics with controls in inflammatory bowel disease and extracted data related to remission/response rates, relapse rates, and adverse events. Subanalyses were also performed.

Results: Twenty-three randomized controlled trials with a total of 1763 participants met the inclusion criteria. From the meta-analysis, probiotics significantly increase the remission rates in patients with active ulcerative colitis (UC) (P = 0.01, risk ratio [RR] = 1.51). The remission rates were significantly higher in patients with active UC treated with probiotics than placebo (P < 0.0001, RR = 1.80). Unfortunately, subgroup analysis found that only VSL#3 significantly increased the remission rates compared with controls in patients with active UC (P = 0.004, RR = 1.74). Interestingly, VSL#3 (P < 0.00001, RR = 0.18) also significantly reduced the clinical relapse rates for maintaining remission in patients with pouchitis. No significantly different adverse events were detected between probiotics and controls in the treatment of UC (P = 0.94, RR = 0.99) or CD (P = 0.33, RR = 0.87).

Conclusions: Administration of probiotics results in additional benefit in inducing remission of patients with UC. VSL#3 are beneficial for maintaining remission in patients with pouchitis. And, probiotics can provide the similar effect as 5-aminosalicylic acid on maintaining remission of UC, although no additional adverse events presented.

Article first published online 25 November 2013Supplemental Digital Content is Available in the Text.

*Department of Gastroenterology, Renji Hospital, Shanghai Jiao-Tong University, School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China;

Department of Medicine, University of Chicago, Chicago, Illinois; and

Committee on Immunology, Department of Pathology, University of Chicago, Chicago, Illinois.

Reprints: Ai-Ping Mao, PhD, Committee on Immunology, Department of Pathology, University of Chicago, Chicago, IL 60637 (e-mail:

Supported by grants from National Natural Science Foundation of China (No. 81000161 and No.81170362).

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received September 16, 2013

Accepted October 15, 2013

© Crohn's & Colitis Foundation of America, Inc.
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