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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


In the article on page 21, volume 20, issue 1, there are some errors in the text and figures. During the review process, the authors found that two randomized controlled trials were inaccurately analyzed and one was mistakenly used.

In the study by Prantera et al (Ref 21), the number of patients in LGG group should be 18 instead of 15, while the number of patients in placebo group should be 19 instead of 17.

In the study by Kruis et al (Ref 24), the number of patients with adverse effect in probiotic group should be 68 instead of 62. Also, the correct numbers of relapsed patients should be 73 and 61 in probiotic and control groups, respectively.

In Ref 39, the study by Wildt et al presents results for patients with ulcerative colitis (UC), which is mistakenly regarded as pouchitis. The authors regret the oversight and thank Dr. S. Wildt for bringing this error to their attention.

As a result, the authors reanalyzed the original Fig. 4 and Figures 6–8 to correct the inaccuracy caused by the above errors. For Figures 5, 6B, 7B, 8, the overall results and conclusions were not affected by slightly change of patients numbers (data not shown). The corrected Figures 4, 6A, 7A were provided below.

The authors moved the study by Wildt et al from pouchitis to UC subgroup analysis in Figure 4, which did not affect the conclusion that probiotics treatment did not have significant advantage over control in maintaining treatment for UC (P = 0.50, RR = 0.91). The corrected Figure 4 showed that treatment with probiotics significantly reduced the relapse rate in patients with pouchitis (P < 0.00001, RR = 0.18). Since all the three remaining trials for pouchitis used VSL#3 in the probiotic group and placebo as control, there was little heterogeneity (P = 0.88, Fig. 4).

Since the study by Wildt et al was the only trial that used placebo as control in maintaining therapy for UC, adding this study to the subgroup analysis based on different trial design did not change the conclusion in Figure 6A. Also, this study was the only trial used bifidobacteria as probiotic treatment and thus did not affect Figure 7A. The original Figure 7C will be eliminated due to repeat subgroup analysis for pouchitis in Fig. 4.

In summary, the authors would like to correct their previous conclusion and emphasize that patients with pouchitis were actually significantly benefited from treatment with VSL#3.

The authors deeply regret their errors and sincerely apologize to those who might be affected.

Inflammatory Bowel Diseases. 20(12):2526-2528, December 2014.

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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