Did you know that every surface of your skin is covered with bacteria? Most of the time, these bacteria live on your skin without causing any problems. Problems occur when there is a break in the skin or an infection with harmful bacteria. Did you also know that the inside wall of your intestines are covered with bacteria as well? Again, most of the time the intestinal bacteria do not cause problems. In fact, some bacteria actually aid in digestion and prevent other bacteria from occupying that space. This is the basic concept of probiotics, so-called “good” bacteria. Probiotics are intended to supply healthy, gut-friendly bacteria to populate the intestinal wall.

Ulcerative Colitis and Bacteria

Ulcerative colitis is an inflammatory disease of the large intestine that causes bloody diarrhea, cramping, and bloating. The disease has an unusual course in that it is relapsing and remitting. There will be times that the disease is quiet and then it will flare up, causing symptoms. Standard medical treatment has two components: keeping the flare-ups from happening and treating the active flare-up when it occurs. Active flare-ups are often treated with corticosteroids like prednisone. For long-term maintenance, however, doctors and patients prefer drugs other than steroids. While the precise cause of ulcerative colitis is not known, it is believed to be related to problems with the immune system in the gut.1 In fact, current theories hold that an imbalance of gut bacterial flora (normal, healthy bacterial content of the bowel) may exacerbate the disease.2 

Can Probiotics Stop a Flare-up of Ulcerative Colitis?

Recently, a group of researchers collected and reviewed all the clinical studies that examined probiotics for the treatment of active ulcerative colitis—in a report called a systematic review—and found that probiotics do not shorten the duration of a flare-up when added to regular treatment. The researchers reviewed studies on several different types of probiotics and found that none was able to induce remission faster than placebo or no treatment.3 Likewise, no preparation of probiotics was able to resolve the clinical symptoms of the disease faster than people not taking probiotics, the control group. Interestingly, ulcerative colitis patients taking probiotics reported fewer and less-severe symptoms during the flare-up, according to this review of studies. In other words, while probiotics did not end the flare-up faster, the severity of symptoms was not as bad in patients taking probiotics. 

Are Probiotics a Useful Ulcerative Colitis Maintenance Treatment?

Some clinical studies have shown that probiotics may be as effective as traditional ulcerative colitis medications, including the gold-standard treatment mesalazine. German researchers followed a group of 327 patients with a history of ulcerative colitis, giving half of them the standard drug mesalazine and the other half probiotics (namely Escherichia coli Nissle 1917). After one year of treatment, the average time to remission was the same in both groups and the quality of remission (time without a flare-up) was the same in both groups.4 Similar results were seen in other studies. 5 Another probiotic, Lactobacillus GG, may also be helpful in sustaining remission in ulcerative colitis. 1

What Are the Potential Drawbacks of Probiotics?

So far, no serious side effects have been associated with prolonged use of probiotics in ulcerative colitis. In a systematic review of studies, the rate of side effects was the same in probiotics users as in those taking mesalazine.6 However, as these agents are cultures of living bacteria, caution should be used in patients with compromised immune systems (such as those on long-term corticosteroids). Generally speaking, the potential benefits of probiotics over traditional pharmacological interventions for ulcerative colitis are that they are potentially less expensive and possibly safer over long periods. They may also protect against other diseases of the bowel including Clostridium difficile colitis, travelers’ diarrhea, and diarrhea associated with prolonged use of antibiotics.

Probiotics are probably not useful in inducing a faster remission during a flare-up of ulcerative colitis, however, the preparations of healthy bacteria may make the symptoms less severe. Probiotics may be helpful in increasing the time between flare-ups. This benefit may be even more impressive when added to standard maintenance therapy. While probiotics are generally free of serious adverse events (side effects), it is important to consult with your physician before adding probiotics to your ulcerative colitis treatment regimen. This is especially important if you have a compromised immune system or are on high-dose corticosteroids.