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Factors associated with the prescription of probiotics in patients with inflammatory bowel disease: a cross-sectional study

  • Joo Kyung Kim (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Jae Hee Cheon (Department of Internal Medicine, Yonsei University College of Medicine)
  • Received : 2022.01.08
  • Accepted : 2022.03.17
  • Published : 2023.01.31

Abstract

Background: Commensal bacteria play an important role in the pathogenesis of inflammatory bowel disease (IBD) and probiotics have been used as treatment options. We aimed to explore the current use of probiotics and factors associated with their prescription in patients with IBD. Methods: This cross-sectional study was conducted on a single hospital-based cohort. Patients were eligible if they were ≥18 years old, visited the IBD clinic as an outpatient more than twice during the study period, and had a confirmed diagnosis of IBD. Patients were divided into two groups based on the prescription of probiotics. Clinical assessments were compared between the two groups. Results: In total, 217 patients were enrolled in this study. In patients with Crohn disease (CD), moderate or severe abdominal pain; prior use of methotrexate (MTX), iron, thiopurines, or biologics; history of IBD-related surgery; and stool frequency were independently associated with the prescription of probiotics. In patients with ulcerative colitis (UC), moderate or severe abdominal pain, hematochezia, stool frequency, and moderate or severe physician global assessment score were independently associated with the prescription of probiotics. Conclusion: Increased disease activity may be associated with fewer prescriptions of probiotics in patients with IBD. However, physicians prescribed probiotics to control symptoms, such as abdominal pain and increased stool frequency in patients with UC and CD, and hematochezia in patients with UC. Additionally, the use of MTX and iron, and a history of IBD-related surgeries were associated with more frequent probiotic prescriptions in patients with CD.

Keywords

References

  1. Ramos GP, Papadakis KA. Mechanisms of disease: inflammatory bowel diseases. Mayo Clin Proc 2019;94:155-65. https://doi.org/10.1016/j.mayocp.2018.09.013
  2. Mizoguchi E, Low D, Ezaki Y, Okada T. Recent updates on the basic mechanisms and pathogenesis of inflammatory bowel diseases in experimental animal models. Intest Res 2020;18:151-67. https://doi.org/10.5217/ir.2019.09154
  3. Khor B, Gardet A, Xavier RJ. Genetics and pathogenesis of inflammatory bowel disease. Nature 2011;474:307-17. https://doi.org/10.1038/nature10209
  4. Elson CO, Cong Y, McCracken VJ, Dimmitt RA, Lorenz RG, Weaver CT. Experimental models of inflammatory bowel disease reveal innate, adaptive, and regulatory mechanisms of host dialogue with the microbiota. Immunol Rev 2005;206:260-76. https://doi.org/10.1111/j.0105-2896.2005.00291.x
  5. Norouzinia M, Chaleshi V, Alizadeh AH, Zali MR. Biomarkers in inflammatory bowel diseases: insight into diagnosis, prognosis and treatment. Gastroenterol Hepatol Bed Bench 2017;10:155-67.
  6. Mow WS, Vasiliauskas EA, Lin YC, Fleshner PR, Papadakis KA, Taylor KD, et al. Association of antibody responses to microbial antigens and complications of small bowel Crohn's disease. Gastroenterology 2004;126:414-24. https://doi.org/10.1053/j.gastro.2003.11.015
  7. Jakubczyk D, Leszczynska K, Gorska S. The effectiveness of probiotics in the treatment of inflammatory bowel disease (IBD): a critical review. Nutrients 2020;12:1973.
  8. Choi CH, Moon W, Kim YS, Kim ES, Lee BI, Jung Y, et al. Second Korean guidelines for the management of ulcerative colitis. Intest Res 2017;15:7-37. https://doi.org/10.5217/ir.2017.15.1.7
  9. Park JJ, Yang SK, Ye BD, Kim JW, Park DI, Yoon H, et al. Second Korean guidelines for the management of Crohn's disease. Intest Res 2017;15:38-67. https://doi.org/10.5217/ir.2017.15.1.38
  10. Maaser C, Sturm A, Vavricka SR, Kucharzik T, Fiorino G, Annese V, et al. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis 2019;13:144-64. https://doi.org/10.1093/ecco-jcc/jjy113
  11. Sutherland LR, Martin F, Greer S, Robinson M, Greenberger N, Saibil F, et al. 5-Aminosalicylic acid enema in the treatment of distal ulcerative colitis, proctosigmoiditis, and proctitis. Gastroenterology 1987;92:1894-8. https://doi.org/10.1016/0016-5085(87)90621-4
  12. Kim SB, Park SJ, Chung SH, Hahn KY, Moon DC, Hong SP, et al. Vaccination and complementary and alternative medicine in patients with inflammatory bowel disease. Intest Res 2014;12:124-30. https://doi.org/10.5217/ir.2014.12.2.124
  13. Irving P, Barrett K, Nijher M, de Lusignan S. Prevalence of depression and anxiety in people with inflammatory bowel disease and associated healthcare use: population-based cohort study. Evid Based Ment Health 2021;24:102-9. https://doi.org/10.1136/ebmental-2020-300223
  14. Opheim R, Hoivik ML, Solberg IC, Moum B; IBSEN Study Group. Complementary and alternative medicine in patients with inflammatory bowel disease: the results of a population-based inception cohort study (IBSEN). J Crohns Colitis 2012;6:345-53. https://doi.org/10.1016/j.crohns.2011.09.007
  15. Tamaki H, Nakase H, Inoue S, Kawanami C, Itani T, Ohana M, et al. Efficacy of probiotic treatment with Bifidobacterium longum 536 for induction of remission in active ulcerative colitis: a randomized, double-blinded, placebo-controlled multicenter trial. Dig Endosc 2016;28:67-74. https://doi.org/10.1111/den.12553
  16. Tursi A, Brandimarte G, Papa A, Giglio A, Elisei W, Giorgetti GM, et al. Treatment of relapsing mild-to-moderate ulcerative colitis with the probiotic VSL#3 as adjunctive to a standard pharmaceutical treatment: a double-blind, randomized, placebo-controlled study. Am J Gastroenterol 2010;105:2218-27. https://doi.org/10.1038/ajg.2010.218
  17. van der Waal MB, Flach J, Browne PD, Besseling-van der Vaart I, Claassen E, van de Burgwal LH. Probiotics for improving quality of life in ulcerative colitis: exploring the patient perspective. Pharmanutrition 2019;7:100139.
  18. Palumbo VD, Romeo M, Marino Gammazza A, Carini F, Damiani P, Damiano G, et al. The long-term effects of probiotics in the therapy of ulcerative colitis: a clinical study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2016;160:372-7. https://doi.org/10.5507/bp.2016.044
  19. Plein K, Hotz J. Therapeutic effects of Saccharomyces boulardii on mild residual symptoms in a stable phase of Crohn's disease with special respect to chronic diarrhea: a pilot study. Z Gastroenterol 1993;31:129-34.
  20. Fujimori S, Tatsuguchi A, Gudis K, Kishida T, Mitsui K, Ehara A, et al. High dose probiotic and prebiotic cotherapy for remission induction of active Crohn's disease. J Gastroenterol Hepatol 2007;22:1199-204. https://doi.org/10.1111/j.1440-1746.2006.04535.x
  21. Matsuoka K, Uemura Y, Kanai T, Kunisaki R, Suzuki Y, Yokoyama K, et al. Efficacy of bifidobacterium breve fermented milk in maintaining remission of ulcerative colitis. Dig Dis Sci 2018;63:1910-9. https://doi.org/10.1007/s10620-018-4946-2
  22. Dore MP, Bibbo S, Fresi G, Bassotti G, Pes GM. Side effects associated with probiotic use in adult patients with inflammatory bowel disease: a systematic review and meta-analysis of randomized controlled trials. Nutrients 2019;11:2913.
  23. Jitsumura M, Kokelaar RF, Harris DA. Remission endpoints in ulcerative colitis: a systematic review. World J Metaanal 2017;5: 85-102. https://doi.org/10.13105/wjma.v5.i4.85
  24. Frolkis AD, Dykeman J, Negron ME, Debruyn J, Jette N, Fiest KM, et al. Risk of surgery for inflammatory bowel diseases has decreased over time: a systematic review and meta-analysis of population-based studies. Gastroenterology 2013;145:996-1006. https://doi.org/10.1053/j.gastro.2013.07.041
  25. Ueno F, Matsui T, Matsumoto T, Matsuoka K, Watanabe M, Hibi T, et al. Evidence-based clinical practice guidelines for Crohn's disease, integrated with formal consensus of experts in Japan. J Gastroenterol 2013;48:31-72. https://doi.org/10.1007/s00535-012-0673-1
  26. Fedorak RN, Feagan BG, Hotte N, Leddin D, Dieleman LA, Petrunia DM, et al. The probiotic VSL#3 has anti-inflammatory effects and could reduce endoscopic recurrence after surgery for Crohn's disease. Clin Gastroenterol Hepatol 2015;13:928-35. https://doi.org/10.1016/j.cgh.2014.10.031
  27. Campieri M, Rizzello F, Venturi A, Poggioli G, Ugolini F. Combination of antibiotic and probiotic treatment is efficacious in prophylaxis of post-operative recurrence of Crohn's disease: a randomized controlled study vs mesalamine. Gastroenterology 2000;118:A781.
  28. Prantera C, Scribano ML, Falasco G, Andreoli A, Luzi C. Ineffectiveness of probiotics in preventing recurrence after curative resection for Crohn's disease: a randomised controlled trial with Lactobacillus GG. Gut 2002;51:405-9. https://doi.org/10.1136/gut.51.3.405
  29. Marteau P, Lemann M, Seksik P, Laharie D, Colombel JF, Bouhnik Y, et al. Ineffectiveness of Lactobacillus johnsonii LA1 for prophylaxis of postoperative recurrence in Crohn's disease: a randomised, double blind, placebo controlled GETAID trial. Gut 2006;55:842-7. https://doi.org/10.1136/gut.2005.076604
  30. Gao X, Tang Y, Lei N, Luo Y, Chen P, Liang C, et al. Symptoms of anxiety/depression is associated with more aggressive inflammatory bowel disease. Sci Rep 2021;11:1440.
  31. Maconi G, Gridavilla D, Vigano C, Sciurti R, Asthana AK, Furfaro F, et al. Perianal disease is associated with psychiatric co-morbidity in Crohn's disease in remission. Int J Colorectal Dis 2014;29:1285-90. https://doi.org/10.1007/s00384-014-1935-6
  32. McDonald JW, Wang Y, Tsoulis DJ, MacDonald JK, Feagan BG. Methotrexate for induction of remission in refractory Crohn's disease. Cochrane Database Syst Rev 2014;2014:CD003459.
  33. Southcott E, Tooley KL, Howarth GS, Davidson GP, Butler RN. Yoghurts containing probiotics reduce disruption of the small intestinal barrier in methotrexate-treated rats. Dig Dis Sci 2008;53:1837-41. https://doi.org/10.1007/s10620-008-0275-1
  34. Kulnigg S, Gasche C. Systematic review: managing anaemia in Crohn's disease. Aliment Pharmacol Ther 2006;24:1507-23. https://doi.org/10.1111/j.1365-2036.2006.03146.x
  35. Constante M, Fragoso G, Lupien-Meilleur J, Calve A, Santos MM. Iron supplements modulate colon microbiota composition and potentiate the protective effects of probiotics in dextran sodium sulfate-induced colitis. Inflamm Bowel Dis 2017;23:753-66. https://doi.org/10.1097/MIB.0000000000001089
  36. Hoppe M, Onning G, Hulthen L. Freeze-dried Lactobacillus plantarum 299v increases iron absorption in young females: double isotope sequential single-blind studies in menstruating women. PLoS One 2017;12:e0189141.
  37. Dignass AU, Gasche C, Bettenworth D, Birgegard G, Danese S, Gisbert JP, et al. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel https://doi.org/10.12701/jyms.2022.00031 diseases. J Crohns Colitis 2015;9:211-22.
  38. Banerjee R, Chuah SW, Hilmi IN, Wu DC, Yang SK, Demuth D, et al. Efficacy and safety of vedolizumab in Crohn's disease in patients from Asian countries in the GEMINI 2 study. Intest Res 2021;19:83-94. https://doi.org/10.5217/ir.2019.09160
  39. Feagan BG, Sandborn WJ, Gasink C, Jacobstein D, Lang Y, Friedman JR, et al. Ustekinumab as induction and maintenance therapy for Crohn's disease. N Engl J Med 2016;375:1946-60. https://doi.org/10.1056/NEJMoa1602773
  40. Norton BA, Thomas R, Lomax KG, Dudley-Brown S. Patient perspectives on the impact of Crohn's disease: results from group interviews. Patient Prefer Adherence 2012;6:509-20. https://doi.org/10.2147/PPA.S32690