By Melisa Bunderson-Schelvan, PhD, DCT(P)
Ulcerative colitis (UC) is a type of inflammatory bowel disease that affects individuals of any age group with symptoms that can range from mild to severe. Extreme cases often result in total proctocolectomy with ileostomy in order to prevent colon cancer, which has an increased occurrence in uncontrolled UC patients. There is a significant need for alternative strategies for treating UC, and this need has resulted in the development of a new study to examine the efficacy of a direct method for probiotic delivery on severity and length of remission in UC patients. The goal of the study is to extend the periods of inactive disease and reduce the severity of subsequent flares.
The proposed study is anticipated to examine the differences in patient response to probiotics taken orally or through direct implantation to the large intestine using colon hydrotherapy in patients with controlled UC.
While it is unknown precisely what causes an episode of active UC, research has indicated that an aberrant immune response against the populations of resident microflora may play a role.1 Accordingly, both anti-inflammatory and antibiotic drug therapies have been used to treat UC. However, these treatments have potentially serious side effects and have been used only with limited success. Alternatively, probiotics have been successfully used both to induce and maintain remission of UC patients in a number of studies with minimal side effects.2-4
Therefore, the use of probiotics in the treatment of UC is arguably one of the most promising therapies due to its demonstrated efficacy and lack of side effects. Nonetheless, there are inherent difficulties to oral administration of a “living" therapy which must reach the large intestine in a viable state. Such factors include known differences in pH, transit time, pancreatic enzyme activity and liver status which may affect the environment within the GI tract of individuals.
These differences likely interfere with the viability of the probiotics once they reach the target area of the large intestine and contribute to the unreliability of patient response associated with their use. Consequently, probiotics are not currently a first line therapy for the treatment of UC.
However, it is possible that bypassing these factors and directly applying the probiotics to the large intestine will result in a more effective treatment as well as improving the consistency of desired outcome in patients.