The following is a summary of “Prebiotics for Induction and Maintenance of Remission in Inflammatory Bowel Disease: Systematic Review and Meta-Analysis,” published in the May 2024 issue of Gastroenterology by Limketkai et al.

Despite prebiotics’ ability to promote gut health, their effectiveness in treating inflammatory bowel disease (IBD) remains uncertain.

Researchers conducted a retrospective study to comprehensively assess the existing body of research on prebiotics as a treatment for IBD.

They searched in PubMed, Embase, Cochrane, and Web of Science. Eligible articles were randomized controlled trials or prospective observational studies that included comparing a prebiotic with a placebo or lower-dose control in patients with IBD. Meta-analyses used random-effects models to assess clinical remission, relapse, and AEs.

The results showed that in 17 studies, for induction of clinical remission in ulcerative colitis (UC), fructooligosaccharide (FOS) kestose showed effectiveness with a relative risk of 2.75 (95% CI, 1.05-7.20; n = 40), while oligofructose-enriched inulin (OF-IN) and lactulose did not. For maintenance of remission in UC, germinated barley foodstuff showed a trend towards preventing clinical relapse with a relative risk of 0.40 (95% CI, 0.15-1.03; n = 59), but not with OF-IN, oat bran, and Plantago ovata. For Crohn’s disease (CD), OF-IN and lactulose were comparable to controls for remission induction, and FOS was comparable to controls for maintenance of remission. Flatulence and bloating were more familiar with OF-IN, while reported AEs were otherwise similar to controls for other prebiotics.

Investigators concluded that while prebiotics, particularly FOS and germinated barley foodstuff, showed promise for UC treatment, the overall evidence was of very low certainty, highlighting the need for further research on prebiotics as potential complementary therapies for IBD.

Source: academic.oup.com/ibdjournal/advance-article-abstract/doi/10.1093/ibd/izae115/7680448