Understanding why probiotic therapies can be effective in treating IBD.J Clin Gastroenterol 2008; 42 Suppl 3 Pt 1:S111-5JC
Probiotics, for the treatment of inflammatory bowel disease, are a group of specific nonpathogenic bacteria that are functionally and genetically defined by their ability to reduce inflammation in the intestine. Although probiotics also seem to have broad beneficial effects in humans, both as a food and as a therapeutic agent, there are specific identified mechanisms in some, but not all, of these bacteria that are important relative to the pathogenesis of inflammatory bowel disease. Recently, studies relative to the mechanism of action of probiotics have identified that these organisms can have a direct effect on epithelial cell function and intestinal health, including enhancing epithelial barrier function, modulating epithelial cytokine secretion into an anti-inflammatory dominant profile, altering mucus production, changing bacterial luminal flora, modifying the innate and systemic immune system, and inducing regulatory T-cell effects. For probiotics to have a therapeutic role in the management of clinical inflammatory bowel disease, their therapeutic mechanism of action must be aligned with the pathogenic mechanism of action of the disease. In this regard, the role of probiotics for the clinical treatment of inflammatory bowel disease is emerging as the mechanisms and pathogenesis are being unraveled. It remains clear that probiotics are able to reduce gastrointestinal inflammation by exerting positive effects on epithelial cell and mucosal immune dysfunction.