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Editor,—We read with interest the therapy update by Shanahan (
). This is an excellent summary of the potential role of bacteria both in the pathogenesis and treatment of inflammatory bowel disease (IBD). The author is correct in stating that our knowledge of the composition and interactions of endemic gut bacteria remains limited. However, the increasing data showing a reduction in inflammation and symptoms in experimental and clinical enterocolitis treated with probiotics1 strengthen the hypothesis that bacteria are involved in the aetiology of IBD.2
It is indeed unlikely that a single probiotic will be effective in everyone with IBD as different bacteria may be contributing to the persistence of intestinal inflammation in individual patients. Similarly, different species of probiotic bacteria may be the dominant protective bacterial species in each patient. Therefore, as the author rightly comments, a single probiotic is unlikely to be equally effective in all patients.
We have shown for the first time that treatment withLactobacillus plantarum species 299 stabilises the gut mucosal barrier in patients with ulcerative colitis and in the interleukin 10 knockout mouse model of colitis.3 4 There was also a reduction in laboratory markers and indices of disease activity in ulcerative colitis patients.4 These findings suggest that probiotic therapy, by reducing intestinal inflammation, results in stabilisation of the gut mucosal barrier and a consequent reduction in the systemic inflammatory response in patients with ulcerative colitis. Further research is required to elucidate the mechanisms by which these bacteria reduce inflammation and improve symptoms in patients with IBD.
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