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The double-blind placebo controlled study performed by Benjamin et al1 published in Gut (see page 923) shows that the daily consumption of 15 g fructo-oligosaccharides (FOS) worsens the clinical signs of active Crohn's disease. The message for the clinician and the patient is clear: despite a strong rationale and hopes from open studies,2 there is presently no evidence of efficacy of prebiotics in Crohn's disease. The same conclusion applies for probiotics and synbiotics.3 However, one should avoid throwing the baby out with the bath water.
Descriptive studies of the microbiota and microenvironment in Crohn's disease have repeatedly shown dysbiosis, which is probably partly a consequence of the ecological modifications induced …