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World J Gastroenterol. Apr 14, 2023; 29(14): 2078-2100
Published online Apr 14, 2023. doi: 10.3748/wjg.v29.i14.2078
Role of prebiotics, probiotics, and synbiotics in management of inflammatory bowel disease: Current perspectives
Supriya Roy, Suneela Dhaneshwar
Supriya Roy, Amity Institute of Pharmacy, Lucknow, Amity University Uttar Pradesh, Sector 125, Noida 201313, Uttar Pradesh, India
Suneela Dhaneshwar, Amity Institute of Pharmacy, Amity University Maharashtra, Mumbai 410206, Maharashtra, India
Author contributions: Dhaneshwar S conceived the idea and designed the review article protocol, edited the final draft of the manuscript; Roy S collected the data and wrote the paper; and all authors reviewed and approved the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Suneela Dhaneshwar, PhD, Director, Pharmacist, Professor, Researcher, Amity Institute of Pharmacy, Amity University Maharashtra, Mumbai-Pune Expressway, Bhatan, Post-Somathne, Panvel, Mumbai 410206, Maharashtra, India.
Received: October 28, 2022
Peer-review started: October 28, 2022
First decision: November 14, 2022
Revised: November 29, 2022
Accepted: March 21, 2023
Article in press: March 21, 2023
Published online: April 14, 2023

Experimental evidence supports the fact that changes in the bowel microflora due to environmental or dietary factors have been investigated as implicating factors in the etiopathogenesis of inflammatory bowel disease (IBD). The amassing knowledge that the inhabited microbiome regulates the gut physiology and immune functions in IBD, has led researchers to explore the effectiveness of prebiotics, probiotics, and synbiotics in treating IBD. This therapeutic approach focuses on restoring the dynamic balance between the microflora and host defense mechanisms in the intestinal mucosa to prevent the onset and persistence of intestinal inflammation. Numerous microbial strains and carbohydrate blends, along with their combinations have been examined in experimental colitis models and clinical trials, and the results indicated that it can be an attractive therapeutic strategy for the suppression of inflammation, remission induction, and relapse prevention in IBD with minimal side effects. Several mechanisms of action of probiotics (for e.g., Lactobacillus species, and Bifidobacterium species) have been reported such as suppression of pathogen growth by releasing certain antimicrobial mediators (lactic and hydrogen peroxide, acetic acid, and bacteriocins), immunomodulation and initiation of an immune response, enhancement of barrier activity, and suppression of human T-cell proliferation. Prebiotics such as lactulose, lactosucrose, oligofructose, and inulin have been found to induce the growth of certain types of host microflora, resulting in an enriched enteric function. These non-digestible food dietary components have been reported to exert anti-inflammatory effects by inhibiting the expression of tumor necrosis factor-α-related cytokines while augmenting interleukin-10 levels. Although pro-and prebiotics has established their efficacy in healthy subjects, a better understanding of the luminal ecosystem is required to determine which specific bacterial strain or combination of probiotics and prebiotics would prove to be the ideal treatment for IBD. Clinical trials, however, have given some conflicting results, requiring the necessity to cite the more profound clinical effect of these treatments on IBD remission and prevention. The purpose of this review article is to provide the most comprehensive and updated review on the utility of prebiotics, probiotics, and synbiotics in the management of active Crohn’s disease and ulcerative colitis/pouchitis.

Keywords: Ulcerative colitis, Crohn’s disease, Pouchitis, Dysbiosis, Microbiota, Inflammation

Core Tip: Current treatments for inflammatory bowel disease (IBD), such as corticosteroids and immunosuppressants, have potential adverse effects, and a significant proportion of patients dependent on these treatments are exposed to these associated long-term side effects. The discovery of novel and efficacious therapeutic strategies is a worldwide goal of IBD research, and probiotics, prebiotics, and synbiotics can offer viable solutions. These products offer a novel strategy to deliver beneficial components into the gut and emerge as promising new treatments for IBD, as intestinal dysbiosis has been reported as a major cause of his IBD. The review highlights the current state and action mechanism of these microbial therapies along with various studies that have reported their effectiveness in restoring balance in the gastrointestinal microbiota and thus eventually reducing intestinal inflammation.