Lactobacillus GG in inducing and maintaining remission of Crohn's disease

TLDR

Luminal antigens contribute to chronic intestinal inflammation in Crohn’s disease and ulcerative colitis, and altering gut microflora with antibiotics or probiotics has been shown to induce and sustain remission. The study aimed to assess whether oral Lactobacillus GG could induce or maintain remission in patients with Crohn’s disease. Eleven moderate‑to‑active Crohn’s disease patients were randomized to receive 2 × 10⁹ CFU/day of Lactobacillus GG or placebo for six months while tapering steroids and receiving a week of antibiotics; sustained remission (no relapse defined as a CDAI increase >100) at six months was the primary endpoint. Only five of the eleven participants completed the trial, with two in each group achieving sustained remission; the median time to relapse was 16 ± 4 weeks for Lactobacillus GG versus 12 ± 4.3 weeks for placebo (p = 0.5), and the study found no evidence that Lactobacillus GG improves remission in Crohn’s disease.

Abstract

Experimental studies have shown that luminal antigens are involved in chronic intestinal inflammatory disorders such as Crohn's disease and ulcerative colitis. Alteration of the intestinal microflora by antibiotic or probiotic therapy may induce and maintain remission. The aim of this randomized, placebo-controlled trial was to determine the effect of oral Lactobacillus GG (L. GG) to induce or maintain medically induced remission. Eleven patients with moderate to active Crohn's disease were enrolled in this trial to receive either L. GG (2 × 109 CFU/day) or placebo for six months. All patients were started on a tapering steroid regime and received antibiotics for the week before the probiotic/placebo medication was initiated. The primary end point was sustained remission, defined as freedom from relapse at the 6 months follow-up visit. Relapse was defined as an increase in CDAI of >100 points. 5/11 patients finished the study, with 2 patients in each group in sustained remission. The median time to relapse was 16 ± 4 weeks in the L. GG group and 12 ± 4.3 weeks in the placebo group (p = 0.5). In this study we could not demonstrate a benefit of L. GG in inducing or maintaining medically induced remission in CD.