Inflammatory bowel diseases (IBD) are chronic inflammatory conditions of the intestines that are believed to be induced by abnormal activation of the immune cells in response to resident intestinal bacteria in genetically susceptible hosts. Probiotics, prebiotics and dietary fibres alter the gut microbiota and improve its function, thus potentially counteracting the development of inflammation. Unlike the current standard medications for IBD, these supplements are relatively safe. As such they are suggested as promising novel adjuvant modalities in the treatment of IBD. Although the role of these compounds in the prevention and treatment of IBD is understudied, there seems to be a widespread, undocumented use of these supplements by patients. Identification of usage of probiotics and prebiotics in IBD patients, will allow for optimization of therapy, and improved clinical outcomes. To assess the intake of probiotics, prebiotics and dietary fibre supplements in patients with IBD in Edmonton, Alberta. A cross-sectional, observational study using a 20-item survey questionnaire was used in patients with a diagnosis of IBD in the IBD Clinic at the University of Alberta. Data regarding demographics, disease characteristics, use and knowledge of probiotics, prebiotics and dietary fibre supplements was collected and analyzed using Fisher’s exact test. In this pilot study, 23 participants with a known diagnosis of IBD (57% ulcerative colitis, 39% Crohn’s disease, 4% indeterminate colitis) completed survey questionnaires. Statistical analysis demonstrated that a large number of participants were knowledgeable about probiotics and dietary fibres, but less about prebiotics (87% probiotics, 74% fibres, 43% prebiotics, P < 0.38). Sixty five per cent of surveyed patients have used these products in the past. However, regular usage (in the last year), was much lower (48% probiotics, 28% fibres, 4% prebiotics). Of those who used these alternative treatments in the past, 31% of patients experienced an increase in quality of life (QoL). Those without a university degree were more likely to use these products (67%, P < 0.37). The effect of gender on usage was negligible (53% males, 47% females, P < 1.0). Preliminary results did not reach statistical significance. This pilot study shows that a large proportion of IBD patients have used probiotics, prebiotics and dietary fibre supplements in the past despite the lack of well-proven efficacy. Since these microbiota targeting strategies have a great potential to improve disease outcomes, it is important that clinicians and researchers document their use. CIHR

Inflammatory bowel diseases (IBD) are chronic inflammatory conditions of the intestines likely induced by abnormal immune response to resident intestinal bacteria in genetically susceptible hosts. Probiotics, prebiotics and dietary fibres alter the gut microbiota and improve its function, thus potentially counteracting the development of inflammation. Although the role of these compounds in the prevention and management of IBD is relatively understudied, anecdotal evidence suggests widespread, undocumented use of these supplements by patients. Investigating the use of probiotics and prebiotics by IBD patients and association with disease severity may allow for optimization of therapy and improved clinical outcomes. To assess if the self-motivated intake of probiotics, prebiotics and dietary fibre supplements is associated with the disease severity in patients with IBD. We conducted a cross-sectional study of patients with a diagnosis of IBD in the University of Alberta IBD clinic. Using a 20-item questionnaire we collected data from patients on demographics, disease characteristics and knowledge and use of probiotics, prebiotics and dietary fibre supplements. We used a chart review to ascertain the occurrence of flares, disease duration and objective markers of inflammation such as fecal calprotectin (FCP) as indicators of disease severity. In this study, 100 participants (45% females) with a known diagnosis of IBD (47% Crohn’s disease, 34% ulcerative colitis, 19% IBD-unclassified) completed questionnaires. Large proportions of participants were knowledgeable about probiotics (88%) and dietary fibres (76%), but less about prebiotics (42%). The majority of users had Crohn’s disease (42% CD vs. 35% UC, p=0.33). 66% of surveyed patients had used these products as an alternate therapy. Disease flares in the last two years did not have an effect on usage (73% users vs. 71% non-users, p=0.8). The use of alternative therapies was higher in patients with longer history of IBD (77% in those with a duration >5 years vs. 22% in those with a duration <5 years, p=1.0). Close to half of patients (48%) with a fecal calprotectin (FCP) >250 µg/g (an indicator of acute disease) during the preceding six months reported supplement use, compared to 52% with FCP values below this value (P=0.11). This study shows that a large proportion of IBD patients are interested in alternative therapies for IBD. Increased flare frequency and objective markers of inflammation did not have an effect on usage. However, longer disease history was the main factor influencing the search for a “cure” by the patients. These microbiota-altering strategies have the ability to affect disease outcomes, therefore clinicians and researchers should identify and document their use. CIHR