Prophylaxis of pouchitis onset with probiotic therapy: a double-blind, placebo-controlled trial

Gastroenterology. 2003 May;124(5):1202-9. doi: 10.1016/s0016-5085(03)00171-9.


Background & aims: We have recently documented the efficacy of a highly concentrated probiotic preparation (VSL#3) in the prevention of flare-up in patients with chronic pouchitis. The aim of this study was to compare probiotic therapy with VSL#3 versus placebo in the ability to prevent the onset of acute pouchitis during the first year after ileal pouch-anal anastomosis.

Methods: Forty consecutive patients who underwent ileal pouch-anal anastomosis for ulcerative colitis were randomized to receive either VSL#3 (1 packet containing 900 billion bacteria/day) (n = 20) or an identical placebo (n = 20) immediately after ileostomy closure for 1 year. The patients were assessed clinically, endoscopically, and histologically after 1, 3, 6, 9, and 12 months. Health-related quality of life was assessed using the Inflammatory Bowel Disease Questionnaire.

Results: Two of the 20 patients (10%) treated with VSL#3 had an episode of acute pouchitis compared with 8 of the 20 patients (40%) treated with placebo (log-rank test, z = 2.273; P < 0.05). Treatment with VSL#3 determined a significant improvement in Inflammatory Bowel Disease Questionnaire score, whereas this was not the case with placebo.

Conclusions: Treatment with VSL#3 is effective in the prevention of the onset of acute pouchitis and improves quality of life of patients with ileal pouch-anal anastomosis.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Aged
  • Chronic Disease
  • Colitis, Ulcerative / surgery*
  • Defecation
  • Double-Blind Method
  • Enterobacteriaceae
  • Female
  • Humans
  • Intestines / microbiology
  • Male
  • Middle Aged
  • Patient Selection
  • Postoperative Complications / drug therapy
  • Postoperative Complications / prevention & control
  • Pouchitis / drug therapy*
  • Pouchitis / prevention & control*
  • Probiotics / administration & dosage*
  • Probiotics / adverse effects
  • Quality of Life
  • Treatment Outcome