A review on treatment, barrier function, and the microbiota
Microscopic colitis (MC) is a chronic inflammatory bowel disease, mostly prevalent in women over 60 years in age. MC patients commonly present chronic, non-bloody watery diarrhoea. Some, however, may suffer from constipation, abdominal pain, or remain symptom free. Although the cause of MC is unknown, it seems that mucosal inflammation, gut barrier alterations and the microbiome might influence the development of the disease. A recent review by Saskia van Hemert (Winclove Probiotics) et al. summarizes the current research on these aspects and their role in MC. The possible role of probiotics on treatment of MC was also explored1.
Current treatment of MC
Treatment of MC aims to improve the quality of life and health. Currently the primary treatment is budesonide. Response rates to budesonide are high at about 80%. Unfortunately, relapses are often experienced (60-80%) when treatment is terminated. Patients in remission can also still suffer from persisting symptoms such as abdominal pain and fatigue. Taking this in consideration, it is of importance to explore the possibilities of alternative treatment or management of MC. To this end, it is important to have a good understanding of how the disease develops.
The impact of barrier dysfunction and microbiota in MC
An increased permeability of the epithelial barrier is associated with many gastrointestinal disorders, including MC. Inflammation influences the intestinal permeability and is widely linked to MC. Multiple studies have also indicated the presence of pro-inflammatory cytokines and other immune response factors in MC patients2,3. It therefore comes as no surprise that an increased intestinal permeability is observed in MC patients. The gut microbiome plays a large part in regulating the epithelial barrier function. The bacteria in the microbiome produce short chain fatty acids and interact with the immune system. Modulation of the microbiota would therefore present an attractive method to eliminate gut injury associated with mucosal inflammation.
Probiotics for microbiota management
A possible way to interact with the microbiota is by intake of probiotics. Probiotics have the potential to induce changes in microbiota activity, promote gut microbiota homeostasis, and influence immune system regulators. Many beneficial effects that might influence MC management have already been found. These include:
- A protective effect on the epithelial barrier function in pouchitis patients4
- Reduced stool frequency and improved consistency in collagenous colitis patients5,6
- Short-term clinical response and improvement of MC symptoms7
Clinical advances and future study
There are significant indications that probiotics could be beneficial to improve life quality of MC patients, and help with management of the disease. To further investigate the potential of probiotics it is important to conduct trials aimed at identifying the subgroups that would most benefit from probiotic treatment. Research into strain selection would further optimize the effect probiotics might have on MC and associated symptoms. The discussed review presents important first indications for successful use of probiotics in MC patients.
1. Microscopic colitis – microbiome, barrier function and associated diseases Saskia van Hemert, Karolina Zydecha-Skonieczna, Igor Loniewski, Piotr Szredzki, and Wojciech Marlicz.
2. Dey I, Beck PL, Chadee K. Lymphocytic Colitis Is Associated with Increased Pro-Inflammatory Cytokine Profile and Up Regulation of Prostaglandin Receptor EP4. PLoS One. 2013;8(4):e61891.
3. Tagkalidis PP, Gibson PR, Bhathal PS. Microscopic colitis demonstrates a T helper cell type 1 mucosal cytokine profile. J Clin Pathol. 2007;60(4):382-387. doi:10.1136/jcp.2005.036376.
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5. Tromm A, Niewerth U, Khoury M, et al. The probiotic E. coli strain Nissle 1917 for the treatment of collagenous colitis: first results of an open-label trial. Z Gastroenterol. 2004;42(5):365-369. doi:10.1055/s-2004-812709.
6. Wildt S, Munck LK, Vinter-Jensen L, et al. Probiotic treatment of collagenous colitis: a randomized, double-blind, placebo-controlled trial with Lactobacillus acidophilus and Bifidobacterium animalis subsp. Lactis. Inflamm Bowel Dis. 2006;12(5):395-401. doi:10.1097/01.MIB.0000218763.99334.49.
7. Rohatgi S, Ahuja V, Makharia GK, et al. VSL#3 induces and maintains short-term clinical response in patients with active microscopic colitis: a two-phase randomised clinical trial. BMJ open Gastroenterol. 2015;2(1):e000018. doi:10.1136/bmjgast-2014-000018.
8. Munch A, Aust D, Bohr J, et al. Microscopic colitis: Current status, present and future challenges: statements of the European Microscopic Colitis Group. J Crohns Colitis. 2012;6(9):932-945. doi:10.1016/j.crohns.2012.05.014.