A110 USE OF PROBIOTICS, PREBIOTICS AND DIETARY FIBRE SUPPLEMENTS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

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

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