Inflammatory bowel diseases (IBDs) are a group of auto-immune pathologies, with Crohn’s disease (CD) and ulcerative colitis (UC) among the most well-known. They are both of recurrent clinical course and show a higher incidence in developed countries [1,2].

The etiology of IBDs is unknown—an inappropriate activation is produced of the immune system against the intestinal mucosa in individuals with a genetic predisposition. Environmental factors have been involved, with possible mediators including geo-localization, tobacco, rest disorders, surgical interventions or infections during childhood, and diet—the latter considered a higher risk factor in the development of such pathologies [2,3].

Treatment is focused on the accepted pathogenic mechanisms. The following have been recommended: quitting tobacco use, specific diet and nutrition, anti-inflammatories such as corticoids (temporary use), immuno-suppressors, biological therapy, and surgery [4]. In similar conditions, different types of diet approaches have been developed for IBDs, such as prebiotics/probiotics/postbiotics, to explore their efficacy as possible change agents of the existent inflammatory processes in these diseases [5]. The microbiota is reciprocally related to the human being: it provides various positive effects in the immune system, competing with harmful micro-organisms, or complementing nutrients which are necessary for the human body [6].The change in the microbiota produced by prebiotics in patients with IBDs, that is, those where low levels of Firmicutes and Bifidobacteria and a high number of bacteria which are pro-inflammatory for the organism (Escherichia, Fusobacterium) have been detected, could favor their remission or maintenance [6,7,9].

There are studies which proposed treating UC with foods from germinated barley, a butyrate precursor. These studies turned out to be very promising and guided research in this direction [12]. Another study proposed that the Escherichia coli Nissle 1917 probiotic was as valid as the usual UC treatment with Mesalazine (5-ASA) to maintain remission. A few years later, studies conducted with the VSL #3 probiotic (a combination of diverse probiotics) and with Lactobacillus GG claimed identical results [13,14]. Likewise, an Italian study found that adding butyric acid in patients with a deficient response to treatment with Mesalazine showed good results in maintaining remission in patients with moderate UC [15]. Finally, a compound made of fermented oats, Lactobacillus plantarum (L. Plantarum) 299v, barley malt, lecithin, and water (Profermín) was tested, which performed well for remission patients in UC [16].

The latest studies have been focusing fundamentally on the use of probiotics and postbiotics. Recent studies have noted that Crohn’s disease and UC affect 1.4 million people in the United States, 2.5 million people in Europe, and millions more in the rest of the world. Besides, during the second half of the 21st century, the incidence of these diseases has risen in developed countries, reaching numbers of 6–10/100,000 inhabitants/year in Europe [8]. These figures apply to Spain, both in terms of the increasing number of cases and in the cardinal differences, and are evident in the regions of Córdoba and Seville [1].

Considering the chronicity and development of outbreaks of these diseases, and their predominant onset between childhood and the first half of life, it can be asserted that the treatment of IBDs consumes a large quantity of resources, both economic and personal, as well as for the health system (diagnoses tests, drugs, hospital stays, health personnel, etc.) and the work environment due to the length of possible sick leave [17]. As an example, the cost of caring for a patient with Crohn’s disease is estimated at approximately EUR 7000 per year [17,18], 57% of which is attributable to hospital admissions, 33% to pharmaceutical expenses, and the remainder to different causes such as consultations, tests, and surgical interventions [18].

4. Objective

As a consequence of this, the following research question arose: In individuals with inflammatory bowel disease (P), is the use of probiotics (with diverse families and strains) (I) efficient for starting/maintaining the remission of these diseases (O) with respect to the use of the placebo or conventional treatment (C)?

In order to answer that question, the following objective was set out: to analyze the efficacy of using probiotics in patients with inflammatory bowel disease in the active or quiescent phase as a coadjuvant therapy at the beginning of remission or maintenance.

5. Conclusions