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Use of Probiotics, Prebiotics and Dietary Fibres in Inflammatory Bowel Disease

  • Author / Creator
    Silva, Melissa P
  • Inflammatory bowel diseases (IBD) are a group of chronic inflammatory conditions including ulcerative colitis (UC) and Crohn’s disease (CD) induced by an interaction between genetic susceptibility, environmental factors, dysbiosis of gut microbiota and an abnormal mucosal immune response. Alternative therapies, such as probiotics, prebiotics and dietary fibre supplements (PPF) are cost-effective, have fewer side effects and can alter the microbial composition of the gut to favour a decrease in gut inflammation. However, these products are relatively understudied with a lack of data on usage patterns. This study aimed to determine factors related to use and awareness of PPF in patients with IBD. A cross-sectional study was conducted in patients with a diagnosis of inflammatory bowel disease in the University of Alberta IBD clinic. Using a 20-item survey questionnaire, data on use and awareness of probiotics, prebiotics and dietary fibre supplements and demographic information of their users were collected. Clinical characteristics such as occurrence of flares, age at diagnosis, clinical scores of severity, presence of extra-intestinal disease and objective markers of disease, were collected from charts. Survey questionnaires were completed by 267 participants with IBD. Ninety-one percent of IBD patients had heard of PPF in their lifetime. Awareness of PPF was associated with female gender (p<0.05) and supplement use (p<0.01), with advertising through television or radio being the primary source of information. Prevalence of PPF use was 63% in a patient’s lifetime and 51% currently (over the last 12 months), with more current users consuming probiotics (46%) in comparison to fibres (12%) or prebiotics (6%). Awareness (OR: 7.7, 95% CI: 2.8-21.5, p<0.001), information received from a physician (gastroenterologist or family practitioner; OR: 4.6, 95% CI: 1.3-15.7, p<0.01), higher educational status (OR: 2.2, 95% CI: 1.1-4.4, p<0.023), intake of a combination of special diets (OR: 3.7, 95% CI: 1.2-11.4, p<0.05), supplements (vitamins [OR: 2.2, 95% CI: 1.2-3.8, p<0.01], minerals [OR: 2.5, 95% CI 1.5-4.2, p<0.001]) and use of other CAMs (OR: 1.8, 95% CI: 1.1-3.0, p<0.05) were predictors of PPF use over an IBD patient’s lifetime. Ulcerative colitis was the only clinical predictor of current use (OR: 1.8, 95% CI: 1.1-3.0, p<0.05). Association with other clinical characteristics such as measures of disease activity, severity and extent was not seen in IBD patients. Danone Activia® yogurt was the most frequently consumed probiotic over the last year, with a lack of approval by Health Canada or proven efficacy for IBD. Participants reported reduction of IBD symptoms as the primary reason for using PPF over the last year with “never users” claiming lack of information from their physician as the motive behind never-use. Though the majority of current users reported receiving the intended benefit of PPF use, almost two thirds of patients experienced no improvement in perceived quality of life in relation to their IBD. However, willingness to spend money on these therapies (probiotic or prebiotic users: $11-50/month) was not affected. Use of probiotics, prebiotics and dietary fibre supplements is prevalent among IBD patients who choose alternative therapies to manage their disease. Patients frequently choose probiotics to manage their symptoms but may choose strains that are not endorsed by national public health organizations or retain clinical evidence in IBD. Physician suggestion influences patient decision-making regarding use; therefore, greater physician awareness and understanding of supplementary probiotics, prebiotics and fibres is necessary in order to offer evidence-based advice, if available.

  • Subjects / Keywords
  • Graduation date
    Fall 2018
  • Type of Item
    Thesis
  • Degree
    Master of Science
  • DOI
    https://doi.org/10.7939/R3125QR85
  • License
    Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.