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A microbiota intestinal e o papel dos probióticos nas doenças inflamatórias intestinais
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Abstract(s)
As doenças inflamatórias intestinais, como a doença de Crohn e a colite ulcerativa, são
patologias inflamatórias crónicas que afetam o trato gastrointestinal, caracterizadas por
períodos alternados de exacerbação e remissão. Clinicamente, comprometem a qualidade
de vida dos doentes e podem levar a complicações graves, exigindo, por isso, terapêutica
imunossupressora a longo prazo. A sua fisiopatologia parece resultar de uma interação
complexa entre fatores genéticos, imunológicos, ambientais e microbianos. A recente
exploração do papel da microbiota intestinal como fator etiológico da doença inflamatória
intestinal tem impulsionado o desenvolvimento de novas estratégias terapêuticas
promissoras, focadas na modulação da microbiota. Entre estas, destacam-se os probióticos,
microrganismos vivos que podem restaurar o equilíbrio da microbiota e, assim, oferecer
benefícios à saúde.
Através de uma revisão bibliográfica, o principal objetivo desta dissertação é analisar os
estudos desenvolvidos nos últimos anos, clarificando o papel da microbiota intestinal e
avaliando as recentes evidências associadas à utilização de probióticos.
Nesta revisão destacam-se alguns resultados promissores sobre a utilização dos probióticos
nas doenças inflamatórias intestinais.
Relativamente à indução da remissão da doença, os diversos randomized controlled trials
que incluíram a administração de Lactobacillus, Enterococcus e Bifidobacterium
apresentaram benefícios a nível da modulação da microbiota intestinal, com subsequentes
benefícios nos índices de atividade de doença, nos parâmetros bioquímicos e inflamatórios
e ainda na qualidade de vida. Especificamente na colite ulcerativa, a vasta evidência sugere
que o VSL#3 é eficaz na indução da remissão clínica em pacientes com doença ativa leve a
moderada. Outros randomized controlled trials com intervenções à base de Lactobacillus,
Bifidobacterium e Escherichia coli Nissle 1917 demonstraram também eficácia na indução
da remissão, possuindo ainda efeitos imunológicos significativos. Já na doença de Crohn,
apesar da existência de significância estatística na redução do índice de atividade de doença
e de alguma melhoria nos marcadores inflamatórios (como a proteína C reativa), os
resultados são pouco consistentes, em comparação a outros estudos e a literatura anterior.
No que diz respeito à manutenção da remissão da doença, a eficácia dos probióticos é menos
clara, mas parece ser mais promissora na colite ulcerativa do que na doença de Crohn,
através da utilização de, por exemplo, Lactobacillus e Bifidobacterium. Contudo, é necessária investigação adicional, especialmente através de estudos
multicêntricos de fase 3, para validar a sua eficácia e estabelecer um perfil de segurança
para a sua utilização, possibilitando a sua futura inclusão em guidelines clínicas.
Inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis, are chronic inflammatory conditions affecting the gastrointestinal tract, characterised by alternating periods of exacerbation and remission. Clinically, they impair patients' quality of life and can lead to severe complications, thus requiring long-term immunosuppressive treatment. Their pathophysiology seems to arise from a complex interaction between genetic, immunological, environmental and microbial factors. The recent exploration of the intestinal microbiota's role as an etiological factor in inflammatory bowel disease has driven the development of promising new therapeutic strategies focused on microbiota modulation. These include probiotics, live microorganisms that can restore microbiota balance and thus benefit health. Through a literature review, the main aim of this dissertation is to analyse the studies conducted in recent years, clarifying the role of the intestinal microbiota and evaluating recent evidence associated with the use of probiotics. This review highlights some promising results regarding the use of probiotics in inflammatory bowel diseases. Concerning the induction of disease remission, various randomized controlled trials that included the administration of Lactobacillus, Enterococcus, and Bifidobacterium have shown benefits in modulating the intestinal microbiota, with subsequent improvements in disease activity indexes, biochemical and inflammatory parameters, as well as quality of life. Specifically, in ulcerative colitis, extensive evidence suggests that VSL#3 is effective in inducing clinical remission in patients with mild to moderate active disease. Other randomized controlled trials with interventions based on Lactobacillus, Bifidobacterium, and Escherichia coli Nissle 1917 have also demonstrated efficacy in inducing remission, with significant immunological effects. In Crohn's disease, despite the existence of statistical significance in the reduction of the disease activity index and some improvement in inflammatory markers (such as C-reactive protein), the results are less consistent compared to other studies and previous literature. Regarding the maintenance of disease remission, the efficacy of probiotics is less clear, but appears to be more promising in ulcerative colitis than in Crohn's disease, particularly with the use of, for example, Lactobacillus and Bifidobacterium. However, further research is needed, especially through multicenter phase 3 studies, to validate their efficacy and establish a safety profile for their use, enabling their future inclusion in clinical guidelines.
Inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis, are chronic inflammatory conditions affecting the gastrointestinal tract, characterised by alternating periods of exacerbation and remission. Clinically, they impair patients' quality of life and can lead to severe complications, thus requiring long-term immunosuppressive treatment. Their pathophysiology seems to arise from a complex interaction between genetic, immunological, environmental and microbial factors. The recent exploration of the intestinal microbiota's role as an etiological factor in inflammatory bowel disease has driven the development of promising new therapeutic strategies focused on microbiota modulation. These include probiotics, live microorganisms that can restore microbiota balance and thus benefit health. Through a literature review, the main aim of this dissertation is to analyse the studies conducted in recent years, clarifying the role of the intestinal microbiota and evaluating recent evidence associated with the use of probiotics. This review highlights some promising results regarding the use of probiotics in inflammatory bowel diseases. Concerning the induction of disease remission, various randomized controlled trials that included the administration of Lactobacillus, Enterococcus, and Bifidobacterium have shown benefits in modulating the intestinal microbiota, with subsequent improvements in disease activity indexes, biochemical and inflammatory parameters, as well as quality of life. Specifically, in ulcerative colitis, extensive evidence suggests that VSL#3 is effective in inducing clinical remission in patients with mild to moderate active disease. Other randomized controlled trials with interventions based on Lactobacillus, Bifidobacterium, and Escherichia coli Nissle 1917 have also demonstrated efficacy in inducing remission, with significant immunological effects. In Crohn's disease, despite the existence of statistical significance in the reduction of the disease activity index and some improvement in inflammatory markers (such as C-reactive protein), the results are less consistent compared to other studies and previous literature. Regarding the maintenance of disease remission, the efficacy of probiotics is less clear, but appears to be more promising in ulcerative colitis than in Crohn's disease, particularly with the use of, for example, Lactobacillus and Bifidobacterium. However, further research is needed, especially through multicenter phase 3 studies, to validate their efficacy and establish a safety profile for their use, enabling their future inclusion in clinical guidelines.
Description
Keywords
Colite Ulcerativa Doença de Crohn Doença Inflamatória Intestinal Microbiota Intestinal Probióticos