The Efficacy and Role of Probiotics for Maintenance of Remission in Crohn’s Disease: A Meta-Analysis and Survey

Crohn’s disease (CD) is a chronic inflammatory disease whose pathogenesis involves disturbances of the gastrointestinal microbiota. As the prevalence of CD increases, the need for a more effective and safe treatment is integral. Probiotics have been reported to be beneficial for numerous gastrointestinal diseases, providing health benefits and considering the microbial characteristics of CD’s pathogenesis. However, our knowledge of the efficacy of probiotic therapy in preventing relapse in CD is limited. How gastroenterologists have incorporated probiotics into their practice or probiotics observed implications for patients with CD has not been assessed. A quantitative survey was distributed to determine how gastroenterologists perceive and use probiotic-based therapies in CD practice. The second objective was to conduct a meta-analysis of the efficacy of probiotics for maintaining remission and preventing clinical and endoscopic relapse in CD. Performing a meta-analysis and survey will examine the role of probiotics in CD treatment. Surveyed gastroenterologists cited that probiotics have an adjunctive role and have been observed to alleviate common CD symptoms. Probiotics seem effective in reducing the relapse rate, specifically those of the multi-strain variety are more likely to be effective in maintaining CD remission. Further research with larger trials is required to replicate and solidify this efficacy. The meta-analysis only assessed the efficacy of probiotics as a maintenance treatment as measured by the risk of relapse;thus, no evidence supports probiotics’ ability to induce remission. The results of the meta-analysis and survey indicate that probiotics cannot treat CD without accompanying conventional drug therapies;nevertheless, independent of treatment capacities, probiotics still yield health benefits for CD patients.

Clinical outcomes of cessation of nucleoside/nucleotide analogues in Chinese patients with HBeAg-negative chronic hepatitis B

Background and aims:Cessation of nucleoside/nucleotide analogue(Nuc)therapy in patients with HBeAg-negative chronic hepatitis B(CHB)remains controversial.Methods:In this prospective,single-center cohort study,we recruited 45 patients with HBeAg-negative CHB from The Fifth Medical Center of Chinese People's Liberation Army General Hospital in China's Mainland.Patients were classified into a Nuc cessation group(n?27)and Nuc continuation group(n?18)and followed-up for 36 months.Nuc were stopped after being inactive for at least 4 years(normal alanine aminotransferase(ALT),undetectable hepatitis B virus(HBV)DNA),with liver fibrosisStage1(S1)and inflammationGrade(G1).Results:Within 3 years of follow-up,51.9%patients with Nuc cessation had virological relapse and 14.8%had ALT elevation,while all patients with Nuc continuation had undetectable HBV DNA and normal ALT.The rate of HBsAg loss after Nuc cessation was 22.2%compared with no seroconversion in patients with Nuc continuation.The hepatitis flare rate was 11.1%and there were no cases of hepatic decompensation after Nuc cessation.End of treatment(EOT)HBsAg,HBV RNA,and decline in HBV core-related antigen(HBcrAg)rate were predictive markers for HBsAg seroconversion at 6 months post-Nuc cessation.Conclusion:This study showed favorable HBsAg loss and low hepatitis flare rates after Nuc cessation.EOT HBsAg,HBV RNA,and decline in HBcrAg rate were predictive markers for HBsAg seroconversion at 6 months post-Nuc cessation.