Bifidobacterium Longum for Crohn's Remission: What Studies Show

randomized-controlled-trial PMID: 32678465

Bifidobacterium Longum for Crohn's Remission: What Studies Show

Quick Summary: A 2020 review of research looked at whether probiotics like Bifidobacterium longum can help put Crohn's disease into remission. It combined results from two small studies with 46 adults and found no clear difference between the probiotics and fake treatments (placebos). The evidence is too weak to say if it's helpful or safe for easing Crohn's symptoms.

What The Research Found

Researchers reviewed studies on probiotics, including Bifidobacterium longum, to see if they could calm down Crohn's disease—an ongoing gut inflammation that causes pain, diarrhea, and weight loss. The main goal was to check if these good bacteria could lead to remission, meaning fewer or no symptoms.

No strong proof that probiotics work better than placebos for remission after six months. The combined results showed a small, unclear benefit (risk ratio of 1.06, with a range that includes no effect).
Side effects were similar between probiotics and placebos, with no big safety concerns spotted, but the data is fuzzy (risk ratio of 2.55, with a wide range).
Overall, the evidence is rated "very low quality" because of small groups and study flaws, so experts say more research is needed before recommending it.

This means Bifidobacterium longum, often found in yogurt or supplements, might tweak the gut's natural bacteria to fight inflammation, but these studies didn't prove it helps Crohn's specifically.

Study Details

This was an update to a big review by Cochrane, a trusted group that checks medical studies. They searched databases up to July 2020 and included only two high-quality trials comparing probiotics to placebos.

Who was studied: 46 adults with active Crohn's disease. One study had 11 people with mild to moderate symptoms; the other had 35 with moderate activity (scored 150-450 on a symptom scale called CDAI).
How long: Both studies followed people for six months to track if symptoms improved.
What they took: In the UK study, people got a mix (synbiotic) of freeze-dried Bifidobacterium longum bacteria plus a prebiotic fiber from a store product, taken as capsules daily (exact bacteria dose not detailed). The other study used a different probiotic (Lactobacillus rhamnosus GG at 2 billion live bacteria per day) or a corn starch fake pill. Everyone started with a week of steroids and antibiotics to kickstart treatment.

One study was well-designed with low risk of errors; the other had unclear details on how groups were picked or if people knew what they were taking.

What This Means For You

If you have Crohn's disease, don't count on Bifidobacterium longum supplements to trigger remission on their own—these studies show it's not proven to work better than nothing. Talk to your doctor before trying probiotics, as they might interact with meds like steroids or biologics that are the go-to treatments.

Daily tip: Probiotics can support general gut health, like for IBS or after antibiotics, but for Crohn's, stick to doctor-recommended plans to avoid flare-ups.
Who might benefit? People with mild symptoms could ask about adding it as a safe add-on, but evidence is slim—focus on diet, stress management, and proven therapies first.
Bottom line: This research highlights the gut microbiome's role in Crohn's, so future studies might find better ways to use bacteria like B. longum for real relief.

Study Limitations

These findings aren't rock-solid, so keep these points in mind:

Tiny groups: Only 46 people total, which makes results unreliable—bigger studies could change everything.
Mixed treatments: One study used B. longum in a combo; the other a different bacteria, so it's hard to pin benefits to B. longum alone.
Unclear methods: Issues like poor blinding (people guessing if it's real or fake) and no exact dose info for B. longum limit trust.
Short-term view: Six months isn't long for a lifelong condition like Crohn's; long-term effects are unknown.
Low certainty: Wide data ranges mean we can't be sure if probiotics help, hurt, or do nothing—more solid trials are needed.

Key Findings

The 2020 Cochrane Review update found no significant difference between probiotics (including Bifidobacterium longum) and placebo in inducing remission in Crohn’s disease (CD) after six months (risk ratio [RR] 1.06; 95% CI 0.65–1.71). Similarly, adverse events were not statistically different (RR 2.55; 95% CI 0.11–58.60). The authors concluded that evidence is very uncertain due to small sample sizes, methodological limitations, and imprecision.

Study Design

This systematic review and meta-analysis included two RCTs (total n=46 participants):
1. Germany (2008): 11 adults with mild-to-moderate CD, randomized to Lactobacillus rhamnosus GG or placebo.
2. UK (2010): 35 adults with active CD (CDAI score 150–450), randomized to a synbiotic (B. longum + commercial product) or placebo.
Both studies followed participants for six months. One study had low risk of bias; the other had unclear bias in randomization, allocation concealment, and blinding.

Dosage & Administration

UK study: Participants received a synbiotic containing freeze-dried B. longum and a commercial prebiotic, but the exact CFU dose was not specified in the summary.
Germany study: L. rhamnosus GG at 2 billion CFU/day (not B. longum).
Placebos were corn starch (Germany) and an inert substance (UK). Both interventions were administered orally as capsules.

Results & Efficacy

Clinical remission: No difference between probiotics/synbiotics and placebo (RR 1.06; 95% CI 0.65–1.71).
Adverse events: Wide CI (0.11–58.60) indicated no conclusive safety differences (RR 2.55; 95% CI 0.11–58.60).
Subgroup analysis: The UK study’s synbiotic (including B. longum) showed no remission benefit in active CD (CDAI 150–450).

Limitations

Small sample size: Total n=46, limiting statistical power.
Heterogeneity: Interventions varied (B. longum synbiotic vs. L. rhamnosus GG monotherapy).
Methodological gaps: One study lacked clarity on randomization and blinding.
Imprecision: Wide CIs for both outcomes suggest unreliable estimates.
Short duration: Six-month follow-up may not capture long-term effects.
Unspecified B. longum dose: Hinders reproducibility and strain-specific conclusions.

Clinical Relevance

For individuals with CD, this review does not support using B. longum or other probiotics as a primary therapy for remission induction. The evidence is too weak to guide practice, and current guidelines do not recommend probiotics for CD. Patients should prioritize evidence-based treatments (e.g., corticosteroids, biologics). Future research must isolate B. longum’s effects, use standardized dosing, and enroll larger cohorts to clarify its role.

Note: This analysis focuses solely on the 2020 Cochrane Review’s findings, which grouped B. longum with other probiotics. Strain-specific conclusions cannot be drawn from the provided data.