Ulcerative colitis (UC) is a chronic relapsing inflammatory disease of the colon with extraintestinal manifestations. UC is associated with increased risk of developing colorectal cancer and increased mortality. Pathogenesis of UC is postulated to be linked to a defect in the microbial population of the colonic mucosa. Patients with UC requiring surgery tend to have proto-colectomy with ileal pouch-anal anastomosis (IPAA). Pouchitis, chronic relapsing inflammation of the ileal reservoir, is a common complication and the pathogenesis is thought to be similar to UC. Probiotics have been used to treat active disease and maintenance of remission in both UC and pouchitis. Early studies in the use of synbiotics in the management of UC and pouchitis have been promising. Probiotics, prebiotics and synbiotics have relatively fewer side-effects than conventional pharmaceutical medications and are attractive alternatives for the long term treatment of UC and pouchitis.
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