Casellas F et al. (2007) Oral oligofructose-enriched inulin supplementation in acute ulcerative colitis is well tolerated and associated with lowered faecal calprotectin. Aliment Pharmacol Ther 25: 1061–1067

Casellas et al. have conducted a prospective double-blind, placebo-controlled trial to investigate the anti-inflammatory potential of the prebiotic Synergy 1 (an oligofructose-enriched inulin) in patients with ulcerative colitis. Nineteen patients who presented with a relapse of mildly to moderately active ulcerative colitis were randomly allocated to receive oral Synergy 1 or placebo (both at 4 g three times daily) in addition to standard mesalazine therapy (3 g/day) and a low-fiber diet for 14 days.

One participant withdrew from the study before starting treatment, and three (one from the placebo group and two from the prebiotic group) withdrew by the end of the first week because their disease activity increased. The prebiotic was well tolerated and no notable side effects were reported. On study completion, all patients in the prebiotic group had a significant reduction in the levels of fecal calprotectin, a noninvasive marker of intestinal inflammation, and were in clinical remission; in the placebo group, the reduction was not significant and two patients still had clinically active disease. Neither group had a change in the levels of fecal human DNA, another noninvasive marker of intestinal inflammation.

The authors conclude that Synergy 1 seems to safely and effectively mitigate intestinal inflammation in patients with ulcerative colitis and thereby improves the response to mesalazine. They recommend that larger studies be performed to evaluate the ability of Synergy 1 to induce or maintain remission of active ulcerative colitis.