Determination of some probiotic properties of kefir and investigation its effects on inflammatory bowel disease symptoms, patient's lactobacillus flora of feces

Probiotics are defined as living microorganisms which are useful for human health when they are consumed in appropriate portions. Some researches show that probiotics have useful effects on inflammatory bowel diseases. Kefir, which is a fermented milk drink, has probiotic properties that are thought to balance the degraded microflora. Chronic Inflammatory Bowel Disease (IBD) is divided into two groups which are; Ulcerative Colitis (UC) and Crohn's Disease (CD). It is being observed that the number of cases of UC and CD is increasing rapidly in every age group. The objective of this study was to investigate the effects of kefir consumption on patients' Lactobacilus microflora, biochemical parameters, symptoms and also quality of life of people with IBD. The patients, who are under regular control of the General Internal Medicine and Gastroenterology Policlinics of Uludağ University Medical Faculty, Department of Internal Diseases, were accepted to the study. All permits are obtained from Uludağ University Ethical Commity (B.30.2.ULU.0.20.70.02-050.99/440, 25.11.2013) for those patients. Kefir, consumed by patients, had been analyzed microbiologically for their total microorganisms and Lactobacillus flora. The species identification of Lactobacillus isolates were performed by Vitek® MS mass spectrometer (bioMerieux, Marcy I'Etoile, France) and API 50 CH (bioMerieux). Identified isolates were examined for their antibacterial activity, against bile and acid tolerance and antibiotic resistance to identify their probiotic activity. As a result, all kefir Lactabacillus isolates, except LB3, showed resistance to 2,5 pH acid and bile 0,3% oxgall. LPL5 strain showed resistance to all antibiotics used in the experiments and was not evaluated as probiotic. LK9 was susceptible to all antibiotics. LF7, LK9 and LL10 showed antagonistic effect on all pathogen test bacteria. The study was performed as a single center, prospective, open-label randomized control trial of 48 patients, with IBD who were separated into two groups (28 patients for treatment and 20 patients for control). Three patients drop out the trial with her/ his own wish. Treatment group consumed, 200 ml. each time for day and night which have 2x1010 cfu/400 ml viable cell, for four weeks and control group didn't consume kefir at all. Their lactobacilus and Lactobacillus kefiri flora were quantitated by Real Time-qPCR (Roche LightCycler Nano). After one month administration, in treatment group the Lactobacillus strain bacterial load of feces of all subjects was 104–109 CFU/g. The Lactobacillus kefiri bacterial load of 17 subjects was of 104–106 CFU/g. The results of this study indicate that after kefir consumption the Lactobacillus quantity in gaita was statistically significant (p=0.001). At the same time the patient's quality of life about disease, monitored by a symptom diary form that includes parameters as stool consistency, abdominal pain, bloating, defacation frequency and feeling good. Patient's with Crohn's disease showed statistically significant differences in terms of all variables after kefir use. There was a significant decrease in ESR and CRP while Crohn's patients showed an increase in HGB after kefir use. For patients with Crohn's disease, the last 2 weeks of bloating were significantly reduced while patients improved (p = 0.012). At the same time, the feeling good score improved in the last two weeks and patients' condition improved (p = 0.032). No statistically significant difference was found between the first week and the second week in patients with ulcerative colitis in terms of abdominal pain, bloating, number of stools, defacation consistency and feeling good. There was a significant statistical difference between the Crohn group and the control group in terms of Lactobacillus and HGB amount change. The increase in Lactobacillus and HGB measurements in Crohn's patients was found to be higher than in the Crohn control group in the last measurement (p= 0.024, p = 0.029). While there were no significant statistical differences between the groups in terms of other variables, there was a statistically significant difference between the ulcerative colitis and control group in terms of stool consistency in the first two weeks (p = 0.026), but no statistically significant difference was found in terms of other variables. Ulcerative colitis group's stool consistency score was higher than control group. While there was a significant statistical difference between Crohn and control group for their abdominal pain and bloating scores (p = 0.006, p = 0.003) there was no other significant statistical difference in terms of other variables. The decrease of abdominal pain and bloating scores of Crohn group was greater than control group in the last two weeks. According to data from this study, regular consumption of kefir may improve both symptoms and quality of life in short term especially for the patient's with Crohn Disease.