Skip to main content Accessibility help

Inulin and oligofructose: impact on intestinal diseases and disorders

  • Francisco Guarner (a1)


A large and diverse variety of bacteria have evolved and adapted to live in the human intestinal habitat in a symbiotic arrangement that influences both physiology and pathology in the host. Symbiosis between host and flora can be optimised by prebiotics. Inulin-type fructans have been shown to improve the metabolic functions of the commensal flora. Clinical and experimental data suggest that they also improve the gut mucosal barrier. Furthermore, modulation of the trophic functions of the flora by these prebiotics could help in the prevention of inflammatory bowel diseases. The anti-inflammatory effects of inulin or oligofructose have been assessed in the rat model of distal colitis induced by dextran sodium sulphate, which histologically resembles human ulcerative colitis, and in the trinitrobenzene sulphonic acid model that resembles human Crohn's disease. Both inulin and oligofructose stimulate colonic production of SCFA and favour the growth of indigenous lactobacilli and/or bifidobacteria. These effects are associated with reduced mucosal inflammation and decreased mucosal lesion scores. Inulin has also been tested in a placebo-controlled clinical trial in patients with relapsing pouchitis. Treatment reduced endoscopic and histological parameters of inflammation of the pouch mucosa. Inulin and oligofructose may offer an opportunity to prevent chronic inflammatory intestinal disorders, and this potential should be tested in further clinical studies.


Corresponding author

*Corresponding author:, Dr Francisco Guarner, fax +34 934894456, email


Hide All
Aderem, A & Ulevitch, RJ (2000) Toll-like receptors in the induction of the innate immune response. Nature 406, 782787.
Appleyard, CB & Wallace, JL (1995) Reactivation of hapten-induced colitis and its prevention by anti-inflammatory drugs. Am J Physiol 269, G119G125.
Bach, JF (2002) The effect of infections on susceptibility to autoimmune and allergic diseases. N Engl J Med 347, 911920.
Borruel, N, Carol, M, Casellas, F, Antolín, M, de Lara, F, Espín, E, Naval, J, Guarner, F & Malagelada, JR (2002) Increased mucosal TNFα production in Crohn's disease can be downregulated ex vivo by probiotic bacteria. Gut 51, 659664.
Borruel, N, Casellas, F, Antolín, M, Carol, M, Llopis, M, Espín, E, Naval, J, Guarner, F & Malagelada, JR (2003) Effects of nonpathogenic bacteria on cytokine secretion by human intestinal mucosa. Am J Gastroenterol 98, 865870.
Bourlioux, P, Braesco, V, Koletzko, B & Guarner, F (2003) The intestine and its microflora are partners for the protection of the host. Am J Clin Nutr 78, 675683.
Carol, M, Borruel, N, Antolín, M, Casellas, F, Guarner, F, Malagelada, J-R (2003) Lactobacillus casei can overcome resistance to apoptosis in lymphocytes from patients with Crohn's disease. Gastroenterology 124 A321
Casellas, F, Borruel, N, Papo, M, Guarner, F, Antolín, M, Videla, S & Malagelada, JR (1998) Antiinflammatory effects of enterically coated amoxicillin–clavulanic acid in active ulcerative colitis. Inflamm Bowel Dis 4, 15.
Cherbut, C, Michel, C & Lecannu, G (2003) The prebiotic characteristics of fructooligo-saccharides are necessary for reduction of TNBS-induced colitis in rats. J Nutr 133, 2127.
Cooper, HS, Murthy, SN, Shah, RS & Sedergran, DJ (1993) Clinicopathologic study of dextran sulfate sodium experimental murine colitis. Lab Invest 69, 238249.
Cummings, JH, Christie, S & Cole, TJ (2001) A study of fructo oligosaccharides in the prevention of travellers' diarrhoea. Aliment Pharmacol Ther 15, 11391145.
D'Haens, GR, Geboes, K, Peeters, M, Baert, F, Penninckx, F & Rutgeerts, P (1998) Early lesions of recurrent Crohn's disease caused by infusion of intestinal contents in excluded ileum. Gastroenterology 114, 262267.
Delzenne, NM, Daubioul, C, Neyrinck, A, Lasa, M & Taper, HS (2002) Inulin and oligofructose modulate lipid metabolism in animals: review of biochemical events and future prospects. Br J Nutr 87, Suppl. 2, S255S259.
Fagarasan, S, Muramatsu, M, Suzuki, K, Nagaoka, H, Hiai, H & Honjo, T (2002) Critical roles of activation-induced cytidine deaminase in the homeostasis of gut flora. Science 298, 14141427.
Femia, AP, Luceri, C, Dolara, P, Giannini, A, Biggeri, A, Salvadori, M, Clune, Y, Collins, KJ, Paglierani, M & Caderni, G (2002) Antitumorigenic activity of the prebiotic inulin enriched with oligofructose in combination with the probiotics Lactobacillus rhamnosus and Bifidobacterium lactis on azoxymethane-induced colon carcinogenesis in rats. Carcinogenesis 23, 19531960.
Gibson, GR & Roberfroid, MB (1995) Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. J Nutr 125, 14011412.
Griffin, IJ, Davila, PM & Abrams, SA (2002) Non-digestible oligosaccharides and calcium absorption in girls with adequate calcium intakes. Br J Nutr 87 Suppl. 2 S187S191.
Guarner, F (2003) Microecology as a target for therapeutic intervention in inflammatory bowel disease. IDrugs 6, 868873.
Guarner, F & Malagelada, JR (2003) Gut flora in health and disease. Lancet 361, 512519.
Hooper, LV, Wong, MH, Thelin, A, Hansson, L, Falk, PG & Gordon, JI (2001) Molecular analysis of commensal host–microbial relationships in the intestine. Science 291, 881884.
Kagnoff, MF & Eckmann, L (1997) Epithelial cells as sensors for microbial infection. J Clin Invest 100, 610.
Kennedy, RJ, Hoper, M, Deodhar, K, Kirk, SJ & Gardiner, KR (2000) Probiotic therapy fails to improve gut permeability in a hapten model of colitis. Scand J Gastroenterol 35, 12661271.
McCarthy, J, O'Mahony, L, O'Callaghan, L (2003) Double blind, placebo controlled trial of two probiotic strains in interleukin 10 knockout mice and mechanistic link with cytokine balance. Gut 52, 975980.
Macpherson, A, Khoo, UY, Forgacs, I, Philpott-Howard, J & Bjarnason, I (1996) Mucosal antibodies in inflammatory bowel disease are directed against intestinal bacteria. Gut 38, 365375.
Madsen, KL, Doyle, JS, Jewell, LD, Tavernini, MM & Fedorak, RN (1999) Lactobacillus species prevents colitis in interleukin 10 gene-deficient mice. Gastroenterology 116, 11071114.
Moreau, NM, Martin, LJ, Toquet, CS, Laboisse, CL, Nguyen, PG, Siliart, BS, Dumon, HJ & Champ, MM (2003) Restoration of the integrity of rat caeco-colonic mucosa by resistant starch, but not by fructo-oligosaccharides, in dextran sulfate sodium-induced experimental colitis. Br J Nutr 90, 7585.
Morris, GP, Beck, PL, Herridge, MS, Depew, WT, Szewezuk, MR & Wallace, JL (1989) Hapten-induced model of chronic inflammation and ulceration in the rat colon. Gastroenterology 96, 795803.
Nyman, M (2002) Fermentation and bulking capacity of indigestible carbohydrates: the case of inulin and oligofructose. Br J Nutr 87, Suppl. 2S163S168.
Olah, A, Belagyi, T, Issekutz, A, Gamal, ME & Bengmark, S (2002) Randomized clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis. Br J Surg 89, 11031107.
Pirzer, U, Schönhaar, A, Fleischer, B, Hermann, E, Meyer, zum, Büschenfelde, KH (1991) Reactivity of infiltrating T lymphocytes with microbial antigens in Crohn's disease. Lancet 338, 12381239.
Rayes, N, Seehofer, D, Hansen, S, Boucsein, K, Muller, AR, Serke, S, Bengmark, S & Neuhaus, P (2002) Early enteral supply of lactobacillus and fiber versus selective bowel decontamination: a controlled trial in liver transplant recipients. Transplantation 74, 123127.
Rook, GA & Brunet, LR (2002) Give us this day our daily germs. Biologist (London) 49, 145149.
Saavedra, JM & Tschernia, A (2002) Human studies with probiotics and prebiotics: clinical implications. Br J Nutr 87, Suppl. 2S241S246.
Seksik, P, Rigottier-Gois, L, Gramet, G, Sutren, M, Pochart, P, Marteau, P, Jian, R, Doré, J (2003) Alterations of the dominant faecal bacterial groups in patients with Crohn's disease of the colon. Gut 52, 237242.
Shanahan, F (2001) Inflammatory bowel disease: immunodiagnostics, immunotherapeutics, and ecotherapeutics. Gastroenterology 120, 622635.
Steidler, L, Hans, W, Schotte, L, Neirynck, S, Obermeier, F, Falk, W, Fiers, W & Remaut, E (2000) Treatment of murine colitis by Lactococcus lactis secreting interleukin-10. Science 289, 13521355.
Swidsinski, A, Ladhoff, A & Pernthaler, A (2002) Mucosal flora in inflammatory bowel disease. Gastroenterology 122, 4454.
Van Loo, J, Gibson, GR, Probert, HM, Van Loo, J, Rastall, RA & Roberfroid, MB (1994) Dietary modulation of the human colonic microbiota: updating the concept of prebiotics. Nutr Res Rev 17, 259275.
Videla, S, Vilaseca, J, Antolín, M, García-Lafuente, A, Guarner, F, Crespo, E, Casalots, J, Salas, A & Malagelada, JR (2001) Dietary inulin improves distal colitis induced by dextran sodium sulfate in the rat. Am J Gastroenterol 96, 14861493.
Welters, CF, Heineman, E, Thunnissen, FB, van den, Bogaard AE, Soeters, PB, Baeten, CG (2002) Effect of dietary inulin supplementation on inflammation of pouch mucosa in patients with an ileal pouch–anal anastomosis. Dis Colon Rectum 45, 621627.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed