Over the past decade, there has been an observed increase in the prevalence and incidence of Inflammatory Bowel Diseases (IBD), specifically Crohn’s Disease (CD) and Ulcerative Colitis (UC) (Molodecky et al., 2012; Roy and Dhaneshwar, 2023). According to a recent epidemiological study conducted by Ng et al. (2017), IBD affects over 0.3% of people in North America and Europe. It is a group of gastrointestinal disorders with chronic inflammation. The cause of IBD is not fully understood but is believed to be a combination of genetic and environmental factors. Factors such as diet, use of antibiotics, and socioeconomic status can influence persistent immune-mediated inflammation in the intestines. (Manichanh et al., 2012; Çavdar and Çavdar, 2023). UC is a chronic gastrointestinal disorder characterised by chronic inflammation of the colorectal mucosa, resulting in non-specific inflammatory changes. The aetiology of this condition remains uncertain, and its conversion into cancer is not easily treatable. Ungaro et al. (2017) conducted epidemiological research which substantiated the global increase in the prevalence of UC. It is a condition caused by a combination of genetic, immune, microbial, and environmental factors. It involves persistent inflammation of the mucosal lining, affecting the rectum and proximal colon segments. The exact mechanisms behind UC development are not fully understood, but it is widely recognised that environmental factors, host genetics, a dysregulated immune system, and microbial dysbiosis play crucial roles. (Ananthakrishnan, 2015).

According to the study conducted by Higuchi et al. (2012), there is evidence to suggest that the adoption of Westernised diets and lifestyles can heighten the susceptibility of genetically predisposed individuals to IBD. Environmental factors encompass various aspects, such as residing in industrialised nations, urbanised settings, and regions situated at higher latitudes. In addition to infections and smoking, other factors also play a role in the pathogenesis of IBD. Patients frequently need lifelong medication, which is the main purpose of therapy, both to persuade clinical remission and to conserve it for a long period. According to the Global Burden of Disease Study, the estimated global prevalence of Crohn’s disease was approximately 6.8 million individuals, while ulcerative colitis affected approximately 10 million individuals. (Alatab et al., 2020).

These data suggest that, in addition to finding effective therapeutic approaches to advance IBD patients’ quality of life and lower healthcare system costs, it is crucial to better understand the factors involved in the development of IBD. Costs of IBD management have increased significantly in the past five years due to different therapeutic interventions and disease characteristics. Patients face increased healthcare utilisation, out-of-pocket expenses, and reduced productivity, necessitating the implementation of cost-effective solutions. (Park et al., 2020) Recent research suggests that microbiota can be therapeutically effective in treating IBD. The gut microbiome influences host processes and can mitigate inflammation. Various therapeutic approaches, including prebiotics, probiotics, and synbiotics, have been developed to alter and restructure the gut microbiome. (Britton et al., 2021) The most common strains currently available as probiotics and possessing beneficial health effects are Enterococcus faecium, Bifidobacterium, Bacillus, Saccharomyces boulardii (S. boulardii) and Lactobacillus strains. Prebiotics like fructo-oligosaccharides (FOS), isomalto-oligosaccharides (IMO), and xylooligosaccharide (XOS) are studied for their potential benefits on stool volume, constipation relief, and faecal acidity, with easily metabolised by Bifidobacteria and other microorganisms. (Guarino et al., 2020).

Ulcerative colitis is a chronic inflammatory disorder of the gastrointestinal tract characterised by a progressive decline in health. UC is characterised by inflammation of the mucosal lining, typically confined to the colon and rectum. On the other hand, CD involves inflammation that extends through the entire thickness of the gastrointestinal tract, with a predilection for the ileum, terminal ileum, and colon. The CD is often associated with additional inflammatory conditions outside of the intestines. According to Çavdar and Çavdar (2023), the medical characteristics encompass symptoms such as hemorrhagic diarrhoea, weight loss, fatigue, and abdominal pain. Additionally, certain individuals may develop extra-intestinal manifestations associated with IBD, such as primary sclerosing cholangitis, skin lesions, or joint complications (Judge and Lichtenstein, 2001). The impact of UC on a global scale has been evaluated, revealing that it affects a population of approximately 5 million individuals. UC is characterised by recurring episodes of inflammation in the mucosal layer of the colon, which alternate between periods of relapse and remission. In ulcerative colitis, inflammation is typically confined to the mucosal surface. The disorder originates in the rectum and typically progresses proximally throughout the entirety of the colon. To date, a conclusive therapeutic approach for UC remains elusive, and the currently available interventions primarily focus on sustaining remission (Roy and Dhaneshwar, 2023).

Conventional therapies for UC consist of pharmacological interventions involving the use of various agents, including azathioprine, aminosalicylates, and corticosteroids. These treatments aim to induce remission, prevent relapses, promote mucosal healing, and ultimately reduce the need for colectomy in individuals diagnosed with UC. In recent times, advancements in medical treatments have been influenced by the utilisation of agents such as monoclonal antibodies that specifically target proinflammatory cytokines, adhesion molecules, T-cell activation, and agents that promote the production of anti-inflammatory cytokines, such as IL-10 (Interleukin) and Transforming Growth Factor (TGF). However, the administration of these medications in the context of ulcerative colitis is associated with a distinct set of systemic and localised adverse effects experienced by individuals. These include but are not limited to, symptoms such as headache, abdominal pain, nausea, cramping, loss of appetite, vomiting, and rash. In addition, it is not recommended to use corticosteroids for an extended period due to their potential to induce glucose intolerance, osteoporosis, myopathy, and increased vulnerability to infections. These adverse effects raise significant concerns regarding the safety profile of corticosteroid usage (Mowat et al., 2011). Similarly, the expenses associated with these promising therapeutic approaches are substantial, considering the increasing prevalence and persistent nature of IBD. Histological examinations conducted on patients with UC have revealed the presence of impaired intestinal epithelial barrier function. However, the significance of this dysfunction with the pathology of UC remains uncertain. Patients diagnosed with UC exhibit changes in the function of the epithelial barrier, impaired function of tight junctions, and reduced secretion of mucin-2. Nevertheless, the exact relationship between these abnormalities and chronic inflammation, accompanied by heightened cytokine production, remains uncertain. Heller et al. (2005) conducted a study that yielded evidence indicating that the overexpression of IL-13 plays a pivotal role in the disruption of tight junctions within the intestinal mucosal layer of individuals who have been diagnosed with active UC. The dysfunction of the barrier function in individuals diagnosed with UC has been linked to a heightened absorption of luminal antigens and an elevated susceptibility to bacterial infiltration in the underlying mucosa. Extensive research has provided comprehensive insights into the dysregulation of the intestinal immune system in individuals afflicted with UC. Dendritic cells (DCs) are known to have a pivotal role in the augmentation of UC patients, thus signifying the substantial contribution of these cells in the initiation and perpetuation of inflammatory processes (Hart et al., 2005).

Conventional therapies play a pivotal role in the management of ulcerative colitis and the mitigation of associated symptoms. The objective of these treatments is to manage inflammation, initiate and sustain remission, and enhance the overall quality of life for patients. The Selecting Therapeutic Targets in IBD (STRIDE)-II statement was revised by the International Organisation for the Study of IBD to enhance the treatment of IBD in adults and children. The revised statement identified several goals at different timeframes. In the short term, achieving symptomatic remission and normalising C-reactive protein levels were prioritised. In the intermediate term, reducing calprotectin levels was identified as a target. Lastly, in the long term, the goals included achieving endoscopic healing and standardising the quality of life for individuals with IBD (Im et al., 2018; Turner et al., 2021). The subsequent therapies listed are commonly employed conventional treatments for ulcerative colitis.

Rifaximin modifies gut microbiota for small intestinal bacterial overgrowth and hepatic encephalopathy, while antibiotics aim to manipulate intestinal flora, potentially disrupting IBD progression. In their study, Khan et al. (2011) conducted a meta-analysis that examined the findings of 10 randomised controlled trials (RCTs) focused on the utilisation of antibiotics in patients diagnosed with active CD. Additionally, the study also included nine RCTs that investigated the impact of antibiotic usage in individuals with UC. Antibiotics significantly impact remission and disease severity in UC and CD. Rifamycin derivatives are effective in treating active CD. However, results vary due to different trials involving rifaximin, fluoroquinolones, macrolides, and anti-tuberculosis antibiotics. (Steinhart et al., 2002).

The gut microbiota, an important group of microorganisms that live in the digestive tract, is correlated to several diseases, including ulcerative colitis. The composition and function of the microbiota in the gut have both been shown to be susceptible to change, as recent research has shown. The gastrointestinal tract of a neonate does not initially contain any microorganisms but is eventually colonised by bacteria that come from the mother and the environment. (Dominguez-Bello et al., 2010). According to Vyas and Ranganathan (2012), the number of bacterial cells present on and within the entire body of an adult human is approximately ten times greater than the total number of human cells. The complexity and diversity of the human microbiome are considerable. The composition and quantity of anatomical features vary across different regions of the gastrointestinal tract, ranging from the nasal and oral cavities to the distal segments of the colon and rectum. The composition and complexity of the gut microbiota exhibit variability during the transition of infants from a liquid diet to solid foods. The alterations in dietary patterns during adulthood play a substantial role in shaping the composition of the gut microbiota. Metagenomic techniques based on 16S ribosomal RNA sequence have improved our understanding of microbial communities in the gastrointestinal tract. This approach reveals that 90% of the bacterial population is attributed to Bacteroidetes and Firmicutes. (Mariat et al., 2009; Hu and Gubatan, 2023).

Probiotics can be traced back to ancient civilisations when humans first began eating fermented foods as part of their regular diet. It was hypothesised by Elie Metchnikoff that the beneficial bacteria found in yoghurt could improve the health of the gut microbiome. Mackowiak (2013) presented the concept of probiotics for the first time. These microorganisms can positively modulate the composition of the gut microflora and reduce the presence of pathogenic bacteria that release harmful compounds within the human gastrointestinal tract. In previous studies, a range of microorganisms have been employed for disease management, thereby giving rise to the term “probiotics”. Probiotics, derived from Greek, refer to living, non-pathogenic organisms with beneficial effects on hosts. Vergin, in 1954, coined the term “probiotic” to compare the harmful effects of antibiotics on intestinal microbiota with the beneficial effects of some beneficial bacteria. The term “probiotic” was subsequently redefined by Lilly and Stillwell as a biologically active product produced by a microorganism that enhances the growth of another microorganism. As a result, the term was subsequently defined by Fuller (1989) as non-pathogenic microorganisms that, when ingested, have a beneficial impact on the health or physiology of the host. The most recent definition proposed by the FDA and WHO in collaboration is that of a live microorganism that, when administered in adequate quantities, confers a health advantage to the host. Several probiotic microorganisms are commonly utilised, species of Bifidobacterium and Lactobacillus, have been reported to be the predominant and subdominant groups among gut microbes, respectively (Casellas et al., 2007; Markowiak and Śliżewska, 2017). Bacterial organisms capable of forming spores, primarily belonging to the genus Bacillus, are prevalent in this context (Derikx et al., 2016; Jin et al., 2023).

Probiotics are incorporated into various food products, particularly fermented dairy products, either individually or in conjunction with other strains. Continuously, novel genera and strains of probiotics are being discovered through increasingly sophisticated and targeted research endeavours. VSL#3 is a combination of eight distinct probiotic strains, exhibiting high strain specificity and variability in benefits across different patient groups. Probiotic products can consist of a solitary strain or a mixture of two or more strains, with the effectiveness of multi-strain probiotics demonstrated in controlled studies. (Chapman et al., 2011). The study of probiotics, particularly Lactobacilli, has experienced significant growth over the past twenty years. This is evident from the substantial increase in research articles published on the topic. Specifically, while there were approximately 180 research articles available between 1980 and 2000, the number of articles on the probiotic Lactobacillus exceeded 5700 between 2000 and 2014. According to a study published in PubMed in 2014, the effectiveness of the probiotic strain Lactobacillus was investigated. The characteristics of an ideal probiotic strain are depicted in Figure 1.

Probiotics act against intestinal diseases through various processes, including colonisation, which enhances their efficacy. They produce inhibitory constituents like organic acids, fatty acids, hydrogen peroxide, SCFAs, and bacteriocin-like inhibitory substances that prevent pathogens. (Tharmaraj and Shah, 2009). Bacteriocins refer to antimicrobial peptides or proteins that are produced by bacteria via ribosomal mechanisms. The aforementioned compounds demonstrate a diverse spectrum of antimicrobial efficacy against pathogenic bacteria, encompassing multiple strains of Staphylococcus, Listeria, Bacillus, Clostridium, and other bacterial species (Dai et al., 2021; Fathizadeh et al., 2022). The significance of bacteriocins synthesised by probiotic bacteria is ascribed to their secure utilisation in diverse domains, including the food industry, pharmaceuticals, veterinary medicine, and human healthcare (Barcenilla et al., 2021; Sharma et al., 2021; Somashekaraiah et al., 2021). The compounds cited in the scholarly articles (Sheoran and Tiwari, 2019; Sheoran and Tiwari, 2020; Chen et al., 2021) exhibit inhibitory effects on a wide range of bacteria. Their mechanism of action involves reducing cell viability, modifying bacterial cell metabolism, and inhibiting toxin production. Additional mechanisms of probiotic action include competitive inhibition on the surface of the intestinal epithelium, wherein the probiotics obstruct the binding sites of the intestinal epithelial surface, as well as a reduction in the interaction between the pathogen and the host. Similarly, the investigation of nutrient competition is also examined as a mechanism underlying probiotic activity. According to the suggestions of the World Health Organization (WHO), Food and Agriculture Organization (FAO), and the European Food Safety Authority (EFSA), in their selection process, probiotic strains must meet both safety and functionality criteria, as well as those related to their technological usefulness. Probiotic characteristics are not associated with the genus or species of a microorganism, but with few and specially selected strains of a particular species (Hill et al., 2014). FAO and WHO have jointly developed guidelines that propose a systematic approach for conducting comprehensive evaluations of probiotics in food products, to provide scientific evidence to support health claims and benefits. The essential criteria for an ideal probiotic are presented by Pandey et al. (2015). The application of the FAO/WHO guidelines on Probiotics has the potential to serve as a universal benchmark for evaluating probiotics in food products, thereby facilitating the validation of health-related assertions.

The guidelines stipulate that the following activities must be carried out:

The identification and categorisation of strains.

The term “prebiotics” is a relatively recent concept that is clearly defined as “nondigestible food ingredients that beneficially alter the host by selectively stimulating the growth and/or activity of a specific group of bacteria in the colon, thereby improving the overall health of the host” (Gibson and Roberfroid, 1995). Recently, the International Scientific Association for Probiotics and Prebiotics (ISAPP) convened a panel of experts to reassess the definition of prebiotics. The panel has expanded the definition to encompass a broader understanding, defining it as “a substrate that is selectively utilised by host microorganisms, resulting in a health benefit.” The definition presented by Gibson et al. (2017) expands upon the concept of prebiotics by considering the potential inclusion of non-carbohydrate substances, exploring their relevance to body sites beyond the gastrointestinal tract, and identifying distinct groups beyond those found in food. These substances are typically classified as short-chain carbohydrates that are resistant to digestion yet serve as substrates for the proliferation of probiotic microorganisms within the upper gastrointestinal tract. Cocoa-derived flavanols are compounds that are not classified as carbohydrates but have been proposed as potential prebiotics. According to Tzounis et al. (2011), experimental studies conducted both in vivo and in vitro demonstrate that flavanols can enhance the proliferation of lactic acid bacteria.

A significant increase in the Bifidobacteria population in faecal samples has been reported due to fructooligosaccharides (FOS) consumption. Prebiotics, consisting of glucose, fructose, galactose and/or xylose, undergo minimal hydrolysis in the intestinal tract and have caloric value due to their resistance to digestion and energy metabolism through fermentation (Roberfroid, 1993). Prebiotics like FOS, isomalto-oligosaccharides (IMO), and xylooligosaccharides (XOS) are studied for their potential benefits on stool volume, constipation relief, and faecal acidity. FOS, like inulin and neosugar, are dietary fibres that improve stool volume and faecal acidity. These prebiotics are easily metabolised by bifidobacteria and other microorganisms like Lactobacillus acidophilus, Bacteroides vulgatus, B. ovatus, B. thetaiotaomicron, B. fragilis, and Enterococcus faecium, E. faecalis (Guarino et al., 2020) An optimal prebiotic substance should possess several key characteristics, as illustrated in Figure 2. IMO can be identified in various fermented food products, including miso, soy sauce, and honey. These compounds are known to be metabolised by bifidobacteria and the Bacteroides groups. IMO facilitates the proliferation of Bifidobacterium and Lactobacillus species, leading to both local and systemic Th1-like immune responses and the regulation of immune function. The presence of positive outcomes has been identified in the clinical trials. XOS are a class of prebiotics that occur naturally in various sources such as fruits, bamboo shoots, vegetables, milk, honey, and others (Aachary and Prapulla, 2010). Previous research has indicated that Bifidobacterium adolescentis can utilise XOS, while, Lactobacillus rhamnosus, L. plantarum and Lactococcus lactis have been found to efficiently metabolise oat -glucooligosaccharides. According to Van Laere et al. (2000), the fermentation process of arabinose-XOS derived from wheat meal by bifidobacteria can be attributed to the existence of xylanolytic enzyme systems such as xylosidase and a limited number of arabinosidases. The presence of a -D-xylosidase derived from Bifidobacterium breve K-110, as well as arabinosidases originating from B. adolescentis DSM20083 (Van Laere et al., 2000) and B. breve (Shin et al., 2000), has been documented in the literature. Zeng et al. (2007) conducted a study on the species B. bifidum, B. adolescentis, and B. infantis, and reported that these species exclusively exhibited arabinosidase and xylosidase activity, while no activity of, glucuronidase, or acetyl xylan esterase and xylanase was observed. Gullon et al. (2008) studied the fermentation process of XOS from rice husks using probiotic bacteria. They found that Bifidobacterium adolescentis CECT 5781 showed significantly greater growth compared to Breve CECT 4839, Bifidobacterium longum CECT 4503 and Infantis CECT 4551 in the presence of XOS. This highlights the importance of industrial development in prebiotics for enhancing food quality and human health.

A variety of functional foods containing prebiotics have been utilised in the production of biscuits, candies, tabletop sweeteners, frozen yoghurt, and other similar products (Davani-Davari et al., 2019). In Japan, the Foods for Specified Health Uses (FOSHU) programme has incorporated various prebiotics, such as FOS, IMO, XOS, lacto-sucrose, and lactulose oligosaccharides, into specific food products. Additional examples of prebiotic foods include yoghurts, cereals, cakes; cereal bars biscuits high in dietary fibre, powdered beverages, pasta, sauces, bread, infant formula products and various fruit juices (Desai, 2008). Prebiotics are commonly associated with specific types of dietary fibre, such as inulin and FOS. However, they can also be found in various food sources, including cultivated plants and wild plants. Below are several examples of food plants that are abundant in prebiotics; categorised accordingly as cultivated and wild plants.

Cultivated plants

Wild Plants:

These are just a few examples, and there are many other cultivated and wild plants that can offer prebiotic benefits. Combining a type of these prebiotic-rich foods into your diet can aid in promoting a healthy gut microbiome (Crittenden and Playne, 2008; Davani-Davari et al., 2019). For a product (food or supplement) to be believed to be a prebiotic, it must meet the below-mentioned conditions (Gibson et al., 2017).

Prebiotic enhance the proliferation and metabolic function of selected bacterial strains that exhibit beneficial impacts on overall well-being in the following ways.

Gibson’s proposition of prebiotics was accompanied by a rationale for the potential advancements that could be achieved through the combination of prebiotics with probiotics, leading to the establishment of what he referred to as Synbiotics (De Vrese and Schrezenmeir, 2008). The term “synbiotics” pertains to the amalgamation of prebiotics and probiotics to improve the well-being of humans or animals (Markowiak and Śliżewska, 2017). According to research conducted by Perrin et al. (2001) and Sharma and Shukla (2016), the probiotic bacteria found in synbiotic food products make selective use of prebiotics as a substrate for their growth. A group of specialists from the International Scientific Association for Probiotics and Prebiotics got together and rethought the concept of synbiotics. Synbiotic treatment aims to improve the endurance and metabolic function of beneficial probiotic strains in the gut microbiota. Common combinations include lactobacilli and bifidobacteria with oligosaccharides, inulin, or fibres as prebiotics. This approach reduces systemic inflammation by increasing the population of bacteria producing SCFAs and providing substrates for fermentation (Pandey et al., 2015).

According to their classification, synbiotics can be categorised into two distinct classes: complementary and synergistic. A complementary synbiotic is comprised of a probiotic and a prebiotic, which collectively provide one or more health benefits without requiring interdependent functions. According to Swanson et al. (2020), a synergistic synbiotic is composed of a substrate that is specifically utilised by microorganisms that are co-administered. These guidelines are expected to be efficacious in establishing expectations regarding the comprehension of the interplay between pre- and probiotics as well as the advancement of synbiotic products for the promotion of health and therapeutic interventions. Numerous reports suggest that the consumption of synbiotic foods has a beneficial impact on the health and nutritional status of the host. The study conducted by Yang et al. (2005) revealed that the administration of synbiotics had a dual effect on the faecal sample. Firstly, it was observed that synbiotics increased the abundance of probiotic bacteria, specifically Lactobacillus and Bifidobacterium, while simultaneously reducing the presence of coliform bacteria. Additionally, the test group exhibited an improvement in the levels of various digestive enzymes, including lactase, sucrase, lipase and isomaltase. Recently, there has been a report indicating that the consumption of synbiotics has significantly decreased various cardiovascular risk factors, the prevalence of metabolic syndrome, and markers of insulin resistance among elderly individuals (Cicero et al., 2021). The ability of bifidobacteria to metabolise prebiotics is dependent on the species, which is a valuable characteristic for modulating the gut microbiota through the use of specialised prebiotics (Bielecka et al., 2002; Biedrzycka and Bielecka, 2004). The β-fructofuranosidase enzyme derived from Bifidobacterium adolescentis G1 exhibits a preference for fructooligomers over inulin as its substrate. This preference is also observed in B. bifidum. In contrast, it has been observed that B. longum and B.animalis possess the ability to hydrolyze a diverse array of FOS and XOS, including those derived from inulin (Bruno et al., 2002). According to a study conducted by Bruno et al. (2002), food products contain the greatest concentration of viable bifidobacteria. Likewise, the efficacy of B. longum supplemented with FOS is greater in curd. According to Martinez-Villaluenga and Gomez (2007), the probiotic B. lactis possesses the enzymes β-glucosidase and β -fructofuranosidase, which enable it to metabolise oligosaccharides present in fermented milk. This metabolic activity promotes the growth and metabolism of the probiotic organism. The therapeutic potentials and health benefits of different probiotics, prebiotics, and synbiotics are presented in Table 4.

When it comes to treating ulcerative colitis, ensuring safety and considering various factors are of paramount importance. Here are some key safety considerations to keep in mind:

UC significantly impacts individuals’ health and quality of life, with treatment options including aminosalicylates, corticosteroids, immunomodulators, biological therapies, and surgical interventions. However, some patients have not responded well to these treatments, leading to prolonged suffering and reduced quality of life. Alternative therapies like experimental drugs are considered, but their effectiveness remains uncertain and comes with risks and complications. As we gain more understanding of the pathophysiology of UC and its relationship with the microbiome, there will be a rise in research trials to determine the efficacy of emerging treatments. Scholars are currently investigating “next-generation” probiotics, such as Clostridium clusters IV, XIVa, and XVIII, Bacteroides uniformis, Bacteroides fragilis, Akkermansia muciniphila, Eubacterium hallii, and Faecalibacterium prausnitzii as potential alternatives.

Collaborative engagement between patients and healthcare providers is crucial for determining the most suitable treatment approach. Emerging treatments like prebiotics, probiotics, and synbiotics have gained attention for their potential therapeutic benefits in improving gut health and treating various conditions. For patients with IBD, traditional medications may not always work for every patient, and their side effects can be severe. In clinical practice, incorporating probiotics, prebiotics, and synbiotics holds great promise for transforming the approach to managing ulcerative colitis, offering patients a safer and more focused alternative to conventional therapeutic interventions. This will facilitate our understanding of the interplay between human physiological processes and the microbiome.

The search for a definitive solution for UC continues to be a persistent effort, with existing therapeutic interventions primarily focused on maintaining a state of remission. In the management of this condition, conventional therapeutic approaches encompass the utilisation of aminosalicylates, corticosteroids, immunomodulators, and biological therapies. These interventions are employed with the objectives of attaining remission, averting relapses, and facilitating the restoration of mucosal integrity. Current therapeutic approaches encompass the use of monoclonal antibodies that specifically target proinflammatory cytokines, adhesion molecules, and T-cell activation, as well as anti-inflammatory cytokines like IL10 and TGF-. However, the administration of these medications can lead to various adverse effects, both at the systemic and local levels. These effects may include headaches, nausea, abdominal pain, loss of appetite, vomiting, and the development of a rash. The use of corticosteroids for an extended period is discouraged due to the potential increase in susceptibility to infections (Mowat et al., 2011). In contemporary times, functional food is increasingly recognised for its dual capacity to ensure nutritional security and confer health benefits on the consumer (Mijan and Lim, 2018). Promising advancements have been observed in the utilisation of probiotics, prebiotics, and synbiotics for the management of UC. Bacterial strains, such as Lactobacillus and Bifidobacterium species, have been linked to beneficial outcomes concerning symptom management and the maintenance of remission in individuals with a diagnosis of UC. By encouraging the growth of advantageous microorganisms and producing anti-inflammatory fatty acids, prebiotics supports gut health and digestion. Non-digestible fibres in foods like whole grains, garlic, and bananas support gut flora, lowering the risk of gastrointestinal conditions like irritable bowel syndrome and enhancing immune function. Prebiotic-rich foods are an excellent way to support digestive health and uphold general wellbeing through diet. The synergistic effects of prebiotics and probiotics allow for the effective management of UC (Fujimori et al., 2009). Therefore, it is imperative to conduct a comprehensive examination of these interventions to effectively mitigate any potential negative consequences and develop strategies for long-term supervision. The management of UC can be tailored to the individual by combining conventional treatments with probiotics, prebiotics, and synbiotics. The evaluated combination therapies demonstrate encouraging synergistic effects through the simultaneous targeting of various aspects of disease pathogenesis, including inflammation, immune dysregulation, and gut microbiota imbalance. Nevertheless, it is of utmost importance to conduct a thorough assessment of treatment interactions, contraindications, and individual patient variables to guarantee the safety and effectiveness of the intervention. It is imperative to undertake additional research, employing meticulously crafted clinical trials, to ascertain the most advantageous strains, compositions, and therapeutic regimens for probiotics, prebiotics, and synbiotics within the particular framework of UC. The aforementioned advancements provide empirical support for the capacity to enhance therapeutic outcomes, alleviate adverse effects, and establish innovative and well-tolerated strategies for managing UC. The current literature on probiotics and prebiotics in IBD is influenced by significant heterogeneity, with varying study designs, doses, and outcomes. The study populations varied, with some focusing on active disease patients and others on remission maintenance. Most studies enrolled small numbers of patients, limiting statistical power. The exact mechanisms of action of probiotics, prebiotics, and synbiotics are not yet fully understood. Insufficient evidence on probiotic dosages and immunological mechanisms is needed to establish health claims. The interaction between microbiota, host, and prebiotic components is also limited. Clinical trials and validation studies with larger sample sizes require understanding of these interactions. Limited published literature in manufacturing processes and formulation further needs improvement. (Astó et al., 2019)

In conclusion, the utilisation of probiotics, prebiotics, and synbiotics in the management of UC showcases a promising advancement with potential implications. These interventions present innovative strategies for manipulating the gut microbiota, reducing inflammation, and improving overall health. Additional investigation is required to determine the most effective utilisation and potential incorporation of these interventions into individualised therapeutic approaches for managing ulcerative colitis. Through the adoption of innovative approaches in the treatment of UC and the consideration of individual patient requirements, we have the potential to advance towards a more optimistic future for individuals afflicted by this complex inflammatory bowel disease.

AJ: Conceptualization, Data curation, Writing – original draft. SJ: Conceptualization, Supervision, Validation, Writing – review & editing. SV: Writing – review & editing. AS: Writing – review & editing. BK: Writing – review & editing.