Supplementation with Lactobacillus reuteri ATCC PTA 4659 in patients affected by acute uncomplicated diverticulitis: a randomized double-blind placebo controlled trial
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Acute uncomplicated diverticulitis (AUD) is an inflammation of the colon diverticulum. We tested the efficacy of Lactobacillus reuteri 4659 (L. reuteri) in treating AUD. Primary outcome was reduced abdominal pain and inflammatory markers (C-RP). Secondary outcome was reduced hours of hospitalization.
Patients and methods
A double-blind, placebo RCT was conducted with 88 (34M/54F mean age 61.9 ± 13.9) patients with a diagnosis of AUD. Group A (44 patients, 26F): ciprofloxacin 400 mg/bid and metronidazole 500 mg/tid for 1 week, plus L. reuteri/bid for 10 days. Group B (44 patients, 28F): same antibiotic therapy for 1 week, plus placebo/bid for 10 days. All patients completed a daily visual analog scale (VAS) for abdominal pain.
Between days 1 and 3, the group A pain decreased by 4.5 points; group B decreased by 2.36 points (p < 0.0001). Between days 1 and 5, the group A decreased by 6.6 points; group B by 4.4 points (p < 0.0001). Between days 1 and 7, the group A decreased by 7.6 points; group B decreased by 5.6 points (p < 0.0001). Between days 1 and 10, the group A decreased by 8.1 points; group B decreased by 6.7 points (p < 0.0001).
For C-RP value, the mean decrease between admission and after 72 h was 45.3 mg/L for group A and 27.49 mg/L for group B (p < 0.0001).
Our RCT showed that supplementation of the standard AUD therapy with L. reuteri strain 4659 significantly reduced abdominal pain and inflammatory markers compared with the placebo group. It also resulted in a shorter period of hospitalization, and thus has economic benefits.
KeywordsAcute uncomplicated diverticulitis Lactobacillus reuteri Inflammatory markers
Compliance with ethical standards
All patients gave written informed consent. The study was approved by the independent Ethics Committee of the Catholic University of Rome (ID 1398) and conducted in accordance with the Declaration of Helsinki. Subjects did not receive any payment for their participation in the study. Intention to treat and per protocol analysis was performed.
- 2.Maconi G (2017 Apr 28) Diagnosis of symptomatic uncomplicated diverticular disease and the role of Rifaximin in management. Acta Biomed 88(1):25–32Google Scholar
- 4.Wilkins T, Embry K, George R (2013 May 1) Diagnosis and management of acute diverticulitis. Am Fam Physician 87(9):612–620Google Scholar
- 5.Hinchey EJ, Schaal PG, Richards GK (1979) Treatment of perforated diverticular disease of the colon. Adv Surg 12:85–109Google Scholar
- 14.Elisei W, Brandimarte G, Tursi A (2017 Oct) Management of diverticulosis: what’s new? Minerva Med 108(5):448–463Google Scholar
- 25.Krokowicz L, Stojcev Z, Kaczmarek BF, Kociemba W, Kaczmarek E, Walkowiak J, Krokowicz P, Drews M, Banasiewicz T (2014 Mar) Microencapsulated sodium butyrate administered to patients with diverticulosis decreases incidence of diverticulitis--a prospective randomized study. Int J Color Dis 29(3):387–393CrossRefGoogle Scholar
- 26.Bene KP, Kavanaugh DW, Leclaire C, Gunning AP, MacKenzie DA, Wittmann A, Young ID, Kawasaki N, Rajnavolgyi E, Juge N (2017) Lactobacillus reuteri surface mucus adhesins upregulate inflammatory responses through interactions with innate C-type lectin receptors. Front Microbiol 8:321CrossRefGoogle Scholar