Skip to main content
Erschienen in: International Journal of Colorectal Disease 9/2007

01.09.2007 | Original Article

Balsalazide and/or high-potency probiotic mixture (VSL#3) in maintaining remission after attack of acute, uncomplicated diverticulitis of the colon

verfasst von: Antonio Tursi, Giovanni Brandimarte, Gian Marco Giorgetti, Walter Elisei, Fabio Aiello

Erschienen in: International Journal of Colorectal Disease | Ausgabe 9/2007

Einloggen, um Zugang zu erhalten

Abstract

Background and aims

The role of probiotics in the treatment of diverticulitis is still not known. The aim of our study was to investigate whether balsalazide and/or VSL#3 is effective in preventing diverticulitis recurrence.

Materials and methods

In this pilot study, 30 consecutive patients (19 males, 11 females, mean age 60.1 years, range 47–75 years) affected by uncomplicated diverticulitis of the colon were monitored. After obtaining remission, the patients were randomly assigned to one of the following groups as follows: group A, balsalazide 2.25 g daily for 10 days every month plus VSL#3 450 billions/day for 15 days every month and group B, VSL#3 alone 450 billions/day for 15 days every month. Primary end-point was considered the maintaining of remission throughout a 12-month follow-up. Secondary end-points considered were (1) the assessment of the overall scores at the end of the follow-up and (2) the effects of the two different treatments with regards to every symptom assessed.

Results/findings

One group A patient was withdrawn from the study at the 6th month and one group B patient was lost at the 6th month of follow-up. One group A patient (6.66%) showed relapse of symptoms at the 10th month of follow-up. At the end of follow-up, 11 patients were completely symptom-free (73.33%), whilst 2 patients complained of only mild, recurrent symptoms (13%). Two group B patients (13.33%) showed relapse of the disease at the 5th and 8th month of follow-up, respectively. At the end of follow-up, 8 patients were completely symptom-free (60%), 2 patients complained of mild, recurrent symptoms (13.33%), 1 patient (6.66%) complained of mild but continuous symptoms. No side effects were recorded throughout the follow-up in both groups.

Interpretation/conclusions

Combination probiotic/anti-inflammatory drug was found better than probiotic treatment in preventing relapse of uncomplicated diverticulitis of the colon, even if without statistical significance.
Literatur
1.
2.
Zurück zum Zitat Painter NS, Burkitt DP (1971) Diverticular disease of the colon: a deficiency disease of western civilization. Br Med J 2:450–454PubMedCrossRef Painter NS, Burkitt DP (1971) Diverticular disease of the colon: a deficiency disease of western civilization. Br Med J 2:450–454PubMedCrossRef
3.
Zurück zum Zitat Parks TG (1975) Natural history of diverticular disease of the colon. Clin Gastroenterol 4:53–69PubMed Parks TG (1975) Natural history of diverticular disease of the colon. Clin Gastroenterol 4:53–69PubMed
4.
Zurück zum Zitat Painter NS, Burkitt DP (1975) Diverticular disease of the colon, a 20th century problem. Clin Gastroenterol 4:3–21PubMed Painter NS, Burkitt DP (1975) Diverticular disease of the colon, a 20th century problem. Clin Gastroenterol 4:3–21PubMed
5.
Zurück zum Zitat Berman LG, Burdick D, Heitzman ER, Prior JT (1968) A critical reappraisal of sigmoid peridiverticulitis. Surg Gynecol Obstet 127:481–491PubMed Berman LG, Burdick D, Heitzman ER, Prior JT (1968) A critical reappraisal of sigmoid peridiverticulitis. Surg Gynecol Obstet 127:481–491PubMed
6.
Zurück zum Zitat Williams RA, Davis IP (1995) Diverticular disease of the colon. In: Haubrich WS, Schaffner F (eds) Bockus gastroenterology, 5th edn. Saunders, Philadelphia, pp 1637–1656 Williams RA, Davis IP (1995) Diverticular disease of the colon. In: Haubrich WS, Schaffner F (eds) Bockus gastroenterology, 5th edn. Saunders, Philadelphia, pp 1637–1656
7.
Zurück zum Zitat Tursi A, Brandimarte G, Daffinà R (2002) Long-term treatment with mesalazine and rifaximin versus rifaximin alone for the patients with recurrent attacks of acute diverticulitis of the colon. Dig Liver Dis 34:510–515PubMedCrossRef Tursi A, Brandimarte G, Daffinà R (2002) Long-term treatment with mesalazine and rifaximin versus rifaximin alone for the patients with recurrent attacks of acute diverticulitis of the colon. Dig Liver Dis 34:510–515PubMedCrossRef
8.
Zurück zum Zitat Ragunath K, Williams JG (2001) Review article: balsalazide therapy in ulcerative colitis. Aliment Pharmacol Ther 15:1549–1554PubMedCrossRef Ragunath K, Williams JG (2001) Review article: balsalazide therapy in ulcerative colitis. Aliment Pharmacol Ther 15:1549–1554PubMedCrossRef
9.
Zurück zum Zitat Green JR, Mansfield JC, Gibson JA, Kerr GD, Thornton PC (2002) A double-blind comparison of balsalazide, 6.75 g daily, and sulfasalazine, 3 g daily, in patients with newly diagnosed or relapsed active ulcerative colitis. Aliment Pharmacol Ther 16:61–68PubMedCrossRef Green JR, Mansfield JC, Gibson JA, Kerr GD, Thornton PC (2002) A double-blind comparison of balsalazide, 6.75 g daily, and sulfasalazine, 3 g daily, in patients with newly diagnosed or relapsed active ulcerative colitis. Aliment Pharmacol Ther 16:61–68PubMedCrossRef
10.
Zurück zum Zitat Mansfield JC, Giaffer MH, Cann PA, McKenna D, Thornton PC, Holdsworth CD (2002) A double-blind comparison of balsalazide, 6.75 g, and sulfasalazine, 3 g, as sole therapy in the management of ulcerative colitis. Aliment Pharmacol Ther 16:69–77PubMedCrossRef Mansfield JC, Giaffer MH, Cann PA, McKenna D, Thornton PC, Holdsworth CD (2002) A double-blind comparison of balsalazide, 6.75 g, and sulfasalazine, 3 g, as sole therapy in the management of ulcerative colitis. Aliment Pharmacol Ther 16:69–77PubMedCrossRef
11.
Zurück zum Zitat Green JR, Gibson JA, Kerr GD, Swarbrick ET, Lobo AJ, Holdsworth CD, Crowe JP, Schofield KJ, Taylor MD (1998) Maintenance of remission of ulcerative colitis: a comparison between balsalazide 3 g daily and mesalazine 1.2 g daily over 12 months. Aliment Pharmacol Ther 12:1207–1216PubMedCrossRef Green JR, Gibson JA, Kerr GD, Swarbrick ET, Lobo AJ, Holdsworth CD, Crowe JP, Schofield KJ, Taylor MD (1998) Maintenance of remission of ulcerative colitis: a comparison between balsalazide 3 g daily and mesalazine 1.2 g daily over 12 months. Aliment Pharmacol Ther 12:1207–1216PubMedCrossRef
12.
Zurück zum Zitat Sanders ME (1999) Probiotics. Food Technol 53:67–77 Sanders ME (1999) Probiotics. Food Technol 53:67–77
13.
Zurück zum Zitat Gionchetti P, Amadini C, Rizzello F, Venturi A, Palmonari V, Morselli C, Romagnoli R, Campieri M (2002) Probiotics—role in inflammatory bowel disease. Dig Liver Dis 34(Suppl 2):S58–S62PubMedCrossRef Gionchetti P, Amadini C, Rizzello F, Venturi A, Palmonari V, Morselli C, Romagnoli R, Campieri M (2002) Probiotics—role in inflammatory bowel disease. Dig Liver Dis 34(Suppl 2):S58–S62PubMedCrossRef
15.
Zurück zum Zitat Bazzocchi G, Gionchetti P, Almerigi PF, Amadini C, Campieri M (2002) Intestinal microflora and oral bacteriotherapy in irritable bowel syndrome. Dig Liver Dis 34(Suppl 2):S48–S53PubMedCrossRef Bazzocchi G, Gionchetti P, Almerigi PF, Amadini C, Campieri M (2002) Intestinal microflora and oral bacteriotherapy in irritable bowel syndrome. Dig Liver Dis 34(Suppl 2):S48–S53PubMedCrossRef
16.
Zurück zum Zitat Cremonini F, Di Caro S, Covino M, Armuzzi A, Gabrielli M, Santarelli L et al (2002) Effect of different probiotic preparations on anti-Helicobacter pylori therapy-related side-effects: a parallel group, triple blind, placebo-controlled study. Am J Gastroenterol 97:2744–2749PubMedCrossRef Cremonini F, Di Caro S, Covino M, Armuzzi A, Gabrielli M, Santarelli L et al (2002) Effect of different probiotic preparations on anti-Helicobacter pylori therapy-related side-effects: a parallel group, triple blind, placebo-controlled study. Am J Gastroenterol 97:2744–2749PubMedCrossRef
17.
Zurück zum Zitat Frič P, Zavoral M (2003) The effect of non-pathogenic Escherichia coli in symptomatic uncomplicated diverticular disease of the colon. Eur J Gastroenterol Hepatol 15:313–315PubMedCrossRef Frič P, Zavoral M (2003) The effect of non-pathogenic Escherichia coli in symptomatic uncomplicated diverticular disease of the colon. Eur J Gastroenterol Hepatol 15:313–315PubMedCrossRef
18.
Zurück zum Zitat Tursi A, Brandimarte G, Giorgetti GM, Elisei W (2006) Mesalazine and/or Lactobacillus casei in preventing recurrence of symptomatic uncomplicated diverticular disease of the colon: a prospective, randomised, open-label study. J Clin Gastroenterol 40:312–316PubMedCrossRef Tursi A, Brandimarte G, Giorgetti GM, Elisei W (2006) Mesalazine and/or Lactobacillus casei in preventing recurrence of symptomatic uncomplicated diverticular disease of the colon: a prospective, randomised, open-label study. J Clin Gastroenterol 40:312–316PubMedCrossRef
19.
Zurück zum Zitat Venturi A, Gionchetti P, Rizzello F, Johansson R, Zucconi E, Brigidi P, Matteuzzi D, Campieri M (1999) Impact on the composition of the faecal flora by a new probiotic preparation: preliminary data on maintenance treatment of patients with ulcerative colitis. Aliment Pharmacol Ther 13:1103–1108PubMedCrossRef Venturi A, Gionchetti P, Rizzello F, Johansson R, Zucconi E, Brigidi P, Matteuzzi D, Campieri M (1999) Impact on the composition of the faecal flora by a new probiotic preparation: preliminary data on maintenance treatment of patients with ulcerative colitis. Aliment Pharmacol Ther 13:1103–1108PubMedCrossRef
20.
Zurück zum Zitat Lamanna A, Orsi A (1984) In vitro activity of rifaximin and rifampicin against some anaerobic bacteria. Chemioterapia 11:365–367 Lamanna A, Orsi A (1984) In vitro activity of rifaximin and rifampicin against some anaerobic bacteria. Chemioterapia 11:365–367
21.
Zurück zum Zitat Papi C, Ciaco A, Koch M, Capurso L (1995) Efficacy of rifaximin in the treatment of symptomatic diverticular disease of the colon. A multicentre double-blind placebo-controlled trial. Aliment Pharmacol Ther 9:33–39PubMedCrossRef Papi C, Ciaco A, Koch M, Capurso L (1995) Efficacy of rifaximin in the treatment of symptomatic diverticular disease of the colon. A multicentre double-blind placebo-controlled trial. Aliment Pharmacol Ther 9:33–39PubMedCrossRef
22.
Zurück zum Zitat Chautems RC, Ambrosetti P, Ludwig A, Mermillod B, Morel P, Soravia C (2002) Long-term follow-up after first acute episode of sigmoid diverticulitis: is surgery mandatory?: a prospective study of 118 patients. Dis Colon Rectum 45:962–966PubMedCrossRef Chautems RC, Ambrosetti P, Ludwig A, Mermillod B, Morel P, Soravia C (2002) Long-term follow-up after first acute episode of sigmoid diverticulitis: is surgery mandatory?: a prospective study of 118 patients. Dis Colon Rectum 45:962–966PubMedCrossRef
23.
Zurück zum Zitat Brandimarte G, Tursi A (2004) Rifaximin plus mesalazine followed by mesalazine alone is highly effective in obtaining remission of symptomatic uncomplicated diverticular disease. Med Sci Monit 10(5):PI70–PI73PubMed Brandimarte G, Tursi A (2004) Rifaximin plus mesalazine followed by mesalazine alone is highly effective in obtaining remission of symptomatic uncomplicated diverticular disease. Med Sci Monit 10(5):PI70–PI73PubMed
24.
Zurück zum Zitat Shanahan F (2001) Inflammatory bowel disease: immunodiagnostics, immunotherapeutics, and ecotherapeutics. Gastroenterology 120:622–635PubMedCrossRef Shanahan F (2001) Inflammatory bowel disease: immunodiagnostics, immunotherapeutics, and ecotherapeutics. Gastroenterology 120:622–635PubMedCrossRef
25.
Zurück zum Zitat Giaccari S, Tronci S, Falconieri M, Ferrieri A (1993) Long-term treatment with rifaximin and lactobacilli in post-diverticulitic stenoses of the colon. Eur Rev Med Pharmacol Sci 15:29–34 Giaccari S, Tronci S, Falconieri M, Ferrieri A (1993) Long-term treatment with rifaximin and lactobacilli in post-diverticulitic stenoses of the colon. Eur Rev Med Pharmacol Sci 15:29–34
26.
Zurück zum Zitat Dugas B, Mercenier A, Lenoir-Wijnkoop I, Arnaud C, Dugas N, Postaire E (1999) Immunity and probiotics. Immunol Today 20:387–390PubMedCrossRef Dugas B, Mercenier A, Lenoir-Wijnkoop I, Arnaud C, Dugas N, Postaire E (1999) Immunity and probiotics. Immunol Today 20:387–390PubMedCrossRef
27.
Zurück zum Zitat Bengmark S (1998) Ecological control of the gastrointestinal tract. The role of probiotic flora. Gut 42:2–7PubMedCrossRef Bengmark S (1998) Ecological control of the gastrointestinal tract. The role of probiotic flora. Gut 42:2–7PubMedCrossRef
28.
Zurück zum Zitat Borruel N, Casellas F, Antolin M, Llopis M, Carol M, Espìin E, Naval J, Guarner F, Malagelada JR (2003) Effects of nonpathogenic bacteria on cytokine secretion by human intestinal mucosa. Am J Gastroenterol 98:865–870PubMedCrossRef Borruel N, Casellas F, Antolin M, Llopis M, Carol M, Espìin E, Naval J, Guarner F, Malagelada JR (2003) Effects of nonpathogenic bacteria on cytokine secretion by human intestinal mucosa. Am J Gastroenterol 98:865–870PubMedCrossRef
29.
Zurück zum Zitat Tursi A, Brandimarte G, Giorgetti GM, Forti G, Modeo ME, Gigliobianco A (2004) Low-dose balsalazide plus high-potency probiotic preparation is more effective than balsalazide alone or mesalazine in the treatment of acute mild-to-moderate ulcerative colitis. Med Sci Monit 10:PI126–PI131PubMed Tursi A, Brandimarte G, Giorgetti GM, Forti G, Modeo ME, Gigliobianco A (2004) Low-dose balsalazide plus high-potency probiotic preparation is more effective than balsalazide alone or mesalazine in the treatment of acute mild-to-moderate ulcerative colitis. Med Sci Monit 10:PI126–PI131PubMed
30.
Zurück zum Zitat Eliakim R, Rachmilewitz D (1992) Potential mediators in inflammatory bowel disease. Gastroenterology Int 5:48–56 Eliakim R, Rachmilewitz D (1992) Potential mediators in inflammatory bowel disease. Gastroenterology Int 5:48–56
31.
Zurück zum Zitat Grisham MB (1994) Oxidants and free radicals in inflammatory bowel disease. Lancet 344:859–861PubMedCrossRef Grisham MB (1994) Oxidants and free radicals in inflammatory bowel disease. Lancet 344:859–861PubMedCrossRef
32.
Zurück zum Zitat Wood AJJ (1996) Inflammatory bowel disease. N Engl J Med 334:841–848CrossRef Wood AJJ (1996) Inflammatory bowel disease. N Engl J Med 334:841–848CrossRef
33.
Zurück zum Zitat Gonçalves E, Almeida LM, Dinis TC (1998) Antioxidant activity of 5-aminosalicylic acid against peroxidation of phosphatidylcholine liposomes in the presence of alpha-tocopherol: a synergistic interaction? Free Radic Res 29:53–66PubMedCrossRef Gonçalves E, Almeida LM, Dinis TC (1998) Antioxidant activity of 5-aminosalicylic acid against peroxidation of phosphatidylcholine liposomes in the presence of alpha-tocopherol: a synergistic interaction? Free Radic Res 29:53–66PubMedCrossRef
34.
Zurück zum Zitat Ulisse S, Gionchetti P, D’Alo S, Russo FP, Pesce I, Ricci G, Rizzello F, Helwig U, Cifone MG, Campieri M, De Simone C (2001) Expression of cytokines, inducible nitric oxide synthase, and matrix metalloproteinases in pouchitis: effect of probiotic treatment. Am J Gastroenterol 96:2691–2699PubMedCrossRef Ulisse S, Gionchetti P, D’Alo S, Russo FP, Pesce I, Ricci G, Rizzello F, Helwig U, Cifone MG, Campieri M, De Simone C (2001) Expression of cytokines, inducible nitric oxide synthase, and matrix metalloproteinases in pouchitis: effect of probiotic treatment. Am J Gastroenterol 96:2691–2699PubMedCrossRef
Metadaten
Titel
Balsalazide and/or high-potency probiotic mixture (VSL#3) in maintaining remission after attack of acute, uncomplicated diverticulitis of the colon
verfasst von
Antonio Tursi
Giovanni Brandimarte
Gian Marco Giorgetti
Walter Elisei
Fabio Aiello
Publikationsdatum
01.09.2007
Verlag
Springer-Verlag
Erschienen in
International Journal of Colorectal Disease / Ausgabe 9/2007
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-007-0299-6

Weitere Artikel der Ausgabe 9/2007

International Journal of Colorectal Disease 9/2007 Zur Ausgabe

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 Ablationstherapie Nachrichten

Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Ureterstriktur: Innovative OP-Technik bewährt sich

19.04.2024 EAU 2024 Kongressbericht

Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.