Probiotics in the Treatment of Diverticular Disease. A Systematic Review
Edith Lahnerl, Cristina Bellisario2, Cesare Hassan3, Angelo Zullo3, Gianluca Espositol, Bruno Annibalel
1) Dipartimento Medico-Chirurgico di Scienze Cliniche e Medicina Traslazionale, Sant’Andrea Hospital, School of Medicine, University Sapienza, Rome;
2) Department of Cancer Screening, Centre for Epidemiology and Prevention in Oncology (CPO), University Hospital Città della Salute e della Scienza di Torino, Turin;
3) Digestive Endoscopy Unit, Ospedale Nuovo Regina Margherita Rome, Italy
Background & Aims: Diverticular disease is a common gastrointestinal condition. Low-grade inflammation and altered intestinal microbiota have been identified as factors contributing to abdominal symptoms. Probiotics may lead to symptoms improvement by modifying the gut microbiota and are promising treatments for diverticular disease. The aim of this study was to systematically review the efficacy of probiotics in diverticular disease in terms of remission of abdominal symptoms and prevention of acute diverticulitis.
Methods: According to PRISMA, we identified studies on diverticular disease patients treated with probiotics (Pubmed, Embase, Cochrane). The quality of these studies was evaluated by the Jadad scale. Main outcomes measures were remission of abdominal symptoms and prevention of acute diverticulitis.
Results: 11 studies (2 double-blind randomized placebo-controlled, 5 open randomized, 4 non-randomized open studies) were eligible. Overall, diverticular disease patients were 764 (55.1% females, age 58-75 years). Three studies included patients with symptomatic uncomplicated diverticular disease, 4 studies with symptomatic uncomplicated diverticular disease in remission, 4 studies with complicated or acute diverticulitis. Mainly (72.7%) single probiotic strains had been used, most frequently Lactobacilli. Follow-up ranged from 1 to 24 months. Interventions were variable: in 8 studies the probiotic was administered together with antibiotic or anti-inflammatory agents and compared with the efficacy of the drug alone; in 3 studies the probiotic was compared with a high-fibre diet or used together with phytoextracts. As an outcome measure, 4 studies evaluated the occurrence rate of acute diverticulitis, 6 studies the reduction of abdominal symptoms, and 6 studies the recurrence of abdominal symptoms. Meta-analysis on the efficacy of probiotics in diverticular disease could not be performed due to the poor quality of retrieved studies.
Conclusion: This systematic review showed that high-quality data on the efficacy of probiotics in diverticular disease are scant: the available data do not permit conclusions. Further investigation is required to understand how probiotics can be employed in this condition.
Key words: diverticular disease – treatment – probiotics – symptomatic uncomplicated diverticular disease – systematic review.
Abbreviations: DD: diverticular disease; IBS: irritable bowel syndrome; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RR: relative risk.