Role Of Lactobacillus Reuteri DSM 17938 In The Non-Complicated Diverticular Disease
Role Of Lactobacillus Reuteri DSM 17938 In The Non-Complicated Diverticular Disease
The aim of this study is to evaluate the effectiveness and the tolerability of the
 Lactobacillus reuteri in the control of the diverticular disease symptoms and in the
 prevention of acute diverticulitis episodes.
The gastrointestinal apparatus hosts a bacterial population that quantifies to around 1011
 microorganisms per gram of content with more than 400 different species. Its principal
 functions are: metabolic, trophic, and protective. The Lactobacillus reuteri (Reuterin®) is
 considered one of the few native species in the human intestinal tract. It is able to
 modulate the immune response CD4+ T-Helper to an ileum level. Lactobacillus reuteri isolated
 for the first time in 1980 is a heterofermantative species. Its probiotic activity is
 attributed to the ability to exercise an inhibitive effect on the pathogenic micro-organisms
 with a combination of mechanisms including the production of lactic acid, hydrogen peroxide,
 antimicrobic substances and bactericide. Moreover, Lactobacillus reuteri is in a position to
 produce various short chain-like fat acids such as the acetic acid from the fermentation of
 carbohydrates. At last, it is in a position to produce a powerful antimicrob substance known
 as Reuterina that is capable of inhibiting the growth of many bacterial species including
 Escherichia, Salmonella, Shigella, Proteus, Pseudomonas, Clostridium and Sfafilococcus as
 well as fungi and protozoa, many of which are pathogens for man.

 Among pathologies in which it is hypothesized that probiotics could have a possible
 therapeutic role, there is the diverticulosis disease. Approximately 20% of patients with
 colonic diverticula have intestinal disturbances and a reduction of the quality of life.
 Moreover approximately 20% of the patients with diverticulosis in the colon have at least 1
 acute diverticulitis attack, characterized by pain, fever, abdominal defence, increment of
 the VES and neutrophil leucocytosis. Usually the acute diverticulitis episode can be
 controlled by medical therapy, but repeated episodes in time often lead to greater
 complications in the perforation, from the abdominal abscesses, from the fistulas and from
 the stenosis. The prevention of acute diverticulitis episodes is therefore very important so
 as to prevent greater complications of such pathology.

 Until now, the scientific evidences have suggested the use of fibre and non-absorbable
 antibiotics (such as rifaximine) for the treatment of a non-complicated diverticular disease
 and for the prophylaxis of the feared complications. The extended use of antibiotics exposes
 to the risk of selecting resistant strains and there are no long-term studies on the outcome
 of the patients suffering from diverticulosis in continuous therapy with rifaximine and
 fibres. The therapy with Lactobacillus reuteri could be effective in the control of symptoms
 of the diverticular disease through its trophic action on coloncytes (thanks to the SCFA
 production), both through the modulation of the activity of the immune system and on the
 intestinal permeability. Moreover the antibacterial activity of Lactobacillus reuteri against
 the pathogenic bacteria could be useful in the prevention and the treatment of acute
 diverticulitis episodes. Finally, thanks to its trophic role on the intestinal epithelium,
 Lactobacillus reuteri could help the mucosal cure of acute diverticulitis episodes.
Inclusion Criteria:

 -  Adult patients affected by symptomatic diverticulosis

 -  Informed consent obtained and signed.

 -  Expected compliance

 Exclusion Criteria:

 -  Patients supplemented with other probiotics

 -  Patients treated with antibiotics

 -  Patients affected by hearth failure, renal failure, neoplasia