Gionchetti Paolo, Rizzello Fernando, Morselli Claudia, Poggioli Gilberto, Tambasco Rosi, Calabrese Carlo, Brigidi Patrizia, Vitali Beatrice, Straforini Giulia, Campieri Massimo
Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy.
Dis Colon Rectum. 2007 Dec;50(12):2075-82; discussion 2082-4. doi: 10.1007/s10350-007-9068-4. Epub 2007 Oct 13.
Pouchitis is the major long-term complication after ileal-pouch anal anastomosis for ulcerative colitis. Broad-spectrum antibiotics are the mainstay of treatment in this condition. Recently, we have shown the efficacy of a highly concentrated probiotic preparation (VSL#3, 900 billions/sachet lyophilized viable bacteria) in preventing relapses of chronic pouchitis and in preventing pouchitis onset. This study was designed to evaluate the efficacy of high-dose VSL#3 in the treatment of mildly active pouchitis.
Twenty-three consecutive patients with mild pouchitis, defined as a score of between 7 and 12 in the Pouchitis Disease Activity Index, which includes clinical, endoscopic, and histological criteria, were treated with VSL#3, 2 sachets b.i.d. (3,600 billion bacteria/day) for four weeks. Symptomatic, endoscopic, and histologic evaluations were undertaken before and after treatment according to Pouchitis Disease Activity Index. Remission was defined as a combination of a Pouchitis Disease Activity Index clinical score of <or=2, endoscopic score of <or=1, and total Pouchitis Disease Activity Index score of <or=4. Patients in remission after treatment were treated with VSL#3, 1 sachet b.i.d. (1,800 billion bacteria), as maintenance treatment for six months. The quality of life was assessed with the Inflammatory Bowel Disease Questionnaire.
Sixteen of 23 patients (69 percent) were in remission after treatment. The median total Pouchitis Disease Activity Index scores before and after therapy were 10 (range, 9-12) and 4 (range, 2-11), respectively (P < 0.01). The median Inflammatory Bowel Disease Questionnaire score also significantly improved from 110 (range, 90-140) to 200 (range, 95-220; P < 0.001). All 16 patients who went into remission maintained remission during maintenance treatment. Only one patient experienced a transient bloating at the beginning of treatment.
High doses of the probiotic VSL#3 are effective in the treatment of mild pouchitis. Further controlled studies are warranted.
袋炎是溃疡性结肠炎行回肠袋肛管吻合术后主要的长期并发症。广谱抗生素是治疗该病的主要手段。最近，我们已经证明一种高浓度益生菌制剂（VSL#3，每袋冻干活菌9000亿个）在预防慢性袋炎复发及预防袋炎发病方面的有效性。本研究旨在评估高剂量VSL#3治疗轻度活动性袋炎的疗效。
连续纳入23例轻度袋炎患者，袋炎疾病活动指数（包括临床、内镜及组织学标准）评分为7至12分，给予VSL#3治疗，每日2次，每次2袋（每日3600亿个细菌），共4周。根据袋炎疾病活动指数在治疗前后进行症状、内镜及组织学评估。缓解定义为袋炎疾病活动指数临床评分为≤2分、内镜评分为≤1分且袋炎疾病活动指数总分≤4分。治疗后缓解的患者给予VSL#3每日2次，每次1袋（1800亿个细菌）作为维持治疗，为期6个月。采用炎症性肠病问卷评估生活质量。
23例患者中有16例（69%）治疗后缓解。治疗前后袋炎疾病活动指数总分中位数分别为10分（范围9 - 12分）和4分（范围2 - 11分）（P < 0.01）。炎症性肠病问卷评分中位数也从110分（范围90 - 140分）显著提高至200分（范围95 - 220分；P < 0.001）。所有16例缓解患者在维持治疗期间保持缓解状态。仅1例患者在治疗开始时出现短暂腹胀。
高剂量益生菌VSL#3治疗轻度袋炎有效。有必要进行进一步的对照研究。
