Lahner Edith, Bellisario Cristina, Hassan Cesare, Zullo Angelo, Esposito Gianluca, Annibale Bruno
Dipartimento Medico-Chirurgico di Scienze Cliniche e Medicina Traslazionale, Sant'Andrea Hospital, School of Medicine, University Sapienza, Rome,Italy.
Department of Cancer Screening, Centre for Epidemiology and Prevention in Oncology (CPO), University Hospital Città della Salute e della Scienza di Torino, Turin, Italy.
J Gastrointestin Liver Dis. 2016 Mar;25(1):79-86. doi: 10.15403/jgld.2014.1121.251.srw.
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.
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.
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.
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.
憩室病是一种常见的胃肠道疾病。低度炎症和肠道微生物群改变已被确定为导致腹部症状的因素。益生菌可能通过改变肠道微生物群来改善症状，是憩室病有前景的治疗方法。本研究的目的是系统评价益生菌在憩室病中缓解腹部症状和预防急性憩室炎方面的疗效。
根据PRISMA，我们检索了关于用益生菌治疗憩室病患者的研究（PubMed、Embase、Cochrane）。这些研究的质量通过Jadad量表进行评估。主要结局指标是腹部症状的缓解和急性憩室炎的预防。
11项研究（2项双盲随机安慰剂对照、5项开放随机、4项非随机开放研究）符合条件。总体而言，憩室病患者有764例（女性占55.1%，年龄58 - 75岁）。3项研究纳入有症状的非复杂性憩室病患者，4项研究纳入处于缓解期的有症状的非复杂性憩室病患者，4项研究纳入复杂性或急性憩室炎患者。主要（72.7%）使用单一益生菌菌株，最常用的是乳酸杆菌。随访时间为1至24个月。干预措施各不相同：8项研究中益生菌与抗生素或抗炎药联合使用，并与单独使用药物的疗效进行比较；3项研究中益生菌与高纤维饮食进行比较或与植物提取物联合使用。作为结局指标，4项研究评估了急性憩室炎的发生率，6项研究评估了腹部症状的减轻情况，6项研究评估了腹部症状的复发情况。由于检索到的研究质量较差，无法对益生菌在憩室病中的疗效进行荟萃分析。
本系统评价表明，关于益生菌在憩室病中疗效的高质量数据匮乏：现有数据无法得出结论。需要进一步研究以了解如何在这种情况下使用益生菌。
