Acute recurrent diverticulitis is prevented by oral administration of a polybacterial lysate suspension.
OBJECTIVE
The main cause of acute diverticulitis is the abnormal accumulation of fecal bacteria within the diverticular lumen, leading to a balancing between normal probiotic microflora and pathogenic species; Gram negative Entero-bacteriaceae, mainly Escherichia coli and Proteus spp, are the genders that usually cause the disease-related symptoms, due to their ability to adhere to intestinal mucosa. The intestine is well known as the largest human lymphoepithelial organ and daily produces more antibodies, mainly secretory IgAs, than do all other lymphoid tissues. IgAs have different immune and anti-inflammatory properties. The aim of this study was to verify the efficacy of an oral immunostimulant highly-purified, polymicrobial lysate in the prevention of recurrent attacks of diverticulitis and in the improvement of symptoms.


METHODS
The study was carried out on 83 consecutive patients suffering from recurrent symptomatic acute diverticulitis and with at least 2 attacks in the previous year; patients were randomly assigned to receive (group A) an oral polybacterial lysate suspension or to a no-treatment clinical follow-up as controls (group B).


RESULTS
A total of 76 patients (41 in group A and 35 in group B) terminated the study period. the sums of the scores for symptoms, reported on day schedules, were calculated and examined by means of ANOVA statistical analysis. Statistical differences between group A vs group B were recorded after 1 month (p<0.05) and 3 months (p<0.01) of treatment with the oral polybacterial lysate suspension.


CONCLUSIONS
Our data suggest that the administration of an oral enterovaccine for the prophylaxis of recurrent diverticulitis is effective and well tolerated, probably due to a direct stimulation of IgA-mediated mucosal defences.
Dughera
L
L
Digestive Motility and Endoscopy Unit, Department of Clinical Physiopathology, University of Turin, Turin, Italy. luca.dughera@libero.it
Serra
A M
AM
Battaglia
E
E
Tibaudi
D
D
Navino
M
M
Emanuelli
G
G
D000208:Acute Disease; D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000284:Administration, Oral; D000368:Aged; D000704:Analysis of Variance; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001419:Bacteria; D001428:Bacterial Vaccines / Q000008:administration & dosage*; D002457:Cell Extracts / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000627:therapeutic use; D003113:Colonoscopy; D004238:Diverticulitis / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control* / Q000628:therapy; D004239:Diverticulitis, Colonic / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D007413:Intestinal Mucosa / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012294:Rifamycins / Q000008:administration & dosage / Q000627:therapeutic use; D000078262:Rifaximin; D013997:Time Factors; D000095983:Bacterial Lysates
D000276:Adjuvants, Immunologic; D000890:Anti-Infective Agents; D001428:Bacterial Vaccines; D002457:Cell Extracts; D002939:Ciprofloxacin; D005765:Gastrointestinal Agents; D012294:Rifamycins; D000078262:Rifaximin; C030259:Broncho-Vaxom; D000095983:Bacterial Lysates