title: High-fibre diet and Lactobacillus paracasei B21060 in symptomatic uncomplicated diverticular disease.
abstract: OBJECTIVE
  To investigate in symptomatic uncomplicated diverticular disease the efficacy of symbiotics associated with a high-fibre diet on abdominal symptoms.
  
  
  METHODS
  This study was a multicentre, 6-mo randomized, controlled, parallel-group intervention with a preceding 4-wk washout period. Consecutive outpatients with symptomatic uncomplicated diverticular disease, aged 40-80 years, evaluated in 4 Gastroenterology Units, were enrolled. Symptomatic uncomplicated diverticular disease patients were randomized to two treatment arms A or B. Treatment A (n = 24 patients) received 1 symbiotic sachet Flortec(©) (Lactobacillus paracasei B21060) once daily plus high-fibre diet for 6 mo. Treatment B (n = 21 patients) received high-fibre diet alone for 6 mo. The primary endpoint was regression of abdominal symptoms and change of symptom severity after 3 and 6 mo of treatment.
  
  
  RESULTS
  In group A, the proportion of patients with abdominal pain < 24 h decreased from 100% at baseline to 35% and 25% after 3 and 6 mo, respectively (P < 0.001). In group B the proportion of patients with this symptom decreased from 90.5% at baseline to 61.9% and 38.1% after 3 and 6 mo, respectively (P = 0.001). Symptom improvement became statistically significant at 3 and 6 mo in group A and B, respectively.The proportion of patients with abdominal pain >24 h decreased from 60% to 20% then 5% after 3 and 6 mo, respectively in group A (P < 0.001) and from 33.3% to 9.5% at both 3 and 6 mo in group B (P = 0.03). In group A the proportion of patients with abdominal bloating significantly decreased from 95% to 60% after 3 mo, and remained stable (65%) at 6-mo follow-up (P = 0.005) while in group B, no significant changes in abdominal bloating was observed (P = 0.11). After 6 mo of treatment, the mean visual analogic scale (VAS) values of both short-lasting abdominal pain (VAS, mean ± SD, group A: 4.6 ± 2.1 vs 2.2 ± 0.8, P = 0.02; group B: 4.6 ± 2.9 vs 2.0 ± 1.9, P = 0.03) and abdominal bloating (VAS, mean ± SD, group A: 5.3 ± 2.2 vs 3.0 ± 1.7, P = 0.005; group B: 5.3 ± 3.2 vs 2.3 ± 1.9, P = 0.006) decreased in both groups, whilst the VAS values of prolonged abdominal pain decreased in the Flortec(©) group, but remained unchanged in the high-fibre diet group (VAS, mean ± SD, group A: 6.5 ± 1.5 vs 4.5 ± 2.1, P = 0.052; group B: 4.5 ± 3.8 vs 5.5 ± 3.5).
  
  
  CONCLUSIONS
  A high-fibre diet is effective in relieving abdominal symptoms in symptomatic uncomplicated diverticular disease. This treatment may be implemented by combining the high-fibre diet with Flortec(©).
authors.affiliation: Department of Digestive and Liver Disease, University Sapienza, Rome 2nd Medical School, Sant'Andrea Hospital, 00189 Rome, Italy.
authors.forename: Edith
authors.initials: E
authors.lastname: Lahner
authors.forename: Gianluca
authors.initials: G
authors.lastname: Esposito
authors.forename: Angelo
authors.initials: A
authors.lastname: Zullo
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.forename: Claudio
authors.initials: C
authors.lastname: Cannaviello
authors.forename: Maria Carla Di
authors.initials: MC
authors.lastname: Paolo
authors.forename: Lorella
authors.initials: L
authors.lastname: Pallotta
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Garbagna
authors.forename: Enzo
authors.initials: E
authors.lastname: Grossi
authors.forename: Bruno
authors.initials: B
authors.lastname: Annibale
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D004043:Dietary Fiber / Q000008:administration & dosage*; D004241:Diverticulum, Colon / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D007558:Italy; D007778:Lactobacillus / Q000254:growth & development*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D058616:Synbiotics; D013997:Time Factors; D016896:Treatment Outcome
keywords: Diverticular disease; High-fibre diet; Lactobacillus paracasei B21060; Probiotics; Symbiotics; Symptomatic uncomplicated diverticular disease