title: Probiotics in the Treatment of Diverticular Disease. A Systematic Review.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Dipartimento Medico-Chirurgico di Scienze Cliniche e Medicina Traslazionale, Sant'Andrea Hospital, School of Medicine, University Sapienza, Rome,Italy.
authors.forename: Edith
authors.initials: E
authors.lastname: Lahner
authors.affiliation: Department of Cancer Screening, Centre for Epidemiology and Prevention in Oncology (CPO), University Hospital Città della Salute e della Scienza di Torino, Turin, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Bellisario
authors.affiliation: Digestive Endoscopy Unit, Ospedale Nuovo Regina Margherita, Rome, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.affiliation: Digestive Endoscopy Unit, Ospedale Nuovo Regina Margherita, Rome, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Zullo
authors.affiliation: Dipartimento Medico-Chirurgico di Scienze Cliniche e Medicina Traslazionale, Sant'Andrea Hospital, School of Medicine, University Sapienza, Rome,Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Esposito
authors.affiliation: Dipartimento Medico-Chirurgico di Scienze Cliniche e Medicina Traslazionale, Sant'Andrea Hospital, School of Medicine, University Sapienza, Rome, Italy. bruno.annibale@uniroma1.it.
authors.forename: Bruno
authors.initials: B
authors.lastname: Annibale
mesh_terms: D004238:Diverticulitis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D000069196:Gastrointestinal Microbiome; D006801:Humans; D007422:Intestines / Q000382:microbiology*; D019936:Probiotics / Q000009:adverse effects / Q000627:therapeutic use*; D012074:Remission Induction; D016896:Treatment Outcome