Microencapsulated sodium butyrate administered to patients with diverticulosis decreases incidence of diverticulitis--a prospective randomized study

Lukasz Krokowicz, Zoran Stojcev, Bartosz Filip Kaczmarek, Wojciech Kociemba, Elżbieta Kaczmarek, Jaroslaw Walkowiak, Piotr Krokowicz, Michal Drews, Tomasz Banasiewicz, Lukasz Krokowicz, Zoran Stojcev, Bartosz Filip Kaczmarek, Wojciech Kociemba, Elżbieta Kaczmarek, Jaroslaw Walkowiak, Piotr Krokowicz, Michal Drews, Tomasz Banasiewicz

Abstract

Background: Microencapsulated sodium butyrate (MSB) has been previously associated with anti-inflammatory and regenerative properties regarding large bowel mucosa. We aimed to examine a role of MSB in patients with diverticulosis, hypothesizing its potential for reduction of diverticulitis episodes and diverticulitis prevention.

Methods: Seventy-three patients with diverticulosis (diagnosed in colonoscopy or/and barium enema or/and CT colography) were recruited for the study and randomized. The investigated group was administered MSB 300 mg daily; the control group was administered placebo. After 12 months, a total of 52 patients completed the study and were subject to analysis (30 subjects and 22 controls). During the study, the number of episodes of diverticulitis (symptomatic diagnosis with acute pain, fever, and leukocytosis), hospitalizations, and surgery performed for diverticulitis were recorded. Additionally, a question regarding subjective improvement of symptoms reflected changes in quality of life during the analysis.

Results: After 12 months, the study group noted a significantly decreased number of diverticulitis episodes in comparison to the control group. The subjective quality of life in the study group was higher than in the control group. There were no side effects of the MSB during the therapy.

Conclusions: MSB reduces the frequency of diverticulitis episodes, is safe, and improves the quality of life. It can play a role in the prevention of diverticulitis.

Figures

Fig. 1
Fig. 1
Flowchart representing the course double-blinded randomized study

References

    1. Parks TG. Natural history of diverticular disease of the colon. Clin Gastroenterol. 1975;4:3–21.
    1. Floch MH, Bina I. The natural history of diverticulitis: fact and theory. J Clin Gastroenterol. 2004;38:S2–S7. doi: 10.1097/.
    1. Munson KD, Hensien MA, Jacob LN, Robinson AM, Liston WA. Diverticulitis: a comprehensive follow-up. Dis Colon Rectum. 1996;39:318–324. doi: 10.1007/BF02049475.
    1. World Medical Association (2008) WMA Declaration of Helsinki—ethical principles for medical research involving human subjects, Seoul, Korea
    1. Mizuki A, Nagata H, Tatemichi M, Kaneda S, Tsukada N, Ishii H, Hibi T. The out-patient management of patients with acute mild-to-moderate colonic diverticulitis. Aliment Pharmacol Ther. 2005;21:889–897. doi: 10.1111/j.1365-2036.2005.02422.x.
    1. Ambrosetti P, Jenny A, Becker C, Terrier TF, Morel P. Acute left colonic diverticulitis—compared performance of computed tomography and water-soluble contrast enema: prospective evaluation of 420 patients. Dis Colon Rectum. 2000;43(10):1363–1367. doi: 10.1007/BF02236631.
    1. Etzioni DA, Mack TM, Beart RW, Jr, Kaiser AM. Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Ann Surg. 2009;249:210–217. doi: 10.1097/SLA.0b013e3181952888.
    1. Krukowski ZH, Matheson NA. Emergency surgery for diverticular disease complicated by generalized and faecal peritonitis: a review. Br J Surg. 1984;71:921–927. doi: 10.1002/bjs.1800711202.
    1. Wong WD, Wexner SD, Lowry A, Vernava A, III, Burnstein M. Practice parameters for the treatment of sigmoid diverticulitis—supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum. 2000;43:290–297. doi: 10.1007/BF02258291.
    1. Parks TG. Natural history of diverticular disease of the colon. A review of 521 cases. Br Med J. 1969;4:639–642. doi: 10.1136/bmj.4.5684.639.
    1. Peppas G, Bliziotis LA, Oikonomaki D, Falagas ME. Outcomes after medical and surgical treatment of diverticulitis: a systematic review of the available evidence. J Gastroenterol Hepatol. 2007;22:1360–1368. doi: 10.1111/j.1440-1746.2007.05118.x.
    1. Brodribb AJ. Treatment of symptomatic diverticular disease with a high-fibre diet. Lancet. 1977;1:664–666. doi: 10.1016/S0140-6736(77)92112-2.
    1. Ornstein MH, Littlewood ER, Baird IM, Fowler J, North WR, Cox AG. Are fibre supplements really necessary in diverticular disease of the colon? A controlled clinical trial. Br Med J (Clin Res Ed) 1981;282:1353–1356. doi: 10.1136/bmj.282.6273.1353.
    1. Lupton JR, Turner ND. Potential protective mechanisms of wheat bran fiber. Am J Med. 1999;106:24–27. doi: 10.1016/S0002-9343(98)00343-X.
    1. Tan KY, Seow-Choen F. Fiber and colorectal diseases: separating fact from fiction. World J Gastroenterol. 2007;13:4161–4167.
    1. Gronek P, Holdys J. (2013) Genes and physical fitness. Trends in Sport Sciences 20(1):16–29.
    1. Tursi A, Brandimarte G, Daffinà R. Long-term treatment with mesalazine and rifaximin versus rifaximin alone for patients with recurrent attacks of acute diverticulitis of colon. Dig Liver Dis. 2002;34:510–515. doi: 10.1016/S1590-8658(02)80110-4.
    1. Colecchia A, Vestito A, Pasqui F, Mazzella G, Roda E, Pistoia F. Efficacy of long term cyclic administration of the poorly absorbed antibiotic rifaximin in symptomatic, uncomplicated colonic diverticular disease. World J Gastroenterol. 2007;13:264–269.
    1. Fric P, Zavoral M. The effect of non-pathogenic Escherichia coli in symptomatic uncomplicated diverticular disease of the colon. Eur J Gastroenterol Hepatol. 2003;15:313–315. doi: 10.1097/00042737-200303000-00015.
    1. Giaccari S, Tronci S, Falconieri M, Ferrieri A. Long-term treatment with rifaximin and lactobacilli in post-diverticulitic stenoses of the colon. Riv Eur Sci Med Farmacol. 1993;15:29–34.
    1. Lamiki P, Tsuchiya J, Pathak S, Okura R, Solimene U, Jain S. Probiotics in diverticular disease of the colon: an open label study. J Gastrointestin Liver Dis. 2010;19:31–36.
    1. Banasiewicz T, Krokowicz L, Stojcev Z, Kaczmarek BF, Kaczmarek E, Maik J, Marciniak R, Krokowicz P, Walkowiak J, Drews M. Microencapsulated sodium butyrate reduces the frequency of abdominal pain in patients with irritable bowel syndrome. Colorectal Dis. 2013;15:204–209. doi: 10.1111/j.1463-1318.2012.03152.x.
    1. Cordel S, Dupas B, Douillard JY, Meflah K. Interleukin-2/sodium butyrate treatment cures rats bearing liver tumors after acquired 5-fluorouracil resistance. Int J Cancer. 1998;78:735–739. doi: 10.1002/(SICI)1097-0215(19981209)78:6<735::AID-IJC11>;2-6.
    1. Hall JF, Roberts PL, Ricciardi R. Long-term follow-up after an initial episode of diverticulitis: what are the predictors of recurrence? Dis Colon Rectum. 2011;54:283–288. doi: 10.1007/DCR.0b013e3182028576.
    1. Vernia P, Annese V, Bresci G, d'Albasio G, D'Incà R, Giaccari S. Topical butyrate improves efficacy of 5-ASA in refractory distal ulcerative colitis: results of a multicentre trial. Eur J Clin Investig. 2003;33:244–248. doi: 10.1046/j.1365-2362.2003.01130.x.
    1. Hamer HM, Jonkers D, Venema K, Vanhoutvin S, Troost FJ, Brummer RJ. Review article: the role of butyrate on colonic function. Aliment Pharmacol Ther. 2008;27:104–119. doi: 10.1111/j.1365-2036.2007.03562.x.
    1. Topping DL, Clifton PM. Short-chain fatty acids and human colonic function: roles of resistant starch and nonstarch polysaccharides. Physiol Rev. 2001;81:1031–1064.
    1. Canani RB, Terrin G, Cirillo P, Castaldo G, Salvatore F, Cardillo G, Coruzzo A, Troncone R. Butyrate as an effective treatment of congenital chloride diarrhea. Gastroenterology. 2004;127:630–634. doi: 10.1053/j.gastro.2004.03.071.
    1. Schmitt MG, Jr, Soergel KH, Wood CM. Absorption of short chain fatty acids from the human jejunum. Gastroenterology. 1976;70:211–215.
    1. Clemens CH, Samsom M, Roelofs J, van Berge Henegouwen GP, Smout AJ. Colorectal visceral perception in diverticular disease. Gut. 2004;53:717–722. doi: 10.1136/gut.2003.018093.
    1. Petruzziello L, Iacopini F, Bulajic M, Shah S, Costamanga G. Review article: uncomplicated diverticular disease of the colon. Aliment Pharmacol Ther. 2006;23:1379–1391. doi: 10.1111/j.1365-2036.2006.02896.x.
    1. Roda A, Simoni P, Magliulo M, Nanni P, Baraldini M, Roda G, Roda E. A new oral formulation for the release of sodium butyrate in the ileo-cecal region and colon. World J Gastroenterol. 2007;13:1079–1084.
    1. Zullo A, Hassan C, Maconi G, Manes G, Tammaro G, De Francesco V, Annibale B, Ficano L, Buri L, Gatto G, Lorenzetti R, Campo SM, Ierardi E, Pace F, Morini S. Cyclic antibiotic therapy for diverticular disease: a critical reappraisal. J Gastrointestin Liver Dis. 2010;19:295–302.
    1. Bijkerk CJ, de Wit NJ, Muris JW, Jones RH, Knottnerus JA, Hoes AW. Outcome measures in irritable bowel syndrome: comparison of psychometric and methodological characteristics. Am J Gastroenterol. 2003;98:122–127. doi: 10.1111/j.1572-0241.2003.07158.x.
    1. IIrvine EJ, Whitehead WE, Chey WD, Matsueda K, Shaw M, Talley NJ, et al. Design of treatment trials for functional gastrointestinal disorders. Gastroenterology. 2006;130:1538–1551. doi: 10.1053/j.gastro.2005.11.058.

Source: PubMed

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