The effect of non-pathogenic Escherichia coli in symptomatic uncomplicated diverticular disease of the colon

Background The effect of probiotics in symptomatic uncomplicated diverticular disease of the colon has not been followed. Design Treatment (T1) with an intestinal antimicrobial (dichlorchinolinol) and absorbent (active coal tablets) was compared with the same set-up supplemented with nonpathogenic Escherichia coli (T2) in a prospective open trial. Setting The study was performed at the outpatient department of a tertiary centre. Participants Fifteen subjects (5 males, 10 females) aged 68-91 years (average 74.8 years) presented with abdominal pain, irregular defecation, bloating and excessive flatulence. Diagnosis was established with colonoscopy, double-contrast barium enema, or both. Interventions The T1 regimen was administered for 1 week. In the T2 regimen, the application of E coli strain Nissle (Mutaflor capsules, 2.5 x 10(10) viable bacteria/capsule) followed immediately after T1 for an average of 5.2 weeks. Main outcome measures The lengths of two successive remissions with the T1 set-up were compared with the length of remission after T2. The intensity of symptoms before and after administration of the probiotic was also evaluated. Results The lengths of two successive remissions after T1 amounted to 2.66 and 2.20 months (average 2.43 months). The average length of remission after T2 was 14.1 months (P < 0.001). All symptoms after T2 decreased significantly (P < 0.001). Conclusions Non-pathogenic E coli strain Nissle significantly prolonged the remission period and improved the abdominal syndrome in symptomatic uncomplicated diverticular disease. A randomized, placebo-controlled study is recommended.