Gut Microbiota and Acute Diverticulitis: Role of Probiotics in Management of This Delicate Pathophysiological Balance

Piccioni, Andrea; Franza, Laura; Brigida, Mattia; Zanza, Christian; Torelli, Enrico; Petrucci, Martina; Nicolo, R; Covino, Marcello; Candelli, Marcello; Saviano, Angela; Ojetti, Veronica; Franceschi, Francesco

doi:10.3390/jpm11040298

Cited by 22 publications

(14 citation statements)

References 57 publications

(32 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Increased rates of complications in the setting of poor nutritional status are likely multifactorial. As previously established, slowed colonic transit results in the buildup of intraluminal colonic pressure, while poor nutritional diets can increase the prevalence of pro-inflammatory bacteria within the microbiome [18][19][20][21]. These changes can contribute to worsening intraluminal microperforation and inflammation, thereby increasing rates of diverticulitis and worsening outcomes.…”

Section: Discussionmentioning

confidence: 90%

“…For example, diets with a large amount of red meat have been associated with an increased prevalence of Enterobacteriaceae within the gut microbiome [19]. A preponderance of this bacterial species, as well as Bacteroides and Streptococcus, has been associated with diverticular disease [20]. Furthermore, a link between microbiome composition and colonic inflammation has been established, with some cases demonstrating the onset of diverticulitis after changes to the colonic microbiome [21].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Malnutrition Imparts Worse Outcomes in Patients With Diverticulitis: A Nationwide Inpatient Sample Database Study

Shaikh¹,

Khrais²,

Le³

et al. 2022

Cureus

View full text Add to dashboard Cite

IntroductionStudies show that malnutrition can lead to worsening morbidity and mortality in patients. However, to our knowledge, no large database study has been conducted describing the effects of malnutrition in patients with diverticulitis. In this article, we aim to assess the impact of pre-existing malnutrition on outcomes of patients admitted for diverticulitis. MethodsData between 2008 and 2014 from the Nationwide Inpatient Sample database were extracted. Inclusion criteria for both groups included patients with a primary diagnosis of diverticulitis using the International Classification of Diseases, Ninth Revision codes. Exclusion criteria included all patients less than 18 years of age. The test group consisted of patients with a primary diagnosis of diverticulitis and a concurrent diagnosis of malnutrition. In-hospital mortality, length of stay, total cost, and complications, including various forms of sepsis, perforation, bleeding, and GI bleeding, were compared between the two groups. Univariate and multivariate analyses were used to generate odds ratios. Multivariate analysis included age, sex, race, income quartile, and calculated Elixhauser scores. Elixhauser comorbidity scores predicting mortality and readmission were calculated based on weighted scores from 29 different comorbidities. Scores were compared between the two groups using univariate analysis. ResultsThere were a total of 1,520,919 patients in the study, of which 427,679 (2.8%) had a pre-existing diagnosis of malnutrition. On univariate analysis, there was a significant increase in mortality in patients with malnutrition (OR: 10.2, p < 0.01). Additionally, patients with malnutrition appeared to have longer lengths of stay (mean: 12.9, p < 0.01) and greater cost of hospitalization (mean: 194436.82, p < 0.01). Patients with malnutrition had greater rates of sepsis events (OR: 12.0, p < 0.01), perforation (OR: 2.8, p < 0.01), and GI bleed (OR: 1.84, p < 0.01). On multivariate analysis, malnutrition appeared to significantly increase mortality (OR: 3.3, p < 0.01). DiscussionPatients who present with diverticulitis with malnutrition appear to have significantly worse outcomes. We hypothesize that malnutrition leads to a shift in the gut microbiota, resulting in increased inflammation. As a result, these patients may have an increased risk of worse outcomes, such as sepsis and death. Addressing nutrition in patients with diverticulosis or those with a history of diverticulitis may improve outcomes.

show abstract

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Malnutrition Imparts Worse Outcomes in Patients With Diverticulitis: A Nationwide Inpatient Sample Database Study

Shaikh¹,

Khrais²,

Le³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…Lactobacilli use as probiotic strains has reduced bloating and abdominal pain levels in patients with symptomatic uncomplicated DD [ 102 ]. Lacticaseibacillus paracasei (formerly Lactibacillus paracasei ) CNCMI1572 (LCDG), a strain normally present in healthy individuals’ microbiota, has been evaluated in several studies.…”

Section: Microbiota and The Digestive Pathologymentioning

confidence: 99%

The Gut Microbiome and Its Implication in the Mucosal Digestive Disorders

et al. 2022

View full text Add to dashboard Cite

The gastrointestinal (GI) tract is one of the most studied compartments of the human body as it hosts the largest microbial community including trillions of germs. The relationship between the human and its associated flora is complex, as the microbiome plays an important role in nutrition, metabolism and immune function. With a dynamic composition, influenced by many intrinsic and extrinsic factors, there is an equilibrium maintained in the composition of GI microbiota, translated as “eubiosis”. Any disruption of the microbiota leads to the development of different local and systemic diseases. This article reviews the human GI microbiome’s composition and function in healthy individuals as well as its involvement in the pathogenesis of different digestive disorders. It also highlights the possibility to consider flora manipulation a therapeutic option when treating GI diseases.

show abstract

“…Dietary factors are key in determining the onset of diverticular disorder and they can also change the composition of one’s microbiota. It is not possible to say without doubt whether the changes in the composition of the microbiota may act as an enhancing factor in the development of diverticulitis, but it is worth nothing that the microbial species associated to diverticular disease are Enterobacteriaceae, Streptococcus and Bacteroides, while so called “good bacteria” (e.g., Bifidobacteria and Lactobacilli ) are reduced [ 65 ].…”

Section: Microbiota and Acute Diverticulitismentioning

confidence: 99%

Microbiota and Probiotics: The Role of Limosilactobacillus Reuteri in Diverticulitis

et al. 2021

Self Cite

View full text Add to dashboard Cite

The microbiota is the set of commensal microorganisms, residing in the organism, helping proper functioning of organs and systems. The role that the microbiota plays in maintaining the health of vertebrates is widely accepted, particularly in the gastrointestinal system, where it is fundamental for immunity, development, and conversion of nutrients. Dysbiosis is an alteration of the microbiota which refers to a disturbed balance, which can cause a number of pathologies. Probiotics have proven to be effective in modulating the microbiota of the gastrointestinal system and, therefore, in promoting the health of the individual. In particular, Lactobacilli are a group of Gram-positive bacteria, which are able to produce lactic acid through glucose metabolism. They are present in different microenvironments, ranging from the vagina, to the mouth, to different tracts of the small intestine. In the present review, we will discuss the use of Limosilactobacillus in human health in general and more specifically in diverticulitis. In particular we analyze the role of Limosilactobacillus reuteri and its anti-inflammatory action. For this review, articles were identified using the electronic PubMed database through a comprehensive search, conducted by combining key terms such as “diverticulitis”, “Limosilactobacillus reuteri”, “human health and disease”, “probiotics”. We selected all the articles published in the last 10 years and screened 1017 papers. Articles referenced in the screened papers were evaluated if considered interesting for our topic. Probiotics have proven to be effective in modulating the microbiota of the gastrointestinal system and, therefore, in promoting the health of the individual. The importance of probiotics in treating diverticular disease and acute diverticulitis can be further understood if taking into consideration some pathophysiological aspects, associated to the microbiota. L. reuteri plays an important role in human health and disease. The effectiveness of L. reuteri in stimulating a correct bowl motility partly explains its effectiveness in treating diverticulitis. The most important action of L. reuteri is probably its immunomodulating activity. Levels of IL-6, IL-8, and Tumor necrosis factor (TNF-alpha) are reduced after supplementation with different strands of Lactobacilli, while T-regulatory cells increase in number and activity. Anyway, new mechanisms of action of probiotics come to light from the many investigations currently taking place in numerous centres around the world and to improve how exactly probiotic administration could make the difference in the management of diverticular disease and acute diverticulitis.

show abstract

Gut Microbiota and Acute Diverticulitis: Role of Probiotics in Management of This Delicate Pathophysiological Balance

Cited by 22 publications

References 57 publications

Malnutrition Imparts Worse Outcomes in Patients With Diverticulitis: A Nationwide Inpatient Sample Database Study

Malnutrition Imparts Worse Outcomes in Patients With Diverticulitis: A Nationwide Inpatient Sample Database Study

The Gut Microbiome and Its Implication in the Mucosal Digestive Disorders

Microbiota and Probiotics: The Role of Limosilactobacillus Reuteri in Diverticulitis

Contact Info

Product

Resources

About