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Maintenance therapy with a probiotic in antibiotic-dependent pouchitis: experience in clinical practice.
Aliment Pharmacol Ther. 2005 Oct 15; 22(8):721-8.AP

Abstract

BACKGROUND

Management of antibiotic-dependent pouchitis is often challenging. Oral bacteriotherapy with probiotics (such as VSL #3) as maintenance treatment has been shown to be effective in relapsing pouchitis in European trials. However, this agent has not been studied in the US, and its applicability in routine clinical practice has not been evaluated.

AIM

To determine compliance and efficacy of probiotic treatment in patients with antibiotic-dependent pouchitis.

METHODS

Thirty-one patients with antibiotic-dependent pouchitis were studied. VSL #3 is a patented probiotic preparation of live freeze-dried bacteria. All patients received 2 weeks of ciprofloxacin 500 mg b.d. followed by VSL #3 6 g/day for 8 months. Baseline Pouchitis Disease Activity Index scores were calculated. Patients' symptoms were reassessed at week 3 when VSL #3 therapy was initiated and at the end of the 8-month trial. Some patients underwent repeat pouch endoscopy at the end of the trial.

RESULTS

All 31 patients responded to the 2-week ciprofloxacin trial with resolution of symptoms and they were subsequently treated with VSL #3. The mean duration of follow-up was 14.5+/-5.3 months (range: 8-26 months). At the 8-month follow-up, six patients were still on VSL #3 therapy, and the remaining 25 patients had discontinued the therapy due to either recurrence of symptoms while on treatment or development of adverse effects. All six patients who completed the 8-month course with a mean treatment period of 14.3+/-7.2 months (range: 8-26 months) had repeat clinical and endoscopic evaluation as out-patients. At the end of 8 months, these six patients had a mean Pouchitis Disease Activity Index symptom score of 0.33+/-0.52 and a mean Pouchitis Disease Activity Index endoscopy score of 1.83+/-1.72, which was not statistically different from the baseline Pouchitis Disease Activity Index endoscopy score of 2.83+/-1.17 (P=0.27).

CONCLUSION

This study was conducted to evaluate bacteriotherapy in routine care. The use of probiotics has been adopted as part of our routine clinical practice with only anecdotal evidence of efficacy. Our review of patient outcome from the treatment placebo showed that only a minority of patients with antibiotic-dependent pouchitis remained on the probiotic therapy and in symptomatic remission after 8 months.

Authors+Show Affiliations

Department of Gastroenteorology/Hepatology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA. shenb@ccf.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

16197493

Citation

Shen, B, et al. "Maintenance Therapy With a Probiotic in Antibiotic-dependent Pouchitis: Experience in Clinical Practice." Alimentary Pharmacology & Therapeutics, vol. 22, no. 8, 2005, pp. 721-8.
Shen B, Brzezinski A, Fazio VW, et al. Maintenance therapy with a probiotic in antibiotic-dependent pouchitis: experience in clinical practice. Aliment Pharmacol Ther. 2005;22(8):721-8.
Shen, B., Brzezinski, A., Fazio, V. W., Remzi, F. H., Achkar, J. P., Bennett, A. E., Sherman, K., & Lashner, B. A. (2005). Maintenance therapy with a probiotic in antibiotic-dependent pouchitis: experience in clinical practice. Alimentary Pharmacology & Therapeutics, 22(8), 721-8.
Shen B, et al. Maintenance Therapy With a Probiotic in Antibiotic-dependent Pouchitis: Experience in Clinical Practice. Aliment Pharmacol Ther. 2005 Oct 15;22(8):721-8. PubMed PMID: 16197493.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maintenance therapy with a probiotic in antibiotic-dependent pouchitis: experience in clinical practice. AU - Shen,B, AU - Brzezinski,A, AU - Fazio,V W, AU - Remzi,F H, AU - Achkar,J-P, AU - Bennett,A E, AU - Sherman,K, AU - Lashner,B A, PY - 2005/10/4/pubmed PY - 2006/2/10/medline PY - 2005/10/4/entrez SP - 721 EP - 8 JF - Alimentary pharmacology & therapeutics JO - Aliment. Pharmacol. Ther. VL - 22 IS - 8 N2 - BACKGROUND: Management of antibiotic-dependent pouchitis is often challenging. Oral bacteriotherapy with probiotics (such as VSL #3) as maintenance treatment has been shown to be effective in relapsing pouchitis in European trials. However, this agent has not been studied in the US, and its applicability in routine clinical practice has not been evaluated. AIM: To determine compliance and efficacy of probiotic treatment in patients with antibiotic-dependent pouchitis. METHODS: Thirty-one patients with antibiotic-dependent pouchitis were studied. VSL #3 is a patented probiotic preparation of live freeze-dried bacteria. All patients received 2 weeks of ciprofloxacin 500 mg b.d. followed by VSL #3 6 g/day for 8 months. Baseline Pouchitis Disease Activity Index scores were calculated. Patients' symptoms were reassessed at week 3 when VSL #3 therapy was initiated and at the end of the 8-month trial. Some patients underwent repeat pouch endoscopy at the end of the trial. RESULTS: All 31 patients responded to the 2-week ciprofloxacin trial with resolution of symptoms and they were subsequently treated with VSL #3. The mean duration of follow-up was 14.5+/-5.3 months (range: 8-26 months). At the 8-month follow-up, six patients were still on VSL #3 therapy, and the remaining 25 patients had discontinued the therapy due to either recurrence of symptoms while on treatment or development of adverse effects. All six patients who completed the 8-month course with a mean treatment period of 14.3+/-7.2 months (range: 8-26 months) had repeat clinical and endoscopic evaluation as out-patients. At the end of 8 months, these six patients had a mean Pouchitis Disease Activity Index symptom score of 0.33+/-0.52 and a mean Pouchitis Disease Activity Index endoscopy score of 1.83+/-1.72, which was not statistically different from the baseline Pouchitis Disease Activity Index endoscopy score of 2.83+/-1.17 (P=0.27). CONCLUSION: This study was conducted to evaluate bacteriotherapy in routine care. The use of probiotics has been adopted as part of our routine clinical practice with only anecdotal evidence of efficacy. Our review of patient outcome from the treatment placebo showed that only a minority of patients with antibiotic-dependent pouchitis remained on the probiotic therapy and in symptomatic remission after 8 months. SN - 0269-2813 UR - https://www.unboundmedicine.com/medline/citation/16197493/Maintenance_therapy_with_a_probiotic_in_antibiotic_dependent_pouchitis:_experience_in_clinical_practice_ L2 - https://doi.org/10.1111/j.1365-2036.2005.02642.x DB - PRIME DP - Unbound Medicine ER -