Background: Abdominal pain and bloating are frequent symptoms in SUDD, which are generally accepted to be related to functional disorders. Albeit no specific standard treatment for SUDD is accepted, guidelines of the American College of Gastroenterology suggest an high-fibre diet in patients with SUDD. Some observations suggest a possible role of gut microflora in determining symptoms related to SUDD, thus these patients may potentially benefit from probiotics treatment. Aim: to assess the efficacy of Lactobacillus paracasei F19 in patients with SUDD. Materials and Methods: Multicentric randomized controlled study on 43 pts, aged 47-78 years (15 M, 28 F) with SUDD, diagnosed by double contrast enema and biochemistry to exclude acute inflammation. SUDD was defined as: presence of abdominal symptoms (pain <24h and bloating) for at least 6 months before enrollment. All pts had a validated detailed questionnaire for abdominal symptoms and functional dyspepsia (FD) including a visual analogic scale (VAS). Exclusion criteria were: complicated diverticular disease, previous colon surgery, antibiotics or laxatives in the 30 days before enrollment, use of NSAIDs. In all pts a daily intake of 30 g of dietary fibre (vegetables and fruit) was recommended. Pts were randomly assigned to receive: 1 sachet b.i.d of L. paracasei F19 (containing 12.5x109 viable bacteria and 750 mg of gluco-oligosaccharides ) for 14 days/ month for 6 months (Group A, n=14), only fibre diet (Group B, n=13) or 1 sachet once daily of L. paracasei F19 for 14 days/month for 6 months (Group C, n=16). Endpoint of the study was to evaluate the decrease of abdominal pain and bloating after 6 months of treatment by VAS. Results are expressed as mean±SD. Results: At baseline, 40 pts (93%) had both abdominal pain and bloating, whereas 3 pts had only bloating. 34 patients (14 M, 20 F, 79%) completed the study: 1 patient (Group A) was withdrawn for diarrhea and 8 patients (3 from Group A, 4 from Group B, 1 from Group C) were lost at follow-up. Symptoms related to FD were minimal and not affected by any treatment. Conclusion: Patients with SUDD benefit of treatment with L. paracasei F19 since it significantly decreases the intensity of abdominal pain and bloating. The efficacy of higher dosage of probiotics is similar to that of lower dosage
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