Probiotic After Acute Colonic Diverticulitis

NCT ID: NCT06040515

Last Updated: 2023-09-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

145 participants

Study Classification

OBSERVATIONAL

Study Start Date

2023-05-01

Study Completion Date

2024-06-30

Brief Summary

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The goal of this observational study is to assess the efficacy and safety of the probiotic Escherichia coli Nissle 1917 (EcN®, Ca.Di.Group S.p.A) in the treatment of symptomatic patients after an episode of both complicated and uncomplicated acute colonic diverticulitis.

The main question it aims to answer are:

* Is the studied probiotic able to significantly reduce symptoms, assessed by means of a validated and dedicated score?
* Is there any difference in microbiota among the study group at baseline and a selected cohort of patients subdivided in subjects with diverticulosis and asymptomatic subjects after an episode of acute uncomplicated diverticulitis or an episode of complicated diverticulitis submitted to surgery with colonic resection without stoma?
* Is there any difference in microbiota in the study group at baseline and after 3 and 6 months of treatment with the probiotic?
* Is there any correlation between microbiota modification and symptoms during follow-up?
* Is there any impact on fecal calprotectin values before and during probiotic therapy?
* Is there any modification of evacuation before and during follow-up?
* Is probiotic able to prevent recurrent episodes of acute diverticulitis during follow-up?
* The safety of the probiotic will be assessed during the follow-up. The study group will be assessed at baseline and during follow-up with a dedicated clinical score and Bristol stool scale. Microbiota and fecal calprotectin values will be also assessed at baseline and during follow-up. Microbiota at baseline will be also evaluated for comparison in the three selected groups with diverticulosis and both asymptomatic and symptomatic after an episode of acute diverticulitis.

Detailed Description

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Conditions

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Diverticulitis, Colonic Therapy

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

PROSPECTIVE

Study Groups

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Symptomatic patients after acute diverticulitis

Patients aged ≥18 with persistent symptoms at least three months after a radiologic and/or endoscopic documented acute diverticulitis or after six months of surgery for complicated acute diverticulitis.

Therapy with Escherichia coli Nissle 1917 (EcN®) will be prescribed for a global duration of six months with the following assumption schedule: 2 capsules b.i.d. during 4 weeks, followed by 1 capsule o.i.d during 20 days each month for 5 months.

Probiotic Formula

Intervention Type DRUG

Capsule with 25 billion live strains of Escherichia coli Nissle 1917

Diverticulosis

Patients with asymptomatic diverticulosis. No therapy will be administered. Microbiota assessment will be performed.

No interventions assigned to this group

Asymptomatic patients after acute uncomplicated diverticulitis

Asymptomatic patients assessed three months after an episode of acute uncomplicated diverticulitis. No therapy will be administered. Microbiota assessment will be performed.

No interventions assigned to this group

Asymptomatic patients after acute complicated diverticulitis

Asymptomatic patients assessed six months after an episode of acute complicated diverticulitis submitted to surgery with resection and without stoma . No therapy will be administered. Microbiota assessment will be performed.

No interventions assigned to this group

Interventions

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Probiotic Formula

Capsule with 25 billion live strains of Escherichia coli Nissle 1917

Intervention Type DRUG

Other Intervention Names

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Escherichia coli Nissle 1917

Eligibility Criteria

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Inclusion Criteria

* Symptomatic patients three months after an episode of uncomplicated acute colonic diverticulitis;
* Symptomatic patients six months after an episode of complicated acute colonic diverticulitis; submitted to .surgical colonic resection without stoma;
* Patients with diverticulosis;
* Asymptomatic patients three months after an episode of uncomplicated acute colonic diverticulitis;
* Asymptomatic patients six months after an episode of complicated acute colonic diverticulitis; submitted to surgical colonic resection without stoma.

Exclusion Criteria

* Ongoing acute diverticulitis at radiologic assessment
* Antibiotic therapy, both systemic and topic, and/or probiotics and/or mesalazine within four weeks before enrolment;
* Lactulose-lactitol use within four weeks before enrolment;
* Presence of chronic inflammatory bowel diseases;
* Presence of Segmental Colitis Associated with Diverticulitis (SCAD);
* Presence of ischemic colitis;
* Severe chronic liver (Child-Pugh C) and/or pancreatic and/or renal diseases;
* Patients with severe renal failure;
* Presence of suspected/actual pregnancy;
* Presence of recent/ongoing neoplasia, under oncological treatment within 6 months before enrolment;
* Presence of COVID-19 infection;
* Patients unable to give informed consent.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Erasmo Spaziani

OTHER

Sponsor Role lead

Responsible Party

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Erasmo Spaziani

MD, PhD

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Walter Elisei, MD

Role: PRINCIPAL_INVESTIGATOR

• UOC di Gastroenterologia, Azienda Ospedaliera "S. Camillo-Forlanini", Roma

Locations

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UOC di Gastroenterologia ed Endoscopia Digestiva, Ospedale "Pugliese-Ciaccio

Catanzaro, Calabria, Italy

Site Status RECRUITING

UOSVD di Endoscopia Digestiva, Ospedale "S. Maria Goretti"

Latina, Lazio, Italy

Site Status RECRUITING

UOC di Gastroenterologia, Azienda Ospedaliera "S. Camillo-Forlanini"

Rome, Lazio, Italy

Site Status RECRUITING

UOSVD di Gastroenterologia ed Endoscopia Digestiva, Ospedale "Umberto I"

Rome, Lazio, Italy

Site Status RECRUITING

UOC di Medicina Interna e Gastroenterologia, Ospedale "Cristo Re"

Rome, Lazio, Italy

Site Status RECRUITING

UOC Chirurgia Generale, Ospedale "P. Colombo"

Velletri, Lazio, Italy

Site Status RECRUITING

UOC di Gastroenterologia, Ospedale "Belcolle",

Viterbo, Lazio, Italy

Site Status RECRUITING

• UOC di Gastroenterologia ed Endoscopia Digestiva, Ospedale Universitario "San Raffaele"

Milan, Lombardy, Italy

Site Status RECRUITING

UOC di Gastroenterologia Azienda Ospedaliero-Universitaria di Padova

Padova, Lombardy, Italy

Site Status RECRUITING

UOC di Gastroenterologia, Ospedale "Guglielmo da Saliceto"

Piacenza, Lombardy, Italy

Site Status RECRUITING

UOC di Gastroenterologia, Ospedale "S. Salvatore",

Pesaro, The Marches, Italy

Site Status RECRUITING

Gastroenterology Service , ASL BAT,

Andria, , Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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Antonio Tursi, MD, PhD

Role: CONTACT

+393473490583

Marcello Picchio, MD

Role: CONTACT

+393392371293

Facility Contacts

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Stefano Rodinò, MD, PhD

Role: primary

Giuseppe Pianese

Role: primary

Roberto Faggiani, MD, PhD

Role: primary

Antonio Cuomo, MD, PhD

Role: primary

Giovanni Brandimarte, MD, PhD

Role: primary

Marcello Picchio, MD

Role: primary

Costantino Zampaletta

Role: primary

Silvio Danese, MD, PhD

Role: primary

Edoardo V. Savarino, MD, PhD

Role: primary

Giovanni Aragona, MD, PhD

Role: primary

Antonella Scarcelli, MD

Role: primary

Antonio Tursi, MD

Role: primary

References

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Kvasnovsky CL, Adams K, Papagrigoriadis S. Diverticular disease as a chronic gastrointestinal condition: experience from a specialist clinic. Eur J Gastroenterol Hepatol. 2015 Apr;27(4):442-8. doi: 10.1097/MEG.0000000000000304.

Reference Type RESULT
PMID: 25874519 (View on PubMed)

Mj O, Turner GA, A S, Frizelle FA, R P. Distinct changes in the colonic microbiome associated with acute diverticulitis. Colorectal Dis. 2022 Dec;24(12):1591-1601. doi: 10.1111/codi.16271. Epub 2022 Aug 11.

Reference Type RESULT
PMID: 35950499 (View on PubMed)

Tursi A, Papa V, Lopetuso LR, Settanni CR, Gasbarrini A, Papa A. Microbiota Composition in Diverticular Disease: Implications for Therapy. Int J Mol Sci. 2022 Nov 26;23(23):14799. doi: 10.3390/ijms232314799.

Reference Type RESULT
PMID: 36499127 (View on PubMed)

Teng G, Liu Z, Liu Y, Wu T, Dai Y, Wang H, Wang W. Probiotic Escherichia coli Nissle 1917 Expressing Elafin Protects Against Inflammation and Restores the Gut Microbiota. Front Microbiol. 2022 May 6;13:819336. doi: 10.3389/fmicb.2022.819336. eCollection 2022.

Reference Type RESULT
PMID: 35602072 (View on PubMed)

Lahat A, Fidder HH, Ben-Horin S. Development and validation of a diverticular clinical score for symptomatic uncomplicated diverticular disease after acute diverticulitis in a prospective patient cohort. Therap Adv Gastroenterol. 2020 May 8;13:1756284820913210. doi: 10.1177/1756284820913210. eCollection 2020.

Reference Type RESULT
PMID: 32523619 (View on PubMed)

Other Identifiers

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EcN2023

Identifier Type: -

Identifier Source: org_study_id

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