Digestive and Liver Disease Supplements最新文献

In recent years, particular attention has been paid to the role of the intestinal microflora in the multiple functions of the small intestinal (absorbent, secretory, immunological, endocrine, transport, barrier). The demonstrated beneficial effects of certain bacteria on human health has enabled probiotics antibiotics to be used for therapeutic purposes in a number of gastrointestinal diseases. Certain products of bacterial metabolism (e.g. butyrate) could provide further therapeutic weapons in a sector in which treatment has long proved difficult.

Butyrate, a substance produced in the colon via bacterial fermentation processes, constitutes an important source of energy for colonic mucosa cells. It also plays an important role in the regulation of intraluminal homeostasis, modulation of inflammation, control of cellular proliferation and differentiation, and repair of mucosal lesions.

Butyrate has been studied in clinical applications, particularly inflammatory bowel diseases of the colon. While available data are not entirely conclusive, this substance appears to have a useful therapeutic role complementary to that of standard drugs. A body of experimental data also suggests that this short-chain fatty acid may exert preventive action against colorectal cancer, but for the moment this is still a hypothesis that remains to be verified. More generally, butyrate has been shown to be useful in certain types of diarrhoea, particularly chronic forms, by promoting absorption of water and electrolytes.

Background

Standard treatment with beclomethasone and/or mesalazine in the late actinic proctitis gives poor results. Butyrate constitutes an energy source for colonocytes and deficiency in this substance can result in mucosal hyperplasia as well as acute or chronic inflammation.

Aims

To assess the efficacy of oral butyrate in late actinic proctitis in prostate cancer patients.

Materials and methods

26 patients were included in the study and treated with oral butyrate in combination with topical mesalazine and/or beclomethasone for 6 months and 44 control subjects received topical therapy with mesalazine and/or beclomethasone for 6 months. Both groups underwent clinical examination as well as pre-treatment (T0) and post-treatment endoscopy (T2).

Results

Endoscopic evaluation between T0 and T2 demonstrated improved clinical condition in 50% of patients vs. 20% of controls (p = NS); complete normalisation was seen in 10% of patients but in none of the controls (p = NS). Evaluation of clinical status between T0-T2 showed remission with resolution of symptoms in 60% of patients vs. none of the controls (p < 0.0001).

Conclusions

The preliminary results of our study show significantly superior efficacy of therapy in the group receiving butyrate supplement. These findings are encouraging and require confirmation in a larger patient population.

Butyric acid is an organic acid containing 4 carbon atoms and is produced in the large intestine through fermentation by the intestinal bacterial flora of undigested sugars and dietary fibre. It is considered the most important source of energy for colonic cells; in addition, it exerts numerous anti-inflammatory effects while regulating proliferation of colonocytes and absorption of water and electrolytes. Many intestinal diseases are characterised by reduced concentrations of butyric acid in the colon and drugs that successfully prevent oxidation have been shown to be effective in the treatment of chronic inflammatory intestinal diseases.