Symptom Severity Following Rifaximin and the Probiotic VSL#3 in Patients with Chronic Pelvic Pain Syndrome (Due to Inflammatory Prostatitis) Plus Irritable Bowel Syndrome.

Enzo Vicari,Michele Salemi,Giuseppe Sidoti,Roberto Castiglione,Mariano Malaguarnera

doi:10.3390/nu9111208

Abstract

This study investigated the effects of long-term treatment with rifaximin and the probiotic VSL#3 on uro-genital and gastrointestinal symptoms in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) plus diarrhoea-predominant irritable bowel syndrome (D-IBS) compared with patients with D-IBS alone. Eighty-five patients with CP/CPPS (45 with subtype IIIa and 40 with IIIb) plus D-IBS according to the Rome III criteria and an aged-matched control-group of patients with D-IBS alone (n = 75) received rifaximin and VSL#3. The primary endpoints were the response rates of IBS and CP/CPPS symptoms, assessed respectively through Irritable Bowel Syndrome Severity Scoring System (IBS-SSS) and The National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), and performed at the start of therapy (V0) and three months after (V3). In IIIa prostatitis patients, the total NIH-CPSI scores significantly (p < 0.05) decreased from a baseline mean value of 21.2 to 14.5 at V3 , as did all subscales, and in the IIIb the total NIH-CPSI score also significantly decreased (from 17.4 to 15.1). Patients with IBS alone showed no significant differences in NIH-CPSI score. At V3, significantly greater improvement in the IBS-SSS and responder rate were found in IIIa patients. Our results were explained through a better individual response at V3 in IIIa prostatitis of urinary and gastrointestinal symptoms, while mean leukocyte counts on expressed prostate secretion (EPS) after prostate massage significantly lowered only in IIIa cases.

Highlights

Our results were explained through a better individual response at V3 in IIIa prostatitis of urinary and gastrointestinal symptoms, while mean leukocyte counts on expressed prostate secretion (EPS) after prostate massage significantly lowered only in IIIa cases
The emerging insights of studies on the concomitant presence of some urologic chronic pelvic pain syndromes (UCPPS) (chronic pelvic pain, interstitial cystitis, painful bladder syndrome, prostatitis syndromes (PS), and vulvodynia) and non-urological associated syndromes (fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome (IBS)) have attracted significant interest by the Multidisciplinary Approach to the Study of Chronic Pelvic Pain research network established by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Nutrients 2017, 9, 1208; doi:10.3390/nu9111208
We observed the simultaneous presence of PS and IBS in 30.2% and 31.8% of patients screened by andrologists and gastroenterologists, respectively [6,7], which is in agreement with other reports [8,9]

Summary

Introduction

The emerging insights of studies on the concomitant presence of some urologic chronic pelvic pain syndromes (UCPPS) (chronic pelvic pain, interstitial cystitis, painful bladder syndrome, prostatitis syndromes (PS), and vulvodynia) and non-urological associated syndromes (fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome (IBS)) have attracted significant interest by the Multidisciplinary Approach to the Study of Chronic Pelvic Pain research network established by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Nutrients 2017, 9, 1208; doi:10.3390/nu9111208 www.mdpi.com/journal/nutrients. We observed the simultaneous presence of PS and IBS in 30.2% and 31.8% of patients screened by andrologists and gastroenterologists, respectively [6,7], which is in agreement with other reports [8,9]. IBS had a significantly higher frequency of chronic bacterial prostatitis (CBP) and lower frequency of non-inflammatory prostatitis (IIIb category) compared with patients with PS alone. PS and IBS are both characterised by a multifactorial pathogenesis, and these conditions are defined on the basis of clinical presentation rather than clear diagnostic markers or findings

Methods

Results

Conclusion