Management of symptomatic uncomplicated diverticular disease (SUDD) of the colon with Clostridium butyricum CBM588 versus rifaximin: a retrospective cross-sectional study

Abstract Background Symptomatic uncomplicated diverticular disease (SUDD) is a chronic condition frequently characterized by abdominal pain, bloating, and altered bowel habits. While cyclic rifaximin is commonly used for symptom control, interest is growing in the potential role of probiotics. This study aimed to compare the clinical outcomes of patients with SUDD treated with either Clostridium butyricum CBM588® or cyclic rifaximin over a 12-month period. Methods This retrospective cross-sectional study included 70 patients with a confirmed diagnosis of SUDD, treated between 2023 and 2024. Patients were divided into two groups based on treatment received: Group A (CBM588® daily for 12 months) and Group B (cyclic rifaximin 400 mg bid for 7 days per month). Clinical data, symptom profiles, and occurrence of diverticulitis were collected and compared. The primary outcome was the reduction of SUDD-related symptoms, and the secondary outcome was the incidence of acute diverticulitis episodes during follow-up. Results A total of 56 patients completed the 12-month follow-up (31 in Group A, 25 in Group B). No significant difference was observed in the rate of symptomatic flares between groups (19.4% vs. 20%, p = 0.7). However, a significantly higher proportion of patients in the CBM588 ® group reported adequate symptom relief (77.4% vs. 44%, p = 0.02). Improvements in bloating and tenesmus were more frequent in the CBM588 ® group, although not statistically significant. No treatment-related adverse events were recorded. Conclusion In this retrospective comparison, Clostridium butyricum CBM588 ® demonstrated similar efficacy to rifaximin in preventing diverticulitis, with a potential advantage in subjective symptom improvement. These findings support further prospective studies to explore the role of CBM588 ® in SUDD management. Trial registration Clinicaltrial.gov reference: NCT06852274