Lactobacilli lozenges in the management of oral ulcers of Behçet's syndrome

There is increasing evidence that lactobacilli, having anti-inflammatory activity, may be useful in some diseases, particularly in inflammatory bowel disease.We aimed to study the efficacy of lactobacilli lozenges (INERSAN, VSL Pharmaceuticals, USA) in the management of oral ulcers of Behçet's syndrome.Twenty-five patients were studied before, during and after lactobacillus use. All patients had mainly skin-mucosa involvement with fresh oral ulcers and none were using systemic immunosuppressives. The patients chewed on 6 lozenges/day at intervals of 2-3 hours during the time they were awake for 7 days. The number of OU before visit 1 and after 1. and 2. weeks after drug use was the main outcome measure.Twenty three patients completed the trial. 1 patient left the trial the second day because of nausea and another was a no show at the 2.visit. There was a significant decrease in the mean number of ulcers following treatment, more pronounced among the females, and this decrease continued at least for 1 week after the treatment was stopped. 4/23 patients had side effects with 3 complaining of nausea and 1 of abdominal fullness.In this pilot and open study Lactobacillus brevis CD2 lozenges seemed to be effective in controlling the OU of BS. Randomized, controlled trials with this seemingly innocuous agent are now needed.