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Review article: the pathophysiology and medical management of diverticulosis and diverticular disease of the colon.
Aliment Pharmacol Ther 2015; 42(6):664-84AP

Abstract

BACKGROUND

The incidence of diverticulosis and diverticular disease of the colon, including diverticulitis, is increasing worldwide, and becoming a significant burden on national health systems. Treatment of patients with diverticulosis and DD is generally based on high-fibre diet and antibiotics, respectively. However, new pathophysiological knowledge suggests that further treatment may be useful.

AIM

To review the current treatment of diverticulosis and diverticular disease.

METHODS

A search of PubMed and Medline databases was performed to identify articles relevant to the management of diverticulosis and diverticular disease. Major international conferences were also reviewed.

RESULTS

Two randomised controlled trials (RCT) found the role of antibiotics in managing acute diverticulitis to be questionable, particularly in patients with no complicating comorbidities. One RCT found mesalazine to be effective in preventing acute diverticulitis in patients with symptomatic uncomplicated diverticular disease. The role of rifaximin or mesalazine in preventing diverticulitis recurrence, based on the results of 1 and 4 RCTs, respectively, remains unclear. RCTs found rifaximin and mesalazine to be effective in treating symptomatic uncomplicated diverticular disease. The use of probiotics in diverticular disease and in preventing acute diverticulitis occurrence/recurrence appears promising but unconclusive. Finally, the role of fibre in treating diverticulosis remains unclear.

CONCLUSIONS

Available evidence suggests that antibiotics have a role only in the treatment of complicated diverticulitis. It appears to be some evidence for a role for rifaximin and mesalazine in treating symptomatic uncomplicated diverticular disease. Finally, there is not currently adequate evidence to recommend any medical treatment for the prevention of diverticulitis recurrence.

Authors+Show Affiliations

Gastroenterology Service, ASL BAT, Andria, BT, Italy.Division of Internal Medicine and Gastroenterology, Complesso Integrato "Columbus", Catholic University, Rome, Italy.IBD Unit, IRCCS "Humanitas", Rozzano, MI, Italy.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

26202723

Citation

Tursi, A, et al. "Review Article: the Pathophysiology and Medical Management of Diverticulosis and Diverticular Disease of the Colon." Alimentary Pharmacology & Therapeutics, vol. 42, no. 6, 2015, pp. 664-84.
Tursi A, Papa A, Danese S. Review article: the pathophysiology and medical management of diverticulosis and diverticular disease of the colon. Aliment Pharmacol Ther. 2015;42(6):664-84.
Tursi, A., Papa, A., & Danese, S. (2015). Review article: the pathophysiology and medical management of diverticulosis and diverticular disease of the colon. Alimentary Pharmacology & Therapeutics, 42(6), pp. 664-84. doi:10.1111/apt.13322.
Tursi A, Papa A, Danese S. Review Article: the Pathophysiology and Medical Management of Diverticulosis and Diverticular Disease of the Colon. Aliment Pharmacol Ther. 2015;42(6):664-84. PubMed PMID: 26202723.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Review article: the pathophysiology and medical management of diverticulosis and diverticular disease of the colon. AU - Tursi,A, AU - Papa,A, AU - Danese,S, Y1 - 2015/07/22/ PY - 2015/03/14/received PY - 2015/04/10/revised PY - 2015/06/05/revised PY - 2015/06/22/revised PY - 2015/06/24/revised PY - 2015/06/28/accepted PY - 2015/7/24/entrez PY - 2015/7/24/pubmed PY - 2016/3/5/medline SP - 664 EP - 84 JF - Alimentary pharmacology & therapeutics JO - Aliment. Pharmacol. Ther. VL - 42 IS - 6 N2 - BACKGROUND: The incidence of diverticulosis and diverticular disease of the colon, including diverticulitis, is increasing worldwide, and becoming a significant burden on national health systems. Treatment of patients with diverticulosis and DD is generally based on high-fibre diet and antibiotics, respectively. However, new pathophysiological knowledge suggests that further treatment may be useful. AIM: To review the current treatment of diverticulosis and diverticular disease. METHODS: A search of PubMed and Medline databases was performed to identify articles relevant to the management of diverticulosis and diverticular disease. Major international conferences were also reviewed. RESULTS: Two randomised controlled trials (RCT) found the role of antibiotics in managing acute diverticulitis to be questionable, particularly in patients with no complicating comorbidities. One RCT found mesalazine to be effective in preventing acute diverticulitis in patients with symptomatic uncomplicated diverticular disease. The role of rifaximin or mesalazine in preventing diverticulitis recurrence, based on the results of 1 and 4 RCTs, respectively, remains unclear. RCTs found rifaximin and mesalazine to be effective in treating symptomatic uncomplicated diverticular disease. The use of probiotics in diverticular disease and in preventing acute diverticulitis occurrence/recurrence appears promising but unconclusive. Finally, the role of fibre in treating diverticulosis remains unclear. CONCLUSIONS: Available evidence suggests that antibiotics have a role only in the treatment of complicated diverticulitis. It appears to be some evidence for a role for rifaximin and mesalazine in treating symptomatic uncomplicated diverticular disease. Finally, there is not currently adequate evidence to recommend any medical treatment for the prevention of diverticulitis recurrence. SN - 1365-2036 UR - https://www.unboundmedicine.com/medline/citation/26202723/Review_article:_the_pathophysiology_and_medical_management_of_diverticulosis_and_diverticular_disease_of_the_colon_ L2 - https://doi.org/10.1111/apt.13322 DB - PRIME DP - Unbound Medicine ER -