Advances in the management of colonic diverticulitis: Figure 1:

Tursi, Antonio

doi:10.1503/cmaj.120580

Cited by 17 publications

(23 citation statements)

References 46 publications

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“…As stated, acute diverticulitis (namely DD with signs and symptoms of diverticular inflammation) is mild in the vast majority of cases. Patients with uncomplicated diverticulitis, are generally treated as out‐patients with a clear liquid diet and antibiotics . In out‐patients, broad‐spectrum antibiotics are usually given for 7–10 days.…”

Section: Medical Treatment Of Diverticulosis and Ddmentioning

confidence: 99%

“…In out‐patients, broad‐spectrum antibiotics are usually given for 7–10 days. Various antibiotics may be used in the treatment of acute diverticulitis, ranging from ampicillin to third‐generation cephalosporins, ensuring complete coverage against Gram‐positive and ‐negative, and aerobic–anaerobic bacterial strains …”

Section: Medical Treatment Of Diverticulosis and Ddmentioning

confidence: 99%

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Review article: the pathophysiology and medical management of diverticulosis and diverticular disease of the colon

Tursi

Papa²,

Danese

2015

Aliment Pharmacol Ther

122

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Summary 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.

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Section: Medical Treatment Of Diverticulosis and Ddmentioning

confidence: 99%

Section: Medical Treatment Of Diverticulosis and Ddmentioning

confidence: 99%

Review article: the pathophysiology and medical management of diverticulosis and diverticular disease of the colon

Tursi

Papa²,

Danese

2015

Aliment Pharmacol Ther

122

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“…Currently, the “blind-pouch”, which implicates fecal stasis and bacterial overgrowth, is the most accepted theory explaining the occurrence of diverticular inflammation 5,6. Hence, the first stage of treatment for mild symptoms may involve a high-fiber diet, along with antibiotic therapy 1,7,8.…”

Section: Current Treatment For An Acute Episode Of Diverticulitismentioning

confidence: 99%

“…A first diagnosis of diverticulitis by colonoscopy is not a rare occurrence 5. A reasonable approach is to treat the patient if there are any relevant symptoms or elevated inflammatory markers.…”

Section: Outpatient Treatment Of Diverticulitismentioning

confidence: 99%

Efficacy, safety, and applicability of outpatient treatment for diverticulitis

Tursi¹

2014

DHPS

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Acute diverticulitis of the colon represents a significant burden for national health systems, in terms of direct and indirect costs. Although current guidelines recommend use of antibiotics for the outpatient treatment of acute uncomplicated diverticulitis, evidence for this is still lacking. Hence, significant effort is now being made to identify the appropriate therapeutic approach to treat and prevent relapses of diverticulitis. Outpatient treatment has been identified as a safe and effective therapeutic approach in up to 90% of patients with uncomplicated diverticulitis. It allows important costs saving to health systems without a negative influence on quality of life for patients with uncomplicated diverticulitis, and reduces health care costs by more than 60%.

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“…Colonic diverticular disease affects approximately 25% of the general population, with an increased prevalence in Western and industrialized countries, and in older adults[1–6]. Approximately 15% of patients with diverticulosis will eventually develop diverticulitis [7, 8].…”

Section: Introductionmentioning

confidence: 99%

Colonic diverticulitis in chemotherapy patients: Should operative indications change? A retrospective cohort study

Samdani¹,

Pieracci²,

Eachempati³

et al. 2014

International Journal of Surgery

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Introduction Management of the immunosuppressed patient with diverticular disease remains controversial. We report the largest series of colon cancer patients undergoing chemotherapy and hospitalized for acute diverticulitis, to determine whether recent treatment with systemic chemotherapy is associated with increased risk for/increased severity of recurrent diverticulitis. Methods Retrospective cohort study of adult patients hospitalized for an initial episode of acute colonic diverticulitis at Memorial Sloan Kettering Cancer Center, 1988–2004. Outcomes in patients receiving systemic chemotherapy within one month of admission for diverticulitis (“Chemo”) were compared to outcomes of patients not receiving chemotherapy within the past month (“No-chemo”). Results A total 131 patients met inclusion criteria. Chemo patients did not differ significantly from No-chemo group in terms of severity of acute diverticulitis at index admission (13.2% vs. 4.4%, respectively, p=0.12), resumption of chemotherapy (median 2 months), failure of non-operative management (13.2% vs 4.4%, respectively, p=0.12), frequency of recurrence (20.5% vs 18.55), hospital length of stay (p=0.08), and likelihood of interval resection (24.0% vs. 16.2%, respectively, p=0.39). Chemo patients recurred with more severe disease, were more likely to undergo emergent surgery (75.0% vs. 23.5%, respectively, p=0.03), and were more likely to be diverted (100.0% vs. 25.0%, respectively, p=0.03). Chemo patients were significantly more likely to incur a postoperative complication (100% vs 9.1% p <0.01) following interval resection. Overall mortality was significantly higher in the Chemo vs. No-chemo group. Median survival in Chemo patients was 3.4 years; in No-chemo patients, median survival was not reached at 10 years Conclusion Our data do not support routine elective surgery for acute diverticulitis in patients receiving chemotherapy. Nonoperative management in the acute or interval setting appears preferable whenever possible.

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Advances in the management of colonic diverticulitis: Figure 1:

Cited by 17 publications

References 46 publications

Review article: the pathophysiology and medical management of diverticulosis and diverticular disease of the colon

Review article: the pathophysiology and medical management of diverticulosis and diverticular disease of the colon

Efficacy, safety, and applicability of outpatient treatment for diverticulitis

Colonic diverticulitis in chemotherapy patients: Should operative indications change? A retrospective cohort study

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